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The Scoop on Specialty Boards

Cosmetic surgery techniques change rapidly, and there is always new technology. Even someone who was board certified as recently as five years ago may not be up to speed in the narrow specialty field of an individual procedure. Certain specialty boards promote themselves as being somehow superior to others, and some claim that no other physicians but those in their group should be doing surgery at all. But this is wrong. Dermatologists, plastic surgeons, ophthalmologists, maxillofacial surgeons, ear-nose-throat specialists and others (the author was originally an emergency physician) have all contributed to the development of modern cosmetic surgery. Competent physicians can be found in these and other groups. Your best bet is always the super-specialist who performs only cosmetic surgery, or even only a few procedures, and doesn't claim to operate "from head to toe." These specialists generally have their own surgical centers or operate out of outpatient facilities, which are statistically safer than hospitals (see for scientific publications about this issue). Hospital-based physicians are usually generalists who may not have as much expertise with your special problem or procedure. Most of them (and their specialty groups) oddly enough promote their hospital privileges as if they were a gold standard of some kind. In fact, the kind of surgeon who is spending much of his or her time at the hospital is not a cosmetic surgery specialist, but a generalist. Modern cosmetic surgery is an outpatient specialty.

Ear-nose-throat specialists (or "facial-plastic surgeons") who've had extra experience with cosmetic surgery might be able to do the best "nose jobs." They are trained to work with the functional breathing apparatus as well as make you look better. Liposuction is done by many specialties. Though much of the liposuction technique was innovated by dermatologists, they tend to do smaller liposuction cases than other specialties. For laser work, dermatologists generally have the most experience, but many other specialty fields are getting involved. Eyelid surgery (blepharoplasty) is performed by dermatologists, plastic surgeons, and also by ophthalmologists specially trained in a field called "oculo-plastics." Asian eyelid surgery is a sub-specialty. Be sure your doctor has done a lot of them. You may want to choose an Asian doctor. Hair transplantation physicians come from many specialties. "Reconstruction surgery" deals with surgery after disease and may mean that the doctor is involved in making new breasts after breast cancer, working with bedsores, or solving other analogous problems. Although these procedures are related to cosmetic surgery (and in many cases are more difficult surgically), each technique has a different learning curve, and the doctor who "does it all" is likely spreading himself too thin to be a top sub-specialist for any given procedure.

I can't emphasize strongly enough how important it is for a doctor to be up-to-date on new procedures, techniques, drugs and other vital information. Things change rapidly in cosmetic surgery. An active physician who is a leader in his field attends several professional seminars or conferences per year. We have to keep learning.

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