(Or, ten facts the general plastic surgeons do not want you to know)

Plastic Surgery and Cosmetic Surgery are not the same. The American Academy of Cosmetic Surgery (AACS) defines cosmetic surgery as a “subspecialty that uniquely restricts itself to the enhancement of appearance through surgical and medical techniques”. Plastic surgery in it’s strictest sense deals with repair or reconstruction of an injury or abnormality, be it congenital or acquired. Obviously there is overlap in the usage of the terms. There is a long -standing and sometimes acrimonious feud between general Plastic Surgeons and Cosmetic Surgeons, a so called “turf battle” for market share.

Today, many surgical specialties contribute to the field of cosmetic surgery. General Surgeons, Facial Plastic Surgeons, Dermatologic Surgeons, Occuloplastic Surgeons, Maxillo-facial Surgeons, Otolaryngology-Head and Neck Surgeons, and Gynecologic Surgeons. Indeed, roughly 80% of all cosmetic surgery is performed by specialists other than general plastic surgeons.

Completion of a “plastic surgery “ program doesn’t guarantee training or proficiency in Cosmetic Surgery.  Training programs vary, but a General Plastic Surgery training program is two years, after completion of a General Surgery residency of five to six years.  During the two years,  half of the time is spent doing hand surgery. Of the other half, only three or four months may be spent OBSERVING Cosmetic Surgery. 50% of trainees feel they have inadequate training in cosmetic surgery, and many residents graduate without ever having performed a rhinoplasty. Half of all plastic surgery program directors urge graduates to seek cosmetic surgery training elsewhere (1).

The six-year Otolaryngology-Head and Neck Surgery program includes two years of General Surgery of the whole body, including breast surgery. Throughout the four years of Head and Neck Surgery, equal amounts of time is devoted to Facial Plastic and Reconstructive Surgery, including cosmetic surgery. A seventh year of surgical training in Facial Plastic and Reconstructive Surgery can be entirely devoted to cosmetic surgery.

The majority of general plastic surgeons aged in their 40’s to 60’s never learned or performed liposuction in their residencies. So how is it now 10 or 20 years later they are all “experts” and no other doctor could possibly learn how to do it, if not during their training. If not for a dermatologist who pioneered tumescent liposuction, liposuction would still be in the dark ages. No wonder the death rate for liposuction at the hands of general plastic surgeons was reportedly 1 in 5,000!  For cosmetic surgeons, the same would be 1 in 100,000! A twenty-fold difference!

General Plastic Surgeons have the highest malpractice rates among all specialties that perform Cosmetic Surgery, nearly one per year of practice. 90% of malpractice suits in cosmetic surgery are from board certified plastic surgeons.

General Plastic Surgeons have the highest death rates for cosmetic surgery compared with other specialties that perform cosmetic surgery. 80% of deaths related to cosmetic surgery come from the hands of general plastic surgeons (2).  In a Florida study, 11 of 12 cosmetic surgery fatalities were at the hands of Board-Certified general Plastic Surgeons.

There is absolutely no proof or study (and probably never will be) that compares the results of general plastic surgeons with cosmetic surgeons. There is no evidence that membership in the American Board of Plastic Surgery confers superior, infallible results. In fact, it is ILLEGAL AND A VIOLATION OF CALIFORNIA BUSINESS AND PROFESSIONS CODE 651 TO MAKE UNSUBSTANTIATED CLAIMS OF SUPERIORITY.

The American Board of Medical Specialties is not a government regulatory agency, and has absolutely no powers of accreditation or enforcement.  General plastic surgeons like to point out that they are recognized by the ABMS.   In spite of all the advances in medicine in the last 30 years, the ABMS has chosen to not recognize a single new organization since then.

The American Academy of Cosmetic Surgery is the only organization dedicated solely to education and the advancement of Cosmetic Surgery. All surgeons of all specialties must consistently learn and add or change their mode of practice during their career. Medicine evolves. Much of what is learned during training eventually becomes outdated and or modified. Therefore, it is entirely sensible and expected for a surgeon to learn a new set of skills after graduating from training. It is absolute malarkey and a turf war to prohibit or condemn a surgeon or organization for learning or teaching new skills. It is also immature and greedy for general plastic surgeons to denigrate and invalidate another surgical specialty and it’s training, all under the phony guise of “safety”. If safety really were the issue, then all the available hard data suggest you should AVOID a general plastic surgeon.

Bottom line is this: I am double boarded in Facial Plastic and Reconstructive Surgery and Otolaryngology Head and Neck Surgery. I obtained additional postgraduate training and education from the American Academy of Cosmetic Surgery. I am proud of my training, and no one has the right to make this seem insignificant or inferior. To the contrary, I feel I have had as much or more “plastic” and “cosmetic” in my training than theirs. Board certification is only part of the package, and is not a guarantee.  A trustworthy and capable cosmetic surgeon must have true talent and skill, years of experience, volumes of cases, and the highest ethical standards of professional character and integrity.  

Why am I a cosmetic surgeon? I love my work, and this is what I do best. I have acquired an excellent skill set  to offer my patients, and I only perform surgery I feel capable, confident and justified in doing, nothing more, nothing less. Most of all, I have compassion for my patients. Honesty and safety come first, and do no harm.


1.  Morrison, CM Rotemberg, SC; Morieraa-gonzalez, A; Zins, J. A Survey of Cosmetic Surgery Training in Plastic Surgery Programs in the United States. Plastic and Reconstructive Surgery: 2008;122(5);1570-1578

2. “Plastic Surgeons Should Uncircle the Wagons” Jeffrey Frenzen Plastic Surgery Practice November 2008

“The Emperor Needs New Clothes” Jeffrey Frenzen Plastic Surgery Practice December 2008