Difference Between Facial Plastic Surgeon or Plastic Surgeon and an ENT or Otolaryngologist?

I expect you are confused, because just about the entire general public is too. When there are overlaping areas of competence between specialties, there is the possibility of conflict. There are several such areas in medicine today. Orthopedics and Neurosurgery interact with spinal surgery, Gastroenterologists and General Surgeons both perform colonoscopies, Sports Medicine and Physiatry are both involved in physiotherapy. And there is for the most part friendly competition amongst them. However in the area of Cosmetic Surgery the 'turf war' unfortunately is sometimes bitter and acrimonious. 

The 2 major players are Plastics and Otolaryngology, although Opthalmology and Dermatology are clearly also involved. Plastic surgeons often feel they 'own' the term and can be upset when others use it. Otolaryngologists are cursed with an unpronouncable name and often use Facial Plastic surgery to identify what they do to the public. Currently there are few doctors who would not support the position that both specialties share competency in Rhinoplasty surgery. Therefore a patient should look beyond the titles and try to select the best surgeon for the job.

Historically speaking, what we describe as "Plastic Surgery" long predates the development of modern medicine, or even the foundation of the United States.  Modern Plastic Surgery, or indeed modern Facial Plastic Surgery arose from the great need created by World Wars I and II to treat traumatic defects of the face and body.  The Surgeons who were instrumental in developing techniques were General Surgeons, Otolaryngologist-Head and Neck Surgeons, Ophthalmologists, Oral Surgeons, and Orthopedic Surgeons.  Sir Harold Delf Gillies, a pioneer in facial reconstructive surgery, was an Otolaryngologist-Head and Neck Surgeon from New Zealand.  Jaque Joseph, largely credited with the first cosmetic Rhinoplasty, was Austrian Orthopedic Surgeon. The less interesting part of the history is the ugly "turf battles" which ensued in the 20th century between General Plastic Surgeons and Facial Plastic Surgeons (who have the basis of their training in Otolaryngology-Head and Neck Surgery).  The use of the term "ENT" is a bit of a historical put down revived by the partisan quips of Dr. Alexander.  I think that marketing terms like "Quicklift" which is advocated by Dr. Alexander, deserve far more scrutiny than do the credentials of a Facial Plastic Surgeon.

The facts are as follows:  1) Facial Plastic Surgery belongs in the hands of someone who specializes in the face.  This can include a Surgeon trained in Facial Plastic Surgery or Plastic Surgery,

2)  It is hard to find a Surgeon more qualified to perform a Rhinoplasty than a Facial Plastic Surgeon.  A large percentage of Facial Plastic Surgeons and General Plastic Surgeons finished in the top 10% of their medical school classes, and are competitive, well trained Surgeons.

3) Both General Plastic Surgeons and Facial Plastic Surgeons receive cosmetic and reconstructive surgery training in the face; the extent of this training varies with the individual program, not the specialty,

4) The ABMS was founded by the American Academy of Otolaryngology and Ophthalmology (in the early 20th century) and recognizes the ability of Otolaryngologists to perform Facial Plastic Surgery.  The lack of inclusion of Facial Plastic Surgery is, in itself a historical turf battle.  For this reason, Facial Plastic Surgery shares ABMS equivalency in Florida and all states in the Union.  This is an argument that those most interested in a "turf battle" seem to cling to; I have found that most patients prefer specialization in the face to Surgeons who bad mouth other Surgeons.

5) As eloquently stated by Dr. Agarwal, the general public has far more to fear with Dentists performing Facelifts and Botox, with Gynecologists performing tummy tucks, and Family Medicine Doctors using lasers than they do from a Facial Plastic Surgeon or Plastic Surgeon performing a Rhinoplasty.

I read your concern:

It would have been best if you had your Rhinoplasty Surgery performed at the time of your septoplasty. I nearly always use septal cartilage for tip support (columella-strut) when performing rhinoplasty with tip alterations. I cannot comment on your particular case without seeing your photos. 

If your ENT is expert at performing nose jobs, this procedure is certainly within his realm of expertise. In my area, there is an ENT that performs many artful rhinoplasties, and he does not have ABFPRS certification. Check lots of before and after photos before proceeding, and it may be helpful to know how many nose jobs he performs yearly, and how many years he's been in practice. Positive rhinoplasty reviews would be a plus.

The heated remarks from the RealSelf experts are interesting.

Bottom line: There are good rhinoplasty surgeons in all 3 specialties: ENT, FPS, and PS. You may get an optimal result if your surgeon is expert at nose jobs and performs many, regardless of specialty.

Opinion: Facial plastic surgeons have the largest number of good rhinoplasty surgeons. ABFPRS.org will give you a list of certified specialists.

More opinion: I refer to myself as an ENT, and do not find this verbiage disrespectful. When I was in med school, I would have given anything to secure a residency in otolaryngology (ENT), and I'm blessed to have certification in both ENT and Facial Plastic Surgery.

Good luck with your search for the best rhinoplasty expert for you.

Dr. Joseph 

Facial Plastic surgeons are generally ENT surgeons who want to specialize in cosmetic surgery, most of the time on the face, but many also migrate south and will do such things as breast and body work.  There is no doubt that there is a turf war over which specialty is better qualified to perform which particular procedure.  When it  comes to rhinoplasty specifically, both specialties have training that enables them to perform this procedure.  I would base my choice on selecting a surgeon who has significant experience with rhinoplasty and one that you have been able to see many examples of their work and that you like the work they do.  When it comes to breast work,  however, I would definitely stick with a fully trained plastic surgeon.

An otolaryngologist/head & neck surgeon is trained to operate on all structures in the head and neck excluding brains, spines, and eyeballs (in a nutshell). 25% of the board certification exam for otolaryngologists covers facial plastic and reconstructive surgery. The term "ENT" is an abbreviation for an otolaryngologist.

Facial plastic & reconstructive surgeons can become board certified as such in one of two ways.  First, they can complete an accredited fellowship focusing in FPRS only for at least one year following completion of EITHER an "ENT" or plastic surgery residency. They must then complete an oral and written board exam and submit a case log of at least 1 1/2 years of procedures performed to establish competence. Alternatively, board-certified "ENTs" or plastic surgeons that do not complete a fellowship must submit a more extensive case log and pass the same exams. 

Hope that helps. 

As Dr. Naderi mentioned, an Ear, Nose, Throat doctor (otolaryngologist) is trained to perform surgery of the nose, which may include rhinoplasty (nose jobs). Not all otolaryngologists have this background, however.

Facial Plastic surgeons have additional board certification dealing with cosmetic and reconstructive surgery of the head, face and neck only. Plastic Surgeons have training that includes the rest of the body (breast, hand, burns, tummy tucks, etc.). Some plastic surgeons focus their practice on the face whereas others may never perform facial surgery.

Septoplasty is a pretty common surgery for otolaryngologists to perform. Though your surgery went well doesn't necessarily mean that your surgeon can also do a rhinoplasty. You should ask to see before and after photos of other patients your surgeon has done and find out how much experience he or she has with this surgery.

Rhinoplasty is generally considered one of the most complex surgeries within our field so you want to do your homework when selecting your surgeon.

I would disagree to some extent with Dr. Naderi.

You should understand that there is a turf battle between ENT surgeons and plastic surgeons, and plastic surgeons are usually annoyed when docs with ENT training call themselves "plastic surgeons."

Most ENT surgeons do a 5 year residency in ENT (otolaryngology).

Most Plastic surgeons do a 5 year residency in general surgery (although ENT, urology, and orthopedics are other pathways), and then a 2-3 year residency in plastic surgery.

Both residencies give exposure to cosmetic surgery, however, cosmetic surgery exposure tends to be greater in plastic surgery residencies. After residency, some plastic surgeons will take additional training in cosmetic surgery (fellowship). After ENT training, and ENT surgeon that wants to do cosmetic surgery will take additional training, and then be qualified to become certified in Plastic Surgery of the Head and Neck.

It is important to note the Plastic Surgery of the Head and neck is not a separate ABMS board. This can be verified at their site. abms.org

However, some states, like CA, recognize this certificate and give it equivalence with the ABMS certification for otolaryngology and plastic surgery.

Dr. Naderi (and other ENT docs) make it sound like ENT and plastic surgery are entry points to become facial plastic surgeons. I know of no plastic surgeon that has done additional training, and then calls himself a facial plastic surgeon, as surgeons know that" facial plastics" refers to those with ENT training. Plastic surgeons who have additional training in the head and neck call themselves craniofacial surgeons. Plastic surgeons specializing in cosmetic surgery of the face call themselves "plastic surgeons specializing in the face."

Any doctor can work anywhere on the body, although it is difficult to get hospital privileges to do so. In a doctor's office that has a surgery center, this is not closely regulated. Therefore, there are many ENT/facial plastic docs that do surgery of the breasts and abdomen, but the public is not aware that they do not have specific training to do so.

When it comes to the nose, ENT, facial plastics, and plastic surgeons are all trained in these procedures. The nose is one of the most challenging procedures to perform. Therefore, the most important qualification here is experience. As a plastic surgeon, I would prefer an ENT surgeon with great experience to a plastic surgeon with little experience, and vice versa.

The most important questions to ask are regarding the surgeon's personal experience doing the recommended procedure, along with his/her actual formal training.

Best of luck going forward.

 

I think that a good rhinoplasty surgeon can come from any one of these backgrounds. I am a bit surprised that you did not have the rhinopalsty performed at the same time as your septal surgery.

The key is to have your rhinoplasty performed by a surgeon who performs rhinoplasty regularly, with excellent results.  You don't want to go to a surgeon who performs rhinoplasty on a very occasional basis, as it is an operation that requires skill, judgement, and learning from one's own operative experiences and results.  There are expert board certified otolaryngologists (ENT surgeons), facial plastic surgeons (otolaryngologists or general plastic surgeons with additional training and/or extensive experience with plastic surgery of the face and neck) and general plastic surgeons who are competent and skilled at rhinoplasty.  Again, you need to find one that does rhinoplasty frequently and well.

There are several surgeons who have talked about "turf wars."  Based on the proliferation of dentists, internists, ER docs, etc... that are performing injectables and cosmetic laser treatments, it should be clear that there has always been and there always will be competition amongst specialties for this type of work.  Try to ignore hype and marketing ploys and instead focus on results.  In fact, results have driven facial plastic surgeons to speak at general plastic surgery conferences, and vice versa!

I do disagree with Dr. Alexander's statement:  "cosmetic surgery exposure tends to be greater in plastic surgery residencies".  I am not sure what the basis for this subjective comment is.  There are otolaryngology (ENT) programs where plastic surgery of the face and neck is a major focus of training.  There are others where it is limited.  By the same token, there are plastic surgery residencies where the focus is on reconstructive surgery, burns, decubitus ulcers, hand surgery etc... with little cosmetic exposure.  Vice versa, there are plastic surgery residencies/fellowships with extensive exposure to cosmetic surgery.

Those surgeons who pursue additional fellowships in facial plastic and reconstructive surgery, or in aesthetic facial/craniofacial surgery, have devoted additional time and study to become proficient in plastic surgery of the face and neck. 

Bottom line, ignore the turf wars.  Trust your face to a specialist.

Thank you very much for your question.  There is much confusion in the public on this subject .  I feel

l that I am in a very good position to answer this question as I am both a board certified otolaryngologist-head and neck surgeon (ENT) and a board certified  plastic surgeon.

Let me explain the differences between a plastic surgeon and a facial plastic surgeon.  

In order to become a plastic surgeon one must complete at least 3 to 5 years of general surgery OR be board certified in another surgical speciality such as opthalmology, otolaryngology (ENT), orthopedic surgery etc.. Having completed this surgical  training there is an additional 2-3 years of study of plastic surgery and then examinations to become a board certified plastic surgeon. 

Facial plastic surgeon are board certified otolaryngologists who spend 1 year of facial plastic surgery training and then have examinations to become board certified facial plastic surgeons.

Both plastic surgeons and facial plastic surgeons are well trained in rhinoplasty surgery.

Now as for your question I would ask your ENT surgeon if he  has experience performing rhinoplasties and ask to see examples of his work.  If you feel comfortable with the surgeon and like his results then by all means proceed with the combined septal and rhinoplasty surgery.