Does Board Certification REALLY Matter?

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True story: A man called my office four days after going to a spa to receive an injection of filler material into a deep line located between his eyebrows. In the state of Georgia, where I practice, anything injectable must be done by a physician, nurse, or physician's assistant. In this instance, a physician was the injector. So the doctor overseeing the spa injects the filler and flattens out the depressed line. What could go wrong? Sounds straightforward and simple enough. Anyone could do that, right?

Four days later, the patient is calling my office because part of his forehead is becoming discolored. It seems that the doctor, in this case a podiatrist, has injected the filler into an artery and now the skin over part of the patient's forehead is struggling to get enough blood supply to survive. To make matters worse, the doctor used a filler that has no antidote. It can't be easily reversed. The options for treatment at this point are limited. Sometimes even the simplest procedures can have some nasty ramifications. It pays to do your research.

The state of medicine is a mess these days. Insurance premiums are going up, medical reimbursements to doctors and hospitals are going down, and insurance companies are enjoying record profits. For doctors, the overhead costs of training, malpractice insurance, and staffing has only gone up, not down. With insurance companies decreasing the amount of money that they will pay for various procedures, doctors in all specialties are seeking out alternative sources of revenue in order to cover their costs of doing business. To this end, many are turning to cosmetic surgery as a means of bypassing insurance companies.

Cosmetic surgery is generally paid for up front in cash. Doctors take weekend courses in breast augmentation, facelifts, or liposuction, then call themselves “board-certified plastic surgeons.” They are board certified (in something) and they are doing plastic surgery. They just aren't board certified by the American Board of Plastic Surgery, the only board recognized by the American Medical Association for the training and certification of plastic surgeons. (

Anyone with an M.D., D.O., or even dental degree can perform cosmetic surgery. There are few regulations governing this. It's up to the patient to determine the doctor's competency for performing the surgery they want done. While cosmetic surgeries may be more difficult to perform since doctors must have a facility and staff with which to work, injecting Botox or fillers is easy to do and requires no special equipment. Most spas offer Botox and fillers these days. They just have to have a doctor, any doctor will do, to oversee what they are doing.

True story: A few years ago, I flew to another state to observe a doctor who was demonstrating a new technique for facelifts that he did under local anesthesia in his office. This doctor had a very high profile because his relative was a marketing genius and promoted him very well. As it turned out, the doctor was board certified in emergency room medicine, not plastic surgery. He did his surgery in an office-based operating room, under the radar of government regulatory groups, and sedated his patients so heavily that they might as well have been under general anesthesia. Also, his technique for facelifts wasn't really anything new. Of the twenty or so doctors in the group observing this “innovator,” I was the only one who was an actual plastic surgeon. The rest were general surgeons, OB/GYNs, family practice doctors, etc., all seeking a new source of income to offset their business costs that didn't involve insurance companies. I felt dirty just mixing with this group and couldn't wait to get out of there. I often wonder how many patients have been disfigured as a result of this group taking a course by this self-taught surgeon and then going out and performing facelifts for the first time in their office. In my mind, it was a disaster waiting to happen.

I am active on the website RealSelf.com, frequently answering questions posed by patients considering surgery or having questions or complications as a result of surgery. There are LOTS of questions from patients who have problems or bad results and I wonder if their doctor was an actual plastic surgeon or a pseudo-plastic surgeon. I wonder why they seek answers from strangers on the internet instead of addressing their questions to their own doctors.

Does having a doctor who is certified by the American Board of Plastic Surgery guarantee a good result? No. Every plastic surgeon, no matter how talented, has had complications or bad results. Still, these are the best trained doctors in cosmetic surgery and the best prepared to handle problems resulting from surgery. Going to an appropriately credentialed plastic surgeon offers the patient the best chance at a good outcome. The patient knows that an ABPS-certified plastic surgeon has been through years of training (not a weekend), as well as rigorous testing and oversight to become properly certified.

So, what should a patient look for when seeking a plastic surgeon? I propose the following:

1. First and foremost, patients should ascertain that the plastic surgeon is certified by the American Board of Plastic Surgery. If you're undergoing a facial plastic surgery procedure, patients may also look for a doctor who's certified by the American Board of Facial Plastic and Reconstructive Surgery. If your doctor is not certified by ABPS or ABFPRS, thank them kindly and leave.

2. Do not go to a plastic surgeon simply because he charges less. Lower fees may be offered to compensate for lack or training, experience, or certification. Do not put costs ahead of your health. You want the surgery done correctly the first time.

3. Does the doctor performing the surgery you're interested in have a significant amount of experience performing that particular surgery? How many does he do in a year? Look at before and after pictures. If possible, speak to former patients who have had that surgery.

4. Talk to friends who have had cosmetic surgery and see which plastic surgeon they recommend and what their experience has been.

5. Finally, when you meet with your plastic surgeon, ask yourself: Do you feel comfortable with him or her? After all, you are entrusting your health and well-being to this person. It would be nice to know that he has taken the time to answer all of your questions and will be there in case you have a problem after the surgery. If you are not totally comfortable then seek out another consultation or two. It never hurts to get differing perspectives.


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Atlanta Plastic Surgeon