Who is doing your Botox® Injections? March 25, 2008

Yesterday I had an interesting conversation I feel like writing about.  I was speaking with an emergency medicine physician.  After 30 years in the emergency room, he now performs a narrow array of non-surgical cosmetic procedures such as Botox® injections and laser treatments.  Typically he performs the procedures at the homes of his patients. 

He made a statement to the effect that as a plastic surgeon, I have “instant credibility” with patients.  He believes that plastic surgeons are the “recognized experts” in the field of cosmetic improvements.  It made me wonder why any patient would want to have a cosmetic procedure performed by someone other than a plastic surgeon. 

Typically plastic surgeons undergo a board certification process verifying appropriate training and the passage of multiple exams related to, among other things, cosmetic procedures.  No specialty understands the facial anatomy and the wide range of cosmetic treatments better than board certified plastic surgeons.   

Non-plastic surgeons mostly learn how to do injections at weekend courses or from other colleagues.  The drive is obviously related to the apparent financial benefits of performing cosmetic procedures.  I imagine some physicians also just get tired of their specialty and they view “injectables” as easy to learn and a welcome alternative to arguing with insurance companies. 

I guess I just find the whole issue intriguing.  I am a board certified plastic surgeon.  Would anyone object to me taking care of heart attack patients in the emergency room or delivering babies in order to make some extra money?  I think the answers are obvious. 

My recommendation for your next Botox® treatment:  your health is the most important thing you have, don’t entrust it to anyone other than a “recognized expert.”

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Dr. Kelly Gallego is a board certified plastic surgeon with offices in Irvine and Corona, CA.

What is a “Board Certified Plastic Surgeon?” March 25, 2008

There seems to be a fair amount of confusion as to the definition and the importance of the term:  Board Certified Plastic Surgeon.

First, let me define the term.  Board certification is a credentialing process where physicians voluntarily complete a list of requirements in order to be certified by a particular specialty board.  Specialty boards require training at an approved program and the completion of an examination process.  Each specialty does it a little differently.  Some boards administer their exams during the training process, others wait until after a doctor has been in practice.  Some specialties require an oral exam, some do not.

The American Board of Medical Specialties (ABMS) recognizes 24 specialty boards that meet certain rigorous standards.  For plastic surgery, the American Board of Plastic Surgery is the only recognized board.  Other boards exist, but are not recognized as meeting the appropriate standards as determined by the ABMS.  Currently there are more than 75 non-ABMS recognized boards.  Examples of these include the American Board of Cosmetic Surgery, and the American Board of Facial Plastic and Reconstructive Surgery. 

In addition, some surgeons who perform cosmetic procedures are board certified in an unrelated field such as head and neck surgery, ophthalmology or obstetrics and gynecology.  Before a consultaion for any cosmetic procedure, patients should always inquire as to whether the surgeon is board certified by the American Board of Plastic Surgery.

The American Board of Plastic Surgery (ABPS) requires the following in order to become board certified.  First, a candidate must complete prerequisite training followed by requisite training at an approved plastic surgery training program.  Next, candidates must pass a comprehensive written exam which is usually taken within the first year after training.  Finally, candidates must pass an oral examination which strenuously evaluates a candidate’s knowledge base, judgement and ethical standards.  Only after completing each of these steps are candidates considered board certified.  The official term is a Diplomate of the American Board of Plastic Surgery.  The ABPS requires re-certification every ten years.

Now to the question of importance.  Are there knowledgeable surgeons who are not board certified?  Sure.  Are there any unethical surgeons who are board certified?  Yes.  Board certification by the American Board of Plastic Surgery does not guarantee a good cosmetic result.  It does not insure that your experience will be free of any complications.  However, it does prove that a plastic surgeon has completed the required training in plastic surgery, and has passed a set of rigorous exams.  When it comes to your health, what could be more important than finding a plastic surgeon who has been appropriately trained and who has proven their knowledge and ethics through a demanding examination process?

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