As a consumer trying to pick a doctor for my facelift, I am extremely confused by the turf war that I surmise between plastic surgeon and otolaryngologist cosmetic surgeons. I don't want to start a war here and I don't know if anyone will touch this question, but is the idea that plastic surgery residencies are more competitive and harder to get and, therefore, you know that if someone went the plastic surgery route, they are the crème de la crème, so to speak?
Confused By Turf War Between Plastic Surgeons and Otolaryngologists
Doctor Answers 21
Both Plastic Surgeons and Facial Plastic Surgeons are trained to perform facelifts
The difference is the original training. Most Plastic Surgeons train in general surgery then plastic surgery. Plastic Surgery training includes the entire body, face, burns and hand surgery. ENT (Otolaryngology) training also starts in general surgery then ENT. As ENT residents, training includes cancer, cosmetic and reconstructive surgery of the face head and neck. Different programs have differing amounts of time devoted to facial cosmetic surgery. Board certified Facial Plastic Surgeons are mostly Otolaryngologist who then go on for further training in facial cosmetic surgery, so the experiece and training is not really that much different.
As for Plastic Surgery being more competitive, I am not sure where these statistics come from. I interview candidates for my facial plastic surgery fellowship and every candidate has either multiple degrees, significant research, numerous publications and was at or near the top of their medical school class.
What you want to do is find out what percentage of your potential doctor's practice is devoted to facial cosmetic surgery, how long they have been in practice and what is their reputation and standing within the medical community instead of deciding based on any particular denigrating statements found from anyone's competitors.
ENT Facial Plastic Surgeon or Plastic Surgeon
The training and board certification process for both Facial Plastic Surgeons and General Plastic Surgeons is rigorous. The Facial Plastic Surgeon focuses on cosmetic and reconstructive surgery of the face and neck, whereas the General Plastic Surgeon is trained in face, body, and reconstruction. There are no back doors or easy paths to credentialling.
Both specialties are extremely capable of performing a facelift. Unfortunately, there is no guarantee that excellent training translates to the same surgical skills. I would suggest visiting with different surgeons from both of these specialties. I don't think you will find a great deal of difference.
ENT vs Plastic Surgeons
There are surgeons talented in facelift surgery in both camps. Dr. Rand is correct in looking closely to see if surgeons from either camp have special interest in facelift surgery. This may come in the form of publications on the field, innovations or new procedures that are published and make sense, and many before and after photographs. There should be no question that you could ask the surgeon that would stump them, because they will have seen it all.
Training wise, many ENT surgeons do not take additional training in Facial Plastic Surgery and therefore have no official fellowship training, yet are Facial Plastic Surgeons. These surgeons would not, in general, be as well qualified as ENT surgeons who did a year-long Facial Plastic Surgery fellowship in my opinion.
Likewise there are Plastic Surgeons who have undertaken specialty training in Aesthetic Surgery in an official year-long fellowship (there will be a certificate from a university showing this). This is additional training that not all Plastic Surgeons have.
The reality of the situation will come during the consultation. Patients generally know right away when they are in the right office. They know they have done their research and have picked the right surgeon.
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Plastic Surgeons and Facial Plastic Surgeons
Most otolaryngologists (a.k.a. head & neck surgeons, ENT surgeons) do NOT perform facelifts but rather, fellowship-trained facial plastic surgeons do.
For most of us plastic & facial plastic surgeons, this "turf" is a non-issue today as we appreciate and understand each others background and training very well. In fact, during national and international meetings, we learn from each other and acknowledge the benefits of exchange.
Although I am not sure about the residency statistics in 2010, both specialties are highly competitive and every plastic surgeon and facial plastic surgeon should be top notch on paper.
But this does not automatically translate into a great facelift result for you. Rather, you want to find a cosmetic surgeon how performs many facelifts a year. You should look at the surgeon's results and feel comfortable about the aesthetic outcome.
There is no turf war
As a busy board certified facial plastic surgeon I see more of a turf war between the various plastic surgeons in my city competing for patients than a war between myself and plastic surgeons. The economy is tight and everyone who does cosmetic surgery is competing for a smaller pool of patients. As the other posters point out, seek at least 3 consultations from either board certified plastic surgeons or facial plastic surgeons and choose someone you feel comfortable with. Hope this helps.
Research each surgeons credentials AND look at before-&-after photos
Facelifts can be performed equally well between plastic surgeons and facial plastic surgeons. Facial plastic surgeons concentrate their surgical training in only the head, neck, and facial area five years during residency and an additional year of facial plastic surgery fellowship.
Facial plastic surgery fellowships are extremely competitive. For example, I was the only person accepted in thirty-five applications for a fellowship at the Lasky Clinic in Beverly Hills in 1991. Otolaryngology residencies are one of the most competitive residencies in the field of medicine today and are very difficult to get into. General plastic surgery residencies are very diverse, which include hand surgery, limb reconstruction, facial orthamatic reconstructive trauma, and some residencies in plastic surgery have very little cosmetic surgery training, much less facial cosmetic surgery training.
Ask the surgeon whom you decide to go to about how many facelifts he performs regularly now and how many facelifts he or she performed in a residency. Ask to speak to some patients that the surgeon has performed surgery upon, and look for a very natural-looking result with minimal stretchability of the incisions. Before-and-after photographs are an excellent way to judge the caliber and quality of the work of the surgeon, whether it is a plastic surgeon or facial plastic surgeon.
The previous responses have done a good job of describing that ENT surgeons who have done a facial plastic surgery fellowship are as qualified to do facelifts (but not plastic surgery in other parts of the body) as plastic surgeons. It might be helpful to understand the differences in training between specialties and what certification means. All medical specialties in the U.S. have a specialty board that is overseen by the American Board of Medical Specialties (ABMS.org). All of them set strict requirements that include accredited residency training after medical school.
However, there are no legal limitations on scope of practice, so any doctor can do any procedure on a willing patient. What makes it doubly confusing is that there are something like 150 non-recognized "boards" that sound very legitimate but have highly variable standards. For example, one non-recognized board is the American Board of Cosmetic Surgery.
Described Succintly: Turf War with Great Quality on Both Sides
The first thing I would recommend is that you ignore Dr. Kasden's ridiculous and ignorant remark which is representative of the tribalism and small mindedness that persists in a small percentage of Doctors.
Since this topic has been well covered by Dr. Rand and Dr. Pearlman, I will say briefly that you should choose a Board Certified Facial Plastic Surgeon or Plastic Surgeon who has a special interest in facial aesthetic surgery. You will not sacrifice quality or credentials with either one.
Creme de la Creme: Both Plastic Surgery and Facial Plastic Surgery have a high percentage of Alpha Omega Alpha Medical School graduates (generally top 10% of the medical school class). Both typically take individuals who have published in the medical literature and are competitive clinically and academically. Both are highly competitive specialties to enter.
Confused By Turf War Between Plastic Surgeons and Otolaryngologists
GREAT question! I feel there is no 'turf' war, patients should see at least 3 boarded surgeons, either pure plastics, pure facial plastics, or both (as Dr Esmailian is). Get a feeling on who you as a patient like then research that specific doctor. For example, I'm a boarded pure plastic, but I have done noses, face lifts for over thirty years. Does that mean I can not do these operations? It is up to the consumer to be informed and chose the doctor that their feel meets all their personal citeria. Regards
Facial Plastic surgeons vs. general plastic surgeons
I agree with Dr. Rand. There are fantastic surgeons in both fields, and, unfortunately, not so great ones in both fields either. Facial plastic surgeons are usually otolaryngologists who do an additional fellowship training in facial plastic surgery. If you go to one, I would strongly recommend that you choose the one who did the fellowship training, is double Board certified, and who actually does facelifts on the regular basis, i.e. every week. I would go further to recommend you review the surgeon's before and after results to ensure you agree with his or her aesthetics.
Even though your question involved facial procedures, I agree with Dr. Rand further that Facial plastic surgeons have no business in doing body procedures. If these procedures attract them on aesthetic level, it would behoove them to go through the appropriate training. If they just do it to help their income, it is a less than endorsing testiment to our specialty.
On the other hand, general plastic surgeons can specialize in the face as well and some of them do. Some of them go through the same Board certification in facial plastic surgery as the facial plastic surgeons. If you go to one, do your homework as well and make sure they do the facelifts on a regular basis, and don't just spend their time doing breast implants and liposuction. Make sure you like their results as well.
I would recommend you go to at least two or three surgeons for a consult. We all agree these days that turf war does not help either of our specialties. We want the patients to have great results, and be a walking advertisement for our practice, our specialty, and the business of cosmetic facial surgery in general.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.