Reconstructive vs Cosmetic Surgery: Is It Necessary to Specialize

Reconstructive Surgery is the “restoration of appearance and function following injury or disease, or the correction of congenital defects, using the techniques of plastic surgery.” (Source). In contrast, Cosmetic Surgery is defined as a unique discipline of medicine focused on enhancing appearance through surgical and medical techniques. Cosmetic surgery can be performed on all areas of the head, neck and body. Because treated areas function properly but lack aesthetic appeal, cosmetic surgery is elective.

“Cosmetic surgery is a surgical specialty dedicated to the reconstruction of facial and body defects due to birth disorders, trauma, burns, and disease. Plastic surgery is intended to correct dysfunctional areas of the body and is reconstructive in nature.” (source).

So why are reconstructive, plastic, and cosmetic surgery so frequently used interchangeably in contemporary decision? And, when push comes to shove, can anyone in the field just jump right in on any part of this? Or is it necessary to specialize?

 

Cosmetic Surgeons Are Board Certified by The American Board of Cosmetic Surgery

As noted by the American Academy of Cosmetic Surgery:

Cosmetic surgery is the surgery of appearance. It is elective and focuses on the aesthetics of beauty.A. Because the procedures and outcomes of each are quite different, the training of cosmetic surgeons and plastic surgeons is also very different… As there are no residency program specifically focused on cosmetic surgery, physicians pursuing cosmetic surgery have backgrounds that include medical school, a residency and/or fellowship program, preferably in a surgical specialty, usually followed by attaining board certification in that specialty, and post-residency training specifically in cosmetic surgery. This can be done through a cosmetic surgery fellowship program, as well as through workshops, seminars and lectures. Physicians with significant experience in cosmetic surgery become certified by the American Board of Cosmetic Surgery (ABCS), which has established a strict set of criteria to ensure experience and proficiency specifically in cosmetic surgery.

 

Plastic Surgeons are Certified by the American Board of Plastic Surgery

Plastic surgeons are not cosmetic surgeons unless they are certified by both boards, in the United States. While these doctors follow a path that resembles that of many of their cosmetic surgery colleagues, they do a residency or fellowship in the field of plastic surgery. Cosmetic surgery would be an additional field they would possibly pursue. This is how some surgeons are certified in both.

According to the American Board of Plastic Surgeons, however, there is some claim of cosmetics:

Plastic surgery deals with the repair, reconstruction, or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand , extremities, breast and trunk, external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles both to improve overall appearance and to optimize the outcome of reconstructive procedures. Special knowledge and skill in the design and surgery of grafts, flaps, free tissue transfer and replantation is necessary. Competence in the management of complex wounds, the use of implantable materials and in tumor surgery is required… Competency in plastic surgery implies an amalgam of basic medical and surgical knowledge, operative judgment, technical expertise, ethical behavior, and interpersonal skills to achieve problem resolution and patient satisfaction.  

 

Reconstructive Surgery is a Specialty

The American Society of Plastic Surgeons and the American Board of Facial Plastic and Reconstructive Surgery are two of the authorities on reconstruction. This is what they each have to say on the topic.

The American Society of Plastic Surgeons reports that “reconstructive surgery is performed to treat structures of the body affected aesthetically or functionally by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally done to improve function and ability, but may also be performed to achieve a more typical appearance of the affected structure. Reconstructive surgery is generally covered by most health insurance policies, although coverage for specific procedures and levels of coverage may vary greatly.”

Procedures include:

• Breast Reconstruction
• Breast Reduction
• Cleft Lip and Palate Repair
• Congenital Anomalies
• Craniosynostosis Surgery
• Gender Confirmation Surgeries
• Giant Nevi Removal
• Hand Surgery
• Lymphedema Treatment
• Microsurgery
• Migraine Surgery
• Orthognathic Surgery
• Jaw Straightening
• Panniculectomy
• Body Contouring
• Scar Revision
• Septoplasty
• Skin Cancer Removal
• Tissue Expansion

Many of the doctors that offer reconstructive surgery are certified by the American Board of Facial Plastic and Reconstructive Surgery. That organization, as noted on their website, was “established in 1986 to improve the quality of medical and surgical treatment available to the public by examining for professional expertise in facial plastic and reconstructive surgery. To carry out this mission, the Board has established a mechanism for the education, qualification, training, review, and certification of surgeons specializing in facial plastic and reconstructive surgery.” It maintains a comprehensive list of doctors that are certified to help patients find options and in its FAQs has information about what makes for a ‘certified’ doctor. These include:

• Has completed an approved residency in one of the two surgical specialties that include identifiable training in all aspects of facial plastic surgery (otolaryngology/head-and-neck surgery or plastic surgery, generally.

• Is double boarded, having earned prior certification in one of those specialties through the American Board of Medical Specialties or the Royal College of Physicians and Surgeons in Canada.
• Has successfully completed a two-day examination.
• Has submitted for peer-review an acceptable record of at least two years’ clinical experience, including operative reports of a minimum 100 facial plastic surgeries.
• Holds proper licensure and subscribes to the ABFPRS Code of Ethics.

In line with all of the information we have provided here, it should be clear that it is necessary to adopt specializations. For more information on this topic follow our blog, and attend SCALE 2019 Music City.