Safe Cosmetic Surgery Requires Certification and Credentials
Stephen W. Gordon, M.D.

Our society has entered into difficult economic times. We may be headed into a recession, or maybe another depression, no one knows for sure. What is clear however is that everyone, including doctors, is greatly affected by it.

The economics of medicine have been changing for some time. Doctors are not making anywhere near the income they once enjoyed and consequently they have been looking at alternative means of augmenting their incomes. The lure of cosmetic surgery dollars seems irresistible to many physicians who lack the formal residency training and background to become properly credentialed to do these cosmetic surgery procedures.

Board certification in family practice, internal medicine or orthopedic surgery does not qualify a doctor to perform cosmetic plastic surgery. There are a lot of doctors masquerading as cosmetic plastic surgeons with no plastic surgery residency training experience. They can be found in the yellow pages in the plastic surgery or cosmetic surgery sections. No one at the yellow pages cares if these persons are legitimate or not. So Buyer Beware! Ask questions. Don’t assume you know the answer.

Let’s look at a real life example; the local community hospital will not grant privileges to a physician to do a certain procedure (like breast augmentation) because of lack of proper training. How could it seem like a good idea to go to his office to get that procedure done? What if there is some awful complication requiring hospitalization, then what? Where would he send you, and who would take care of you?

This whole picture of legality and competency is understandably confusing. The confusion comes about because a license to practice medicine in most states is an unrestricted license to do what ever medical or surgical procedure that doctor might care to do. So it is not illegal for a licensed doctor to do just that-whatever he wants. The matter of whether or not he is adequately trained to do so is quite another matter, and this competency issue is best answered or measured by asking direct questions regarding residency training, and board certification. Weekend courses and other do it yourself educational schemes cannot be compared to an organized, accredited, approved residency training experience and the ultimate accomplishment of passing a rigorous written and then oral examination to receive Board certification. Thank goodness at least the hospitals exercise their responsibility to evaluate each individual and rely on residency training, board eligibility and other guidelines in making decisions regarding privileges.

The most widely accepted and recognized standard for all aspects of cosmetic surgery experience and training is that the individual be certified by the American Board of Plastic Surgery. The American Board of Facial Plastic Surgery certifies that an ear nose and throat surgeon has had additional training in plastic surgery of the facial area and has passed a rigorous written exam. The board of facial plastic surgery does not certify a surgeon to do plastic surgery all over the body; only the American Board of Plastic Surgery does.

The consumer must be careful not to get fooled by a surgeon’s membership in any of the hundreds of societies or associations with very impressive sounding names. These are not certifying agencies recognized by the American Board of Medical Specialties (A.B.M.S.) and they are not affiliated with any formal residency training programs. For example, The American Board of Cosmetic Surgery has a very official and impressive sounding name, but it is not affiliated with any formal residency training program and is not recognized by the A.B.M.S.

In addition to your surgeon’s credentials, it is wise to ask what credentials his staff members have relative to their jobs. For instance the medical assistant helping the doctor should be certified. Likewise the scrub tech should be certified. The R.N. nurse in charge of the operating room should have advanced cardiac life support certification and so should the recovery room nurse. The anesthesiologist should be board certified, and also have advanced cardiac life support credentials. The practice administrator ideally should have a college degree. And last but not least, the facility in which you are about to receive surgery must be accredited.

To become an accredited surgical facility, there are specific physical characteristics and floor plan considerations that must be provided. The entire surgical area must be segregated from all other clinic, patient care or office areas. Separate rooms for the management of dirty and sterilized instruments are required. Oxygen and anesthetic gas cylinders must be securely chained to the wall or strapped to its’ transportation cart. Emergency resuscitation equipment and training must be immediately available and functional. Equipment to monitor vital signs as well as any machines used in patient care such as anesthesia machines, cautery units, lights, O.R. tables, etc., must be inspected every 6 months by a biomedical engineer.

Written protocols which give direction on how to do daily functions in the surgery center must be updated annually, and the facility must undergo a yearly inspection.

If your surgeon’s facility is not accredited, you will have no way of knowing if any of these details and requirements is ever met. Ask questions!

In summary, you need to know what your surgeons true qualifications are, what certifications his staff has obtained, and whether or not the facility in which you are to receive surgery is accredited or not. Good luck!


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