Recently the Australian Medical Council, which is the body in charge of training doctors in Australia, has reported that plastic surgeons have a deficit in their cosmetic training and with the below facts it is easy to see why.
In the cosmetic vs plastic turf war, it is important to understand the history and the difference between cosmetic and plastic surgery.
The Difference Between Cosmetic and Plastic Surgery
Plastic or reconstructive surgery is to bring back to the normal e.g. an injury or a defect to make it normal again whereas cosmetic is to improve on the normal.
Sir Harry Gillies, a New Zealand otolaryngologist is considered to be the father of modern day plastic surgery.
Otolaryngology is the oldest medical specialty in the United States. Otolaryngologists are physicians trained in the medical and surgical management and treatment of patients with diseases and disorders of the ear, nose, and throat (ENT).
During the First World War, Sir Gillies took great pity on soldiers who had been disfigured. Some of these soldiers would not return home, as they did not want to distress their family at how badly they had been injured.
Sir Harry Gillies employed the services of an American wax figure maker to mould faces that were lifelike for these young men. He also embarked on the complex skin and muscle transfers to rebuild their face. Unfortunately, the first patient died of an infection and he quickly learned that small procedures or steps done sequentially were the safest way to reconstruct some of these horrific injuries. Sir Harry Gillies taught what he learnt widely to other surgeons and it was rumoured he was not included in the first plastic surgery college that was formed. This was probably the beginning of the turf war with plastic surgeons vs ENT surgeons, general surgeons, orthopaedic hand surgeons and cosmetic surgeons.
The reasons behind this are complex but include the fact that soft tissues are very hard to define or draw a boundary around unlike bones for an orthopaedic surgeon or the ears, nose and throat for an ENT surgeon. Many orthopaedic surgeons perform hand surgery although in the earlier days they conflicted with plastic surgeons over this piece of surgical turf. General surgeons that perform reconstructive breast surgery and plastic surgeons still have this ongoing conflict in some parts of the world.
In a recent lecture by a well-known professor of plastic surgery, it was mentioned that the finger pointing between both groups should stop. Probably the last turf war will be with the cosmetic surgeons.
Cosmetic Surgery Training
During a Plastic Surgeon’s training, there is an optional 6-month fellowship on Cosmetic Procedures. A Cosmetic Surgeon who is an Australasian College of Cosmetic Surgery (ACCS) fellow undertakes 2 years of mandatory training in Cosmetic Surgery.
|Type of Surgeon Minimum Years of Training|
|Cosmetic Surgeon 12 years
|Plastic Surgeon 12 years
(RACS Fellow and Australian Society of Plastic Surgeons (ASPS) Member)
A recent British journal article letter from a young plastic surgical trainee made it clear some of the problems that plastic surgeons have with the field of cosmetic surgery. His main complaint was that he had received no training as a plastic surgeon trainee and this was widespread. Most cosmetic surgery is performed in the private sector where plastic surgical training is not based.
The British Association of Plastic Surgery stated on their website that the work of a plastic surgeon is predominantly non-cosmetic. It must be asked, if the public has paid for plastic surgeons to be trained, should they be losing these reconstructive skills to cosmetic surgery that does not benefit society to the same degree. As we are all aware there are long waiting lists for plastic reconstructive surgery and these will probably worsen the more plastic surgeons perform cosmetic surgery.
In the turf war, there are many claims made that one should only see a plastic surgeon for this or that procedure. A very honest American plastic surgeon admitted that she had performed a labiaplasty and had never been trained to do so! She also admitted many years later that she had only sat in for 5 days with gynaecologists to hone this procedure. It must be asked how plastic surgeons can say that “you should only see a plastic surgeon for a cosmetic labiaplasty” when it is a well-known fact that a gynaecologist pioneered this procedure. One plastic surgeon that is experienced in cosmetic surgery admitted that he had done most of his fellowship training with cosmetic surgeons. When asked why he said they have the most experience and were full time in this area!
It is interesting to note that the use of the word cosmetic was rejected as part of the name for the plastic surgery society. Some older plastic surgeons admit they looked down on cosmetic work and thought that reconstructive was the more important prestigious work to be performed.
At Absolute Cosmetic we have seen this first hand as a local plastic surgeon has asked to be trained in liposuction as he had never performed it in his training. The optional cosmetic fellowship is as little as 6 months for a plastic surgeon.
What many do not realise is that liposuction was first performed by a gynaecologist and was developed further by a dermatologist. The tumescent method of liposuction was developed by a dermatologist.
In our theatres, we have had both ENT, plastic and cosmetic surgeons, our theatre nurse said there was no difference in skill or knowledge. A US study showed that plastic surgeons were performing too many different types of operations and losing their surgical identity. When the general public was asked for examples of breast surgeons, skin surgeons etc plastic surgeons did not come to mind for the majority.
It should also be noted eye surgeons or dermatological mohs surgeons do not have a Royal Australian College of surgery qualification but are experts in their field.
The government advisor on PIP breast implants was a cosmetic surgeon, not a plastic surgeon. A professor of cosmetic plastic surgery in England named him as one of the most experienced surgeons with polyurethane implants worldwide. This plastic surgical professor is very fair and even-handed and recognises quality skills whether these come from cosmetic, plastic, ENT or general surgeons.
In the recent PR turf war, the media has reported facts incorrectly. The cut-price breast clinic in the eastern states that had multiple cardiac arrests was developed and headed by a plastic surgeon, not cosmetic. In Victoria, liposuction death was performed by a plastic surgeon, not cosmetic. This surgeon considered himself experienced in liposuction but had only performed 117 cases where many cosmetic surgeons have performed as many as 7 or 8 thousand. The recent Brazilian butt lift study that found that the death rate was 1 in 3000 was amongst plastic surgeons not cosmetic. It must be asked why the media is making these omissions.
Recently the turf war has extended between plastic surgeons. Two prominent plastic surgeons with a large social media presence have been caught up in the media spotlight. It was exposed that one of them was allegedly bullying a cosmetic surgery forum host into giving him favourable reviews and preference over another plastic surgeon. It was quite shocking to see that payments were allegedly being made for bias.
There are good and bad in all groups as most people are aware. All procedures have complications and good aftercare limits these in most cases. Being full time or spending the majority of a doctor’s time in a particular field means more experience and practice which common sense tells us is important in performing a procedure.
In The Media
“Your Face is Your Fortune, So Pick Wisely” – The West
Dr Glenn Murray
Dr Murray, Medical Director and full-time Cosmetic Proceduralist, is a fellow of the ACCS and was privately trained by some of the best Plastic and Cosmetic Surgeons in the world. He was named one of the Top 10 Injectors world-wide and has performed thousands of Surgical procedures with a very low complication rate. See Dr Murray’s full profile here.