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Regional Maxillofacial Unit
Southern General Hospital
1345 Govan Road
G51 4TF

Re: Cosmetic competency: OMS’s need full aesthetic facial training to be safe practitioners. Dr S Bresnick, Aug. 2007

Dear Sir/madam,

We read with interest the comments of Dr Bresnick in response to Dr Niamtu’s previous article.

He states that there is a “big difference between exodontia and facelifting” and therefore it may not be in the public interest for oral surgeons to be let “loose” on the public without a full aesthetic fellowship. In fact we do not in principle disagree with this philosophy but would rather extend it to say that there is a big difference between breast implant surgery and facelifting. So would Dr Bresnick think that his plastic surgery colleagues should steer clear of facial aesthetic surgery if they also perform breast augmentation?

He is certainly correct in expressing his misgivings about singly dentally qualified “surgeons” performing facial aesthetic surgery (and in suggesting that dual qualification is an asset) but we would also extend these misgivings to singly medically qualified surgeons. The soft tissues of the face require an underlying bony skeleton upon which they are draped. An inadequate understanding of this (and indeed how it may be manipulated surgically) in our view renders a surgeon compromised in terms of what level of competence he/she may be expected to achieve in facial surgery.

We believe that the model of training in the United Kingdom provides the best solution. Oral and maxillofacial surgery is a medical specialty with surgeons trained to the same standards of general surgery as with all of our surgical colleagues. We would also suggest that technical ability is not the most important factor in surgical success; rather an ability to fully assess and diagnose abnormality (and normality) as well as the training to care for the patient perioperatively. (It is in this final respect that a single dental qualification comes up short in our view>)

Finally, Dr Bresnick states “…the real reason that oral surgeons want to perform cosmetic surgery- the pursuit of money.” We believe this to be entirely disingenuous, unless of course Dr Bresnick and his singly medically qualified colleagues in plastic surgery are available for facial aesthetic surgery completely free of charge.

We suspect that the views expressed may be rooted in the pursuit of money (or at least the pursuit of restricting who else may make the money).

I hope you will welcome these (slightly different) views from across the Atlantic.

Yours truly,

Mr Mark F Devlin

Consultant Cleft Lip and Palate Surgeon
Consultant Oral and Maxillofacial Surgeon
Facial Aesthetic Surgeon
Mr J Jeff Downie
Consultant Oral and Maxillofacial Surgeon
Facial Aesthetic Surgeon

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