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Who is qualified to perform cosmetic procedures

The designation of "cosmetic surgeon," a title long controversial by definition, is stirring new debate since the California Senate recently approved a bill that would allow oral and maxillofacial surgeons to perform elective cosmetic surgery — previously the province strictly of medical doctors.


Dr. Fodor
Senate Bill 1336, approved 33-0 and now in the state Assembly, would allow hundreds of oral surgeons to perform rhinoplasties, facelifts and Botox injections after certification by a state board. The majority of oral surgeons in California do not have dual medical and dental degrees.

Who is qualified?

The controversial bill ignites what has become a debate of growing concern in cosmetic surgery: Who is qualified to perform elective aesthetic procedures?

Aesthetic practitioners offer mixed opinions on just who is qualified to perform cosmetic surgery in an era of increasing elective-medicine activity.

"Oral surgeons have trauma experience and are qualified to treat jaw-related injuries," says Peter Fodor, M.D., president of the American Society for Aesthetic Plastic Surgery (ASAPS). "Plastic surgeons have the medical and surgical training to remold, reshape and remodel the body from head to toe. They are artists of the body."

In response to the approval of the legislation, Dr. Fodor says, "The bill is not designed to benefit the public. Its sole rationale is to benefit a group of dental practitioners who seek to perform outside the scope of their training. At a time when the public is demanding stricter safety standards for patients undergoing surgical procedures, it is inconceivable that California would enact such a bill."

Patients expect home run According to James Carraway, M.D., a plastic surgeon in Virginia Beach, Va., training is critical, and cosmetic surgeons — regardless of their titles — must spend years honing their craft in order to keep patients happy with outcomes.

"Every patient wants a home run," Dr. Carraway told Cosmetic Surgery Times. "Not a double or a triple."

Training is what differentiates cosmetic surgeons, he says.

ASAPS raises the issue of scope of training versus scope of practice, reaching out to the public to keep patients in the hands of what it considers qualified surgeons.

Specifically, ASAPS urges:

  • Adoption of enforceable standards for physician education and training to perform cosmetic surgery, based on board certification in keeping with the American Board of Medical Specialties (ABMS). For example, certification by ABMS would indicate a surgeon's training in reconstructive and cosmetic plastic surgery of the face and the entire body.
  • Prohibition of dentists from performing cosmetic procedures that are clearly medical in nature and not within the scope of dental practice.
  • Prohibition of advertising that threatens patient safety by misrepresenting practitioners.

Dr. Fodor says the certification of physicians and the accreditation of the facilities in which they operate are key to patient safety. Accredited hospitals require surgeons to be certified by the American Board of Plastic Surgery to perform most types of cosmetic procedures.

However, any state-licensed medical doctor — even without formal surgical training or certification — can legally perform the same procedures in an unaccredited surgi-center or office-based surgical facility, according to ASAPS.

According to ASAPS, it is difficult for patients to understand the complexity of the credentialing process and myriad certifying boards around the country — some created independently and not recognized by mainstream medicine.

However, the Federal Restraint of Trade Act clearly spells out that competition cannot be suppressed, even when training is an issue.

"It's a powerful federal law," Dr. Carraway says. "And the Legislature is approving this and going along with it."

According to some cosmetic surgeons, S.B. 1336 simply underscores a reality of aesthetic practice — that board-certified plastics surgeons aren't the only ones qualified to perform procedures.


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