After reading “A Viable Future” in the October 2011 issue, I was surprised to see that W. Grant Stevens, MD, said that since “72% of plastic surgeons are making more than half their income from cosmetic surgery, then why aren’t we teaching cosmetic surgery?” This comment is consistent with the research published in the Journal of Plastic Surgery, where senior residents complained that they do not have enough training in cosmetic surgery. In 1960, the American Academy of Cosmetic Surgery was the first organization founded specifically to teach cosmetic surgery. This organization welcomed specialists from all surgical fields.

The Aesthetic Association of Plastic Surgery was created in 1967. Plastic surgery leaders rejected the idea of cross specialty teaching. On the other hand, the founding organization of the Facial Academy of Plastic Surgery and American Academy of Cosmetic Surgery embraced this idea. Because of pressure being applied from university-based plastic surgeons and from others within the American Board of Medical Specialties, members of the Facial Academy of Plastic Surgery’s facial governing board moved to change its membership criteria and excluded dermatologists as well as oral and maxillofacial surgeons.

In the early years, facial and cosmetic surgeons were hammered by a coordinated smear campaign orchestrated by plastic surgery organizations. The Federal Trade Commission retrieved files from the American Society of Plastic Surgeons’ executive offices in Chicago that described how the plastic surgeon intended to destroy the competition: the cosmetic surgeon. The cold war became so heated that the US Congress called for a congressional hearing. The Federal Trade Commission passed a “consent decree.” This means they found evidence of unlawful and anticompetitive practices.

The Georgia Society of Plastic Surgery published an article called “Things Are Never What They Seem, Skim Milk Masquerades as Cream.” This article called plastic surgeons “cream” and facial plastic surgeons and cosmetic surgeons “skim milk.” A lawsuit for slander and libel was filed by the Facial Academy and the Cosmetic Association. E. Gaylon McCullough, MD, past president of the American Academy of Cosmetic Surgery and secretary of the Facial Academy of Plastic Surgery, testified at the trial. The jury returned a guilty verdict against the plastic surgeons and awarded the largest judgment in history against medical organizations. The plastic surgeons were told to pay $1.5 million in punitive damages.

Now the call by Dr Stevens to embrace the core specialties is an honored one. The only problem is that he still refuses to accept gynecologists and oral maxillofacial surgeons. If we look at the history of cosmetic surgery, you will find that Yves Gerard Illouz, MD, a French gynecologist, invented liposuction, which was later improved by Jeffrey Klein, MD, a dermatologist from California.

In 1800, gynecologist Ignaz Semmelweis, MD, noticed that women giving birth at home had a much lower incidence of fever than those giving birth in the maternity ward. His investigation discovered that washing hands with an antiseptic solution before a delivery reduced childbed fever fatalities by 90%. Thanks to his work, we all scrub before surgery. In 1899, Howard Kelly, MD, a gynecologist from John Hopkins University, invented the abdominoplasty. More recently, David Matlock, MD, a gynecologist from Beverly Hills, Calif, invented laser vaginal rejuvenation, which gave worldwide attention to vaginoplasty and labiaplasty. You will not find many other specialties that have contributed more to cosmetic surgery.

Now I say to you today, my colleagues, which in spite of the difficulties and frustrations of the moment, is that I have a dream, which is a dream deeply rooted in the American Dream. I have a dream that one day this nation will rise up and hold that all surgeons are created equal. I have a dream that one day a surgeon will no longer be judged by their original training, or specialty, but by the content of their surgical skills. Then we will be able to share our knowledge in the benefits of science and humankind. Then we will able to say free at last, free at last.

Efrain Gonzalez, MD, FACS, FACOG, FAACS
Advanced MedSpa Cosmetic Surgery Center
Sacramento, Calif