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The ABC's of plastic and cosmetic surgery: Choosing a cosmetic surgeon

By Dr. Mathew C. Mosher

Choosing a plastic surgeon can be a difficult task. Deciding to have a cosmetic procedure is one of the most important decisions you'll make. In this issue, Dr. Mosher explains the rather confusing aspects of credentials and certification. The purpose is to give you the information you need to make an informed decision.

Finding the Right Credentials

Many people struggle for years before finding the confidence to seek advice about cosmetic procedures. Even when you've made the decision to have plastic surgery, there are still many issues to consider. None is more important than the credentials and certification of the surgeon you choose.

Until recently, consumers have not placed as much emphasis on credentials and certification as they probably should have. Perhaps it's because knowing what to ask can be just as confusing as knowing where to seek the answers. In this column I'll give you the information you need to make your decision easier.

"I view plastic surgery as a partnership between myself and my patients. Prior to surgery, I spend time with each patient, reviewing all the options and working out the most reasonable and realistic way to proceed."

What is a Plastic Surgeon?

Let's start with the basics of what it takes to be a plastic surgeon. Have you ever wondered why it's called plastic surgery? The name is derived from the Greek term plastikos, which means to mould or to shape. Plastic surgeons are all trained in general surgery prior to undertaking two to four years of additional surgical training. In these additional years, surgeons develop the unique qualifications needed to address specific problems that can occur in any area of the body.

These problems may require the plastic surgeon to restore shape and function to a particular area of the body. In other cases it may mean improving physical appearance. Consequently, plastic surgery encompasses both reconstructive and cosmetic procedures.

Cosmetic Versus Reconstructive Surgery

A plastic surgeon performs cosmetic surgery to reshape normal structures of the face or body in order to improve the patient's appearance and self-esteem. For example, body-contouring procedures such as breast augmentation, liposuction, rhinoplasty, and facial rejuvenation surgery are cosmetic procedures. Reconstructive surgery is performed to correct abnormal structures of the face or body caused by congenital defects, developmental abnormalities, injuries, previous or concurrent surgeries, infections, tumours, or disease. The purpose of reconstructive surgery is generally to improve function, but it may also be used to restore a normal appearance. For example, reshaping a nose following an injury involves aspects of both reconstructive and cosmetic surgery. Consequently, plastic surgeons have extensive training, enabling them to address the cosmetic and reconstructive needs of every area of the body.

"Choosing a member of the Canadian Society of Plastic Surgeons or the American Society of Plastic Surgeons ensures that your surgeon has the appropriate credentials to perform plastic surgery."

Certification

The Royal College of Physicians and Surgeons of Canada is the organization responsible for setting and maintaining the standards of post-graduate education, for certifying specialist physicians and surgeons, and for promoting their continued medical education. A plastic surgeon who is certified by the Royal College has successfully completed an approved university residency training program and passed the appropriate written and oral examinations.There are fewer than 20 new plastic surgeons certified each year in Canada.

Once plastic surgeons have been certified by the Royal College and have met further standards set out by their peers, they are accepted into the Canadian Society of Plastic Surgeons (CSPS). By choosing a plastic surgeon who is a member of the CSPS, a patient can be assured that the physician is certified by the Royal College of Physicians and Surgeons of Canada in the specialty of Plastic Surgery. Certified plastic surgeons are the only physicians who have undertaken all the necessary training in this field.

The equivalent body in the United States is the American Board of Medical Specialties (ABMS). The ABMS is the umbrella organization for 24 approved medical specialty boards in the United States. It has a similar mission to the Royal College of Canada in helping to maintain the standards of training in each of the approved specialties. Member boards meet the strict educational and examination criteria necessary for recognition.

Most people have heard the term "board certified". Unfortunately, becoming board certified does not tell the whole story. The ABMS determines which boards are considered legitimate. Although there are only 24 approved specialty boards, more than 100 have been evaluated. The American Society of Plastic Surgeons (ASPS) is a member of the ABMS. Other boards have less strict criteria for certification and are rejected. Some official-sounding boards that are not members of the ABMS are:

Board of Aesthetic Surgery
Board of Cosmetic Surgery
Board of Facial Cosmetic Surgery
Board of Facial Plastic Surgery
Board of Dermatologic Surgery
Board of Ophthalmic Plastic Surgery

If it is not clearly stated, be sure to ask what board a surgeon is certified in.

Choosing a member of the Canadian Society of Plastic Surgeons or the American Society of Plastic Surgeons ensures that your surgeon has the appropriate credentials to perform plastic surgery.

Hospital Privileges

Many consumers are under the false impression that a plastic surgeon is the only doctor who can perform cosmetic surgery. This is not the case in Canada or the United States. Once a physician obtains a licence to practise medicine, there are no restrictions placed on the scope of procedures or treatments that can be performed. However, a doctor must obtain hospital privileges in order to perform a procedure in a hospital. Fortunately, hospitals consider whether or not a doctor has the appropriate certification and peer-approval before granting those privileges. It's important for you to ask your surgeon if they have hospital privileges. You may even want to call the hospital's medical staff secretary to confirm this information.

Specialties

Once you feel confident about the credentials of your surgeon and you know that they have hospital privileges, you may want to consider some other issues. Within any surgical specialty, surgeons will have a particular strength or interest. Surgeons can gain additional expertise through a process commonly called a fellowship. These offer the certified plastic surgeon an opportunity to pursue additional experience in the clinical practice of plastic surgery. These fellowships cover a wide variety of topical areas within plastic surgery, including cosmetic surgery. However, they are not required to follow any generally recognized format or any approved curriculum. The quality of the training experience can, therefore, vary greatly. Fellowship training is of variable duration and may be associated with an institution or with an individual teacher.

Societies

Surgeons also belong to various societies. In general, membership in a particular society indicates a certain interest for the surgeon and does not represent a consistently useful measure of someone's training. However, I feel that society membership is very important as they provide a network within which peers can learn, share ideas, and remain current.

Choosing to have plastic surgery is an extremely important decision. Choosing the right plastic surgeon is equally important and requires you to be willing to do your homework and ask the right questions. The plastic surgeon you choose should be a member of the Canadian Society of Plastic Surgeons or the American Society of Plastic Surgeons and must have hospital privileges to perform the procedure you are interested in.

I hope this column has provided you with a better understanding about the credentials and certification process. Please take this time to review my credentials and the various links to important organizations and information sources.