You enter a well-appointed office. You are greeted by a pleasant receptionist. You look through a book of impressive before-and-after photos. You meet with a surgeon that puts you at ease and promises to make you look the way you have always wanted. How could anything be wrong? You may be surprised.
Becoming a cosmetic surgeon
Most cosmetic surgeons that you will potentially meet will have training in plastic surgery. For many people, there is no difference between a cosmetic surgeon and a plastic surgeon. Some believe that if you are one, you are also the other. While fairly close, this is not always the case. In order to be a plastic surgeon, a person must complete medical school (and do quite well there, actually).
Then the new doctor must complete a five year residency in general surgery. After that, the new surgeon can begin the two year plastic surgery residency. That plastic surgery residency will include training in everything from burns to cleft lip repair. Some of that time will be spent on cosmetic surgery, maybe 3-4 months. For people that truly want to be cosmetic surgeons, they usually perform a cosmetic surgery fellowship after plastic surgery residency (but many do not).
Who can legally practice cosmetic surgery?
Each state sets its own laws about what it takes to be a doctor and what it takes to practice medicine. In many states, if not most states, a licensed physician can legally deliver a baby, treat diabetes, and perform brain surgery. Fortunately most physicians do not do all of these in a single practice. Brain surgery is done by neurosurgeons and diabetes is usually managed by yourprimary care physician.
However since it is legal in most states, some doctors have taken it upon themselves to do a little bit of plastic surgery as part of their practice. This is especially common among surgeons. Surgeons have the operating room privileges, the anesthesiologist on call, and the instruments needed to perform surgery—it is not too much of a logistical problem to start doing cosmetic surgery. Is this legal? Sadly, yes. Is it ethical? Not usually.
How do you protect yourself from shady “cosmetic surgeons?”
Do not settle for a nice office and a friendly staff. Of course this helps, but it is only the beginning of the story. Remember that before-and-after books can be purchased from others. Ask your surgeon if those pictures are actually his or her work. If you are looking for a cosmetic surgeon to perform a major procedure, such as breast augmentation or rhinoplasty, you want someone that is board certified in plastic surgery (not just surgery). It is also very helpful to find a plastic surgeon that has additional cosmetic surgery training, such as a cosmetic surgery fellowship.
Some non-plastic surgeons can perform limited cosmetic procedures ethically. A maxillofacial surgeon can perform rhinoplasty and a gynecologist can perform vaginoplasty. However, if either of these surgeons is looking to perform a breast augmentation, this is a red flag.
The degree to which you pursue this is up to your level of suspicion. Do you ask to see diplomas and certifications? Perhaps, if you feel the person’s word is not enough. There are also a growing number of online resources that display a physician’s credentials and if their practice and license is in good standing. Cosmetic surgery is a big deal—you should protect yourself from the occasional unethical person, even if that person is a physician and surgeon.