Plastic Surgeon or Cosmetic Surgeon—What’s the Difference anyway?
You’re not alone if you’re confused what’s the difference between a Plastic Surgeon and a Cosmetic Surgeon or Cosmetic vs Plastic Surgery. Often, the terms are used interchangeably, especially by plastic surgeons who choose to focus their practices on cosmetic surgery. Due to falling reimbursements, there are also many doctors and non-surgeons in unrelated fields claiming to be cosmetic surgeons. This can be misleading and has led to some confusion in public perception. Even doctors in other medical fields can’t distinguish the difference. This is due to the fact that there are many conflicting descriptions in the media and by surgeons themselves with respect to the two. Cosmetic surgery and plastic surgery both deal with surgical alteration of the human body. The fields are therefore closely related, but not the same.
1. Cosmetic Surgery & Plastic Surgery differ in their objectives.
While both cosmetic surgery and plastic surgery deal with alteration to the human body, the ultimate goals may differ and thus the guiding principles with regard to training, research, and emphasis of procedures may differ.
Cosmetic Surgery: Focused on Enhancing Appearance Aesthetically
The procedures, techniques, and principles of cosmetic surgery are entirely focused on enhancing a patient’s appearance. Improving aesthetic appeal, symmetry, and proportion are the key goals. Cosmetic surgery can be performed on all areas of the head, neck, and body. Because the treated areas function properly, cosmetic surgery is elective. Cosmetic surgery is practiced by doctors from a variety of medical fields, including some plastic surgeons.
Examples of cosmetic surgery procedures include:
-Facelift, Rhinoplasty, Blepharoplasty, Breast Augmentation, Tummy Tuck, Liposuction, Fat Transfers
Plastic surgery on the other hand is defined as a surgical specialty dedicated to reconstruction of facial and body defects due to birth disorders, trauma, burns, and disease. Plastic surgery is reconstructive in nature as it is primarily concerned with restoring function while maximizing form secondarily. Although many of the surgical principles in regard to maximizing aesthetic appearance of the final result are the same, plastic surgery’s primary objective is to restore the underlying function of the body part whether it be mobility, bodily function, or protective tissue coverage. In 1999, the American Society of Plastic and Reconstructive Surgeons changed its name to the American Society of Plastic Surgeons to more strongly communicate the message that “plastic and reconstructive surgeons are one in the same.”¹
Some examples of plastic surgery procedures:
Breast reconstruction after mastectomy, cleft-lip repair, hand surgery and finger re-plantations, scar revisions, scar and skin graft surgery for burns, skin flaps for tissue defects.
2. Cosmetic Surgery and Plastic Surgery differ in their training.
The training required to become a board-certified plastic surgeon is distinctly different than the training to become a board-certified cosmetic surgeon. Since the scope and type of procedures performed by each are different, it’s logical that each specialty undergoes a different training and certification.
Plastic surgery training is completed through a post-graduate or combined residency program
To make things even more confusing, there are two tracks to becoming a plastic surgeon. Some complete an entire 5 years of general or otolaryngology surgery training plus an additional 2-3 years of post-graduate training in plastic surgery. Another path to plastic surgery is a “combined” program in which surgeons complete 3 years of general surgery training followed by 3 years of plastic surgery training. The commonality between the two is that a large portion of the training is dedicated to general surgery or otolaryngology (3-5 years) followed by a period (2-3 years) in which a plastic surgeon must master all aspects of reconstructive surgery including craniofacial surgery, hand surgery, burn surgery, microsurgery, and some cosmetic surgery. In total, only a very small portion of a plastic surgeon’s training (a few months over 6-7 years) is dedicated to training in cosmetic surgery and not all cosmetic surgical procedures are taught. It is for this reason that many plastic surgeons choose to undergo additional fellowships or apprenticeships in cosmetic surgery in order to be comfortable and proficient at cosmetic procedures specifically.
Therefore the title “board certified plastic surgeon” indicates a certain level training and experience with respect to plastic surgery and the vast scope of procedures that are required in their training. Because the scope of training is so broad, the actual number of cosmetic surgical procedures required to graduate a plastic surgery program may actually be very few (see chart above) Furthermore, this certification does not require experience or exposure to many common cosmetic procedures.² Certification only denotes that the surgeon has been exposed to at least the minimum number to qualifying cases in the field, and in regard to cosmetic surgery cases, that minimum number varies greatly between plastic surgery and cosmetic surgery.
Currently, there are no ABMS residency programs in the United States devoted exclusively to cosmetic surgery. Because of this, cosmetic surgeons primarily obtain training and experience after completing their residency training. This is done by completing a post-residency fellowship.
Board certified cosmetic surgeons are residency-trained and certified in a primary surgical specialty and then fellowship-trained specifically for cosmetic surgery.
When it pertains to cosmetic surgery, the training, experience, and knowledge required to become a board certified cosmetic surgeon reflects specialization in cosmetic surgical procedures above and beyond what is required in plastic surgery. Each surgeon who is board certified by the American Board of Cosmetic Surgery has completed a 1 or 2 year fellowship training dedicated to cosmetic surgery alone. During this fellowship, surgeons receive thorough training in all cosmetic surgery procedures of the face, breast, and body, plus non-surgical cosmetic treatments, performing a minimum of 300 individual cosmetic surgery procedures. This fellowship training is in addition to completing a 5-6 year residency program in a related discipline like general surgery ,otolaryngology, oral-maxillofacial surgery, or plastic surgery.
Board-certified plastic surgeons may be very skilled and qualified to perform cosmetic surgery and may be the most experienced in those procedures in your area. However, it is important to understand that this is not always the case. If you look at requirements and training to perform a cosmetic procedure, plastic surgery certification doesn’t always equate more proficiency compared to a dedicated board-certified cosmetic surgeon. That is why some board-certified plastic surgeons seek to also become board-certified cosmetic surgeons.
Because any licensed physician can legally perform cosmetic surgery, regardless of how they received cosmetic surgery training, it is extremely important to do your research when choosing a cosmetic surgeon. In the end, the title doesn’t matter if the surgeon can’t perform a procedure safely and proficiently and this goes back to adequate training. To find the most qualified doctor for a specific cosmetic procedure, you must compare doctors’ overall (residency and post-residency) training, experience, and proven competence with respect to that specific cosmetic procedure. A plastic surgeon may not always be the most well-trained surgeon when it comes t a given cosmetic procedure, just as a cosmetic surgeon may not be the best surgeon to perform a reconstructive procedure. Also remember that many doctors claiming to be cosmetic surgeons aren’t certified surgeons at all. This is why doing your research and asking the right questions are paramount.
² Morrison, M.Sc., Colin, A Survey of Cosmetic Surgery Training in Plastic Surgery Programs in the United States, Plastic and Reconstructive Surgery – Journal of the American Society of Plastic Surgeons, pp.1570-1578, 2008.