Dr. Lindsey's Newsletter #35: PS or FPS: Can the Public Tell the Difference?

Welcome to the latest edition of our newsletter! We are taking a quick pause from the current newsletter series for a Journal Club Edition!

The journal article I am going to discuss today addresses perhaps one of the most confusing topics in facial aesthetic surgery. What is the difference between a Plastic Surgeon and a Facial Plastic Surgeon? Which one has more training? Which one has the most expertise? The public cannot tell.

Welcome to the latest edition of our newsletter! We are taking a quick pause from the current newsletter series for a Journal Club Edition!

The journal article I am going to discuss today addresses perhaps one of the most confusing topics in facial aesthetic surgery. What is the difference between a Plastic Surgeon and a Facial Plastic Surgeon? Which one has more training? Which one has the most expertise? The public cannot tell.

The History of Journal Club:

In residency we used to have monthly journal club meetings where we would read papers on an assigned topic and then come together with leaders in the field to discuss the articles over dinner. The goal of journal club is to critically evaluate an article and when appropriate adopt the principles of the article into your own practice in order to improve your own patient outcomes. In the world of medicine, training ends but learning never does.

The History of Journal Club:

In residency we used to have monthly journal club meetings where we would read papers on an assigned topic and then come together with leaders in the field to discuss the articles over dinner. The goal of journal club is to critically evaluate an article and when appropriate adopt the principles of the article into your own practice in order to improve your own patient outcomes. In the world of medicine, training ends but learning never does.

Journal Club: Plastic Surgery or Facial Plastic Surgery: Can the Public Tell the Difference?

Pyon, Rachel E. MD*; Sayadi, Lohrasb R. MD†; Pakvasa, Mikhail MD†; Vyas, Raj M. MD†; Wang, Eric D. MD†. Plastic Surgery or Facial Plastic Surgery: Can

Authors, Affiliation and Publication

This study was performed by the Division of Plastic & Reconstructive Surgery at the University of California San Francisco. This passes the first checkpoint for me, as this program is reputable in our field.

The article was published in PRS Global Open in March, 2024. This passes the second checkpoint for me, as this journal is one of the most highly regarded journals in our field.

These two elements are the very first things that I read prior to reading a journal article.

Authors, Affiliation and Publication

This study was performed by the Division of Plastic & Reconstructive Surgery at the University of California San Francisco. This passes the first checkpoint for me, as this program is reputable in our field.

The article was published in PRS Global Open in March, 2024. This passes the second checkpoint for me, as this journal is one of the most highly regarded journals in our field.

These two elements are the very first things that I read prior to reading a journal article.

Background and Purpose

Because of the increase in social media and online advertising, the authors were interested in whether the general public can distinguish the difference in training and credentials amongst medical professionals that advertise online. The study showed public expectation regarding distinction between plastic surgery and facial plastic surgery.

The Study Design

An online surveying service was used to collect information about assumptions made solely based upon the terminology “facial plastic surgery” and “plastic surgery”.

Participants

253 people responded to the sruvey, they were all US residents.

Results

Based upon the term facial plastic surgeon, respondents agreed that:

They expected a facial plastic surgeon to have completed a plastic and reconstructive surgery residency program.
They would feel misled if they visited a facial plastic surgeon for a consultation and later learned that the provider did not complete a plastic and reconstructive surgery residency.

Background and Purpose

Because of the increase in social media and online advertising, the authors were interested in whether the general public can distinguish the difference in training and credentials amongst medical professionals that advertise online. The study showed public expectation regarding distinction between plastic surgery and facial plastic surgery.

The Study Design

An online surveying service was used to collect information about assumptions made solely based upon the terminology “facial plastic surgery” and “plastic surgery”.

Participants

253 people responded to the sruvey, they were all US residents.

Results

Based upon the term facial plastic surgeon, respondents agreed that:

They expected a facial plastic surgeon to have completed a plastic and reconstructive surgery residency program.
They would feel misled if they visited a facial plastic surgeon for a consultation and later learned that the provider did not complete a plastic and reconstructive surgery residency.

My Summary

The Key Points:

Social media and the internet are highly impactful tools for marketing in plastic surgery.
Despite efforts by professional societies, the public often cannot distinguish between Plastic Surgeons and Facial Plastic Surgeons in terms of training and certification.
Most respondents believed Facial Plastic Surgeons and Plastic Surgeons undergo similar training, with many expecting Facial Plastic Surgeons to have completed a plastic surgery residency.
Learning that a Facial Plastic Surgeon lacks formal plastic surgery training would negatively impact respondents' choice of surgeon.
Respondents felt that completion of a plastic surgery residency should be a requirement for advertising oneself as a plastic surgeon.
The study highlights the importance of transparent communication about training and certification in the plastic surgery field, particularly in online marketing.

Do you know?

I wonder how many of you know the difference between a Facial Plastic Surgeon and a Plastic Surgeon. The intent of this is not to disparage Facial Plastic Surgeons by any means, but rather to clarify the position of Plastic Surgeons in the field.

My Summary

The Key Points:

Social media and the internet are highly impactful tools for marketing in plastic surgery.
Despite efforts by professional societies, the public often cannot distinguish between Plastic Surgeons and Facial Plastic Surgeons in terms of training and certification.
Most respondents believed Facial Plastic Surgeons and Plastic Surgeons undergo similar training, with many expecting Facial Plastic Surgeons to have completed a plastic surgery residency.
Learning that a Facial Plastic Surgeon lacks formal plastic surgery training would negatively impact respondents' choice of surgeon.
Respondents felt that completion of a plastic surgery residency should be a requirement for advertising oneself as a plastic surgeon.
The study highlights the importance of transparent communication about training and certification in the plastic surgery field, particularly in online marketing.

Do you know?

I wonder how many of you know the difference between a Facial Plastic Surgeon and a Plastic Surgeon. The intent of this is not to disparage Facial Plastic Surgeons by any means, but rather to clarify the position of Plastic Surgeons in the field.

If this still reads like a foreign language to you, let me just clarify simply. Plastic & Reconstructive Surgery training is comprehensive (from head to toe) and is a minimum of 6 years. That means that 6 years are spent learning, practicing, and being held to rigorous standards by the overseeing board. Comparatively, Facial Plastic Surgeons only spend one year learning any sort of plastic surgery and it is limited to above the clavicles. This does not mean that they have more experience, in fact they have 5 years less experience learning and practicing plastic surgery than plastic surgeons. Why does this matter? Because there are surgeons that grossly misrepresent their credentials and mislead the public to believe that they have better, more extensive, more specialized training than plastic surgeons.

Excerpt from a Facial Plastic Surgeon’s Website defining, incorrectly, their credentials:

If this still reads like a foreign language to you, let me just clarify simply. Plastic & Reconstructive Surgery training is comprehensive (from head to toe) and is a minimum of 6 years. That means that 6 years are spent learning, practicing, and being held to rigorous standards by the overseeing board. Comparatively, Facial Plastic Surgeons only spend one year learning any sort of plastic surgery and it is limited to above the clavicles. This does not mean that they have more experience, in fact they have 5 years less experience learning and practicing plastic surgery than plastic surgeons. Why does this matter? Because there are surgeons that grossly misrepresent their credentials and mislead the public to believe that they have better, more extensive, more specialized training than plastic surgeons.

Excerpt from a Facial Plastic Surgeon’s Website defining, incorrectly, their credentials:

Here the website says that Facial Plastic Surgeons offer “extra assurance of their expertise in facial anatomy and surgery”. This is blatant misinformation.

I have 5 more years of training in plastic surgery than my Facial Plastic Surgeon counterparts. Every single one of those six years included rigorous training in facial plastic surgery - from the ground up. This is not replaceable nor can it be superseded with a one year fellowship.

What Really Matters Here?

I chose this article because it is objective data on an issue that has never been more relevant. To be honest, I know a number of fantastic Facial Plastic Surgeons, ones that do not misrepresent their training in order to gain an edge in the field. They own their training in otolaryngology and also factually represent themselves for who they are. At least they are real surgeons, with real training. That basis of surgical training in anatomy is so very important for patient safety.

The greater problem and crisis in our culture are medicine doctors that have no surgical training offering plastic surgery. The cases that come to mind are ones that I have either read about in the news or have witnessed first hand and include:

-A nurse practitioner with a “doctorate in nursing” who represents herself as a “doctor” and performs plastic surgery on unsuspecting patients

-An internal medicine doctor who opened up a plastic surgery practice and has many thousands of followers on instagram - meanwhile he never had a legitimate day of training in surgery a day in his life

-Family medicine doctors that run an “aesthetic practice”

-An ER doctor with his own private operative suite that he uses to perform plastic surgery procedures

-A pediatrician that killed a mom performing liposuction on her

-A non-medical personnel that disfigured patients with Kybella injections all over the body in the wrong anatomical plane

There is a crisis unique to the field of aesthetic plastic surgery because it is a luxury business within the larger umbrella of medicine. With luxury services come luxury prices and profit. This has created a desire across all medical fields (and even non-medically trained people) to get a piece of the pie, so to speak. And thus we find ourselves in a crisis where the news is filled with horror stories from the field of aesthetics. These horror stories usually come from doctors, nurses, and random non-medical personnel who were never trained in plastic surgery.

There is no way to fix the problem that everyone wants a piece of the pie, it is a problem as old as time. What we can do on a practical level is educate. I have seen a push amongst my peers to help educate the public, but frankly it is exhausting. Often it seems the public is willing to participate in these scams because it means a cheaper price. But as I said before, the problem with bootleg plastic surgery is you get bootleg outcomes.

You are probably wondering why all of these non-plastic surgeons didn’t just train in plastic surgery. The answer is simple, it’s an extremely competitive field to get into and they didn’t make the cut. Others realized later that reimbursements for their speciality were going down and so they pivoted into a field that was cash-based - but didn’t want to actually go through the training. Plastic Surgery is one of the hardest specialties to earn a spot in and those of us who made it sacrificed MANY days and nights in the library. I personally gave up a lot of time away from my friends and family. Anyone in my field has sacrificed a lot to get the scores, to prove their work ethic, to go the extra mile and impress programs so that we would get drafted.

My hope with this newsletter is not that you come away thinking poorly of Facial Plastic Surgeons. My hope is that you start discerning credentials and understand who people are based upon their training. I hope that you understand that there is no comparable training to Plastic Surgeons.

I also think it is important to state that even with the rigorous training there is still a mixed bag amongst credentialed plastic surgeons. If your gut tells you they aren’t honest or a credible person, choose someone else. Just this week I was reading a news story about a “real” plastic surgeon with an impressive training record from medical school through residency. He tragically killed his wife while operating on her. She reportedly prepared her own medication for her surgery (she wasn’t a medical professional) and she died from a lidocaine overdose. There are bad apples everywhere, even in good training programs. There are also mistakes made by humans in the moment. The very least that you can do to advocate for yourself as a patient is to find a plastic surgeon who you have direct, honest communication with. Find someone that has a proper education and an honest relationship with their patients.

If you have questions about this topic feel free to shoot me an email or DM on instagram. If you have an article that you would like reviewed and explained - send it over via email.

As always, here's to choosing how we age, on our own terms!