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Face-off: Specialists split over oral surgery ruling "No single specialty owns the face."

Article-Face-off: Specialists split over oral surgery ruling "No single specialty owns the face."

Dr. Niamtu
Multiple specialties perform safe and effective cosmetic facial surgery. Plastic surgeons, otolaryngologists, oral and maxillofacial surgeons, dermatologists, ophthalmologists, oculoplastic surgeons and various other specialists have all demonstrated competence in this area. These disciplines have added to the cumulative knowledge and skills needed to perform cosmetic facial surgery.

No single specialty "owns the face." Yet, the public, in seeking care, is often confused. They may believe that general dentists — instead of board-certified oral and maxillofacial surgeons — are performing facelifts. They may believe that oral and maxillofacial surgeons only receive training in "dental" surgery. This misinformation is exasperated by a turf battle among specialties due to fear of competition rather than concern for patient safety. There exists no evidence that one specialty has better outcomes or fewer complications.

After dental school, all oral and maxillofacial surgeons perform a four- to six-year hospital-based surgical residency in which rotations are performed alongside, and at the same level, of physician peers. General surgery, medicine, medical ER, surgical ER, anesthesia and pathology are included in these rotations, which also may include neurosurgery, ENT, plastic surgery, and others. Most training institutions split facial trauma call among oral and maxillofacial surgery, plastic surgery and ENT. Cosmetic facial surgery is taught in our residency programs, is part of our boards, it is a section in our Parameters of Care and Clinical Pathways and is covered by our malpractice insurance. In short, it is a component of contemporary oral and maxillofacial surgery.

Oral and maxillofacial surgeons have always performed procedures that were medical and dental in nature. All board-certified oral and maxillofacial surgeons in my city have privileges at eight local hospitals which include history and physical privileges, ICU admission privileges, privileges to harvest hip and skin grafts for facial reconstruction and privileges to treat complex facial fractures including the orbit.

Currently, 50 percent of oral and maxillofacial surgeons finishing residency will have both a dental and medical degree. I am a proponent of the dual-degree system, but there exist thousands of competent, excellently trained oral and maxillofacial surgeons who do not possess a medical degree.

Sixteen states have so far successfully updated their dental practice acts to reflect the contemporary scope of oral and maxillofacial surgery. Competitive naysayers can cloud the issue, but when the public and the legislators elected to represent them examine the issue, victory has followed my specialty more often than not. In many states, any person with an M.D. degree and a medical license can legally perform cosmetic facial surgery. By this logic, any pediatrician or psychiatrist could legally perform a facelift, but a board-certified oral and maxillofacial surgeon with four to six years of hospital-based medical and surgical training cannot perform these procedures? Something is wrong with this picture, this logic and this antiquated legislation.

A good, general rule for all of us is to withhold judgment about the qualifications of any specialty until we fully appreciate how they train and what they do.

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