About 10 years ago—long before “extreme makeover” became a household term—the media became interested in plastic surgery. Most of the early-day television specials were dedicated to reconstructive plastic surgery for patients in need and exemplified the personal changes achieved afterward.

Nearly 5 years later, the media turned its focus on the extreme makeovers performed on “common folks.” Of course, as more people became interested in aesthetic procedures as a result of this media hype, more physicians became interested in performing these procedures—especially when confronted with the national health care reimbursement dilemma.

Let’s look at the trends from 2000 to 2005, according to data collected by the American Society of Plastic Surgeons (ASPS)1:

  • aesthetic procedure growth: 38%;
  • top five surgical procedures in 2005: rhinoplasty, liposuction, blepharoplasty, breast augmentation, rhytidectomy; and
  • top five minimally invasive procedures in 2005: chemical peel, microdermabrasion, sclerotherapy, botulinum toxin Type A, laser hair removal.

Choose Wisely

The wealth of new plastic surgery procedures to choose from is presenting a far greater opportunity for physicians other than plastic surgeons to practice elective fee-for-service medicine. Dermatologists may believe they are the best ones to treat patients interested in injectibles, but so may internal-medicine physicians or gynecologists. Gynecologists may also believe that they are best suited to perform vaginal rejuvenation.

Many types of surgeons may be interested in performing liposuction. A large number of dentists are now performing facial-rejuvenation procedures. However, market-drive forces have presented greater challenges.

As aesthetic surgery has become more popular, the credentials of physicians who perform these procedures have gone unregulated. Many states have no laws preventing practically any licensed physician—including those trained via weekend courses or through manufacturers of new technologies—from performing these procedures. To make matters more complex, there are many unaccredited facilities that pose unnecessary safety risks for patients.

Peter B. Fodor, MD, FACS, a Los Angeles-based plastic surgeon, says, “With any surgery—and aesthetic surgery is no exception—there are potential complications, some of which can even be life-threatening in untrained hands. Prospective patients may not fully realize or understand this.

“The fact of the matter is that a weekend course is hardly adequate to prepare doctors of various backgrounds to perform aesthetic surgery in a safe manner,” he continues. “Also, as with any surgery, unexpected events can occur during the procedure as well as during the postsurgical recovery period. It is best to prevent these as much as possible.

“To recognize them early and to treat them appropriately is the next best thing to do. Appropriate training goes a long way in this effort.”

As things stand today, consumers can walk into just about any physician’s office and request more information about the beautifying results they see displayed on their television screens. Stephen H. Miller, MD, MPH, a board-certified plastic surgeon who practices in Evanston, Ill, and president of the American Board of Medical Specialties (ABMS), cautions, “We have market-forced entry with no rules in terms of board certification. There is no system in place to categorize board certification, and the burden of proof for competency of a doctor has been put on the patient.” So what does board certification imply today?

The Tides Are Turning

The ABMS is working harder than ever to influence board-certification changes. Recently, it has developed a maintenance certification program, titled the “ABMS Patient Safety Improvement Program,” to keep up to date with industry trends. To date, all 24 boards recognized by the ABMS have placed their application for maintenance certification, and 22 are expected to be in place shortly.

In the past 6 months, the ABMS has reorganized to meet key initiative goals in areas such as information services, product management, and business development. On the horizon, joint initiatives among leading organizations to help create changes in state licensing-board requirements will aim to develop new criteria for licensing based on practice focus.

Because the number of office-based surgical procedures is growing so rapidly, the need for standardized facilities is also rising. According to the American Society of Anesthesiologists, approximately 10 million procedures were performed in a physician’s office in 2005—double the number in 1995.2,3

The problems with standardization in office-based surgery are complex. In 2004, only 14 states had accreditation mandates for office-based surgical facilities. Until November 2005, there was no consensus among health care accrediting agencies to define unfavorable medical errors during procedures that occur in office-based surgical centers, according to the ASPS. In fact, there are inconsistent definitions for reporting requirements at the state level, which should be reported and investigated by independent third parties.2

To help solve these issues, in late 2005 the ASPS sponsored a collaboration among the American Association of Accreditation of Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which was facilitated by the American College of Surgeons.2 The goal of the collaboration was to create a safeguard movement for office-based surgical procedures, including:

  • Hospital privileges for procedures: The AAAASF requires that surgeons who perform outpatient surgery in office-based surgical facilities have hospital privileges to perform the same procedure as well.
  • Office-based surgical standards: Office-based surgical centers that are accredited must agree to follow through on the standards established by the accrediting agency to maintain their status.

According to a study released in 2004, the AAAASF used the first-ever Internet-based Quality Improvement and Peer Review Program central data system to evaluate the more than 400,000 procedures performed in more than 600 AAAASF-accredited surgical centers during a 2-year period. The study found that these procedures had an overall safety record comparable to those performed in hospital surgical facilities.2,3

Fodor adds, “Any potential patient is well-served in knowing that the surgeon of their choice, beyond board certification, has obtained privileges to perform a given procedure in a hospital setting. In order to do so, he or she is subject, on an ongoing basis, to the peer-review process of the hospital and its credentialing committee.”

More independent groups of leading plastic surgeons have developed collaborations and higher standards for teaching new techniques and procedures. Scott Miller, MD, FACS, who practices in La Jolla, Calif, explains, “The new techniques in plastic surgery have to be learned in a formal, organized format for surgeons to have a good understanding of who would be the appropriate candidate and how the technique is best applied. Furthermore, board certification by the American Board of Plastic Surgery and the training that it represents are critical in having the foundation upon which to learn these new procedures and adapt to the changes in technique and technology.”

Miller is a course director and clinical instructor in the use of barbed sutures for facelifts. Many more resources offering additional credible training are available today so that patients may receive the best care.

Taking Ownership

As we know, a physician’s credentials can be described to patients through the media in many ways. Some articles and advertisements do not distinguish between a licensed medical doctor, a board-certified plastic surgeon, or a cosmetic surgeon.

Although many types of specialists may be listed under the yellow pages category “cosmetic surgery,” the day may soon come when this will be a thing of the past. Several states are working to create legislation that will force publishers to better disclose credentials in editorial and advertising.

Richard J. Greco, who practices in Savannah, Ga, warns, “It is prudent for surgeons to identify ways to build on their credentials when necessary in order to avoid detriment that may be caused by riding on the notoriety of plastic surgery in today’s environment.” Greco serves on national committees for organizations such as the ASPS.

The due diligence of practices today may be best demonstrated by participating in hospital committees, on boards, and in the community; and by building one’s credentials through continuing education with organizations like the ASPS and the American Society for Aesthetic Plastic Surgery.

Public-relations strategies that involve television, print, or radio may not be for everyone. James H. Wells, MD, who practices in Long Beach, Calif, suggests four questions to ask yourself before you embark on a campaign that incorporates television, print, or radio:

  • Is it good for plastic surgery?
  • Does it inform the public?
  • Does it avoid self-promotion?
  • Does it focus on wellness, patient safety, and education?

If you answer no to any of these questions, reconsider the campaign. It is important today to seek out accreditation with federal- and state-recognized accrediting agencies, such as the AAAASF or the AAAHC. Finally, it is critical to receive licensure in the state where the facility is located.

Since individuals who are considering elective aesthetic surgery often use the information found through public relations activities to help decide on a particular surgeon, it then becomes your responsibility to inform your patients about your experience with a particular procedure and the likelihood that they will obtain the desired outcome. Now, perhaps more than ever before, it is also important to seek out the best credentials for patient care as well.

Lesley Ranft is is a contributing writer for Plastic Surgery Products. For additional information, please contact [email protected].


See also “Navigating the Accreditation Maze” by Wendy Lewis in the January 2006 issue of PSP.
  1. American Society of Plastic Surgeons. 2000/2004/2005 National Plastic Surgery Statistics. Available at: [removed][removed]http://www.plasticsurgery.org/media/statistics/loader.cfm?url=/commonspot/security/getfile.cfm&pageid=17870[/removed][/removed]. Accessed March 16, 2007.
  2. Consumer Guide to Plastic Surgery. Office based surgery centers. Available at: [removed]http://www.yourplasticsurgeryguide.com/ choose-surgeon/office-surgery.htm[/removed]. Accessed March 16, 2007.
  3. American Society of Plastic Surgeons. Some cosmetic plastic surgery patients continue to place themselves at risk. Available at: [removed]http://www.plasticsurgery.org/media/press_ releases/cosmetic-plastic-surgery-patients-at-risk.cfm[/removed]. Accessed March 16, 2007.