Is there a difference between a Plastic Surgeon, an Aesthetic Surgeon and a Cosmetic Surgeon?
Aesthetic surgery is surgery to rejuvenate someone’s appearance – to make them resemble their younger self or improve some aspect of their appearance that they dislike enough for it to affect their self-confidence and happiness -something essentially “normal” but improvable. Aesthetic surgery and cosmetic surgery can be used interchangeably when the terms are describing the range of procedures included in this area of surgery – and you’ll see me use both terms in this site, partly because most lay people are more familiar with the term cosmetic surgery. The techniques used by surgeons in these procedures are all techniques that have been developed by Plastic Surgeons and used in the reconstructive aspects of plastic surgery.
In New Zealand, “Plastic Surgeon” is a protected title – only someone who has trained and passed a specialist exam and who is vocational registered can use it. Anyone who isn’t able to call themselves a plastic surgeon, but who wants to earn money by doing those procedures that fall within the ambit of Aesthetic Surgery is stuck with having to call themselves a cosmetic surgeon, which is not a protected title and can be used by any qualified and registered doctor – a GP, a psychiatrist, a dermatologist could all, in theory, call themselves a cosmetic surgeon and advertise for business with no further training in surgery after medical school.
Any doctor in New Zealand with a basic medical degree and current registration with the Medical Council of New Zealand (MCNZ) is allowed to call themselves a cosmetic surgeon and perform cosmetic surgery. Compare this with a Specialist Plastic Surgeon who trained in the Australasian training scheme to gain the Fellowship of the Royal Australasian College of Surgeons (FRACS) has undertaken 8-12 years of specialist surgical training beyond their basic medical training and has passed a qualifying exam. Similarly, in the UK, I spent 14 years of specialist surgical training beyond my basic medical training, plus a further 4 years of research to gain a PhD, and passed the FRCS (Plast) exam (which the RACS and the MCNZ deem equivalent to FRACS with no need for extra training to be vocationally registered here as specialist). I also past the equivalent exam to accredited through Europe. During my specialist training in Plastic Surgery, I spent time on an Aesthetic Fellowship in Britain attached to 4 Consultant Aesthetic Surgeons, one of whom was the President of the British Association of Aesthetic Plastic Surgeons, and after that, I travelled to Dallas and spent time a further period of time with 4 surgeons there. After that I was elected to the British Association of Aesthetic Plastic Surgeons and the American Society for Aesthetic plastic Surgery. Most Specialist Plastic Surgeons in New Zealand will be able to point to similar experience before they took up specialist posts and started private Aesthetic Surgery practice. Before you embark of cosmetic surgery, find out how qualified your surgeon is and what their training and experience has been.
Any doctor in New Zealand with a basic medical degree and current registration with the Medical Council of New Zealand (MCNZ) is allowed to call themselves a cosmetic surgeon and perform cosmetic surgery. Compare this with a Specialist Plastic Surgeon who trained in the Australasian training scheme to gain the Fellowship of the Royal Australasian College of Surgeons (FRACS) has undertaken 8-12 years of specialist surgical training beyond their basic medical training and has passed a qualifying exam. Similarly, in the UK, I spent 14 years of specialist surgical training beyond my basic medical training, plus a further 4 years of research to gain a PhD, and passed the FRCS (Plast) exam (which the RACS and the MCNZ deem equivalent to FRACS with no need for extra training to be vocationally registered here as specialist). I also past the equivalent exam to accredited through Europe.
During my specialist training in Plastic Surgery, I spent time on an Aesthetic Fellowship in Britain attached to 4 Consultant Aesthetic Surgeons, one of whom was the President of the British Association of Aesthetic Plastic Surgeons, and after that, I travelled to Dallas and spent time a further period of time with 4 surgeons there. After that I was elected to the British Association of Aesthetic Plastic Surgeons and the American Society for Aesthetic plastic Surgery. Most Specialist Plastic Surgeons in New Zealand will be able to point to similar experience before they took up specialist posts and started private Aesthetic Surgery practice. Before you embark of cosmetic surgery, find out how qualified your surgeon is and what their training and experience has been.
In the next section I suggest some questions you should ask of any surgeon you are considering choosing to operate on you for cosmetic/ aesthetic surgery. Uppermost in my my mind would be: If you aren’t a trained and vocationally registered plastic surgeon, why not? Couldn’t you be bothered? Didn’t you want to invest that decade or more in training to become an expert in your field? Did you not make the cut and win a place on training scheme?
What questions should I be asking when I choose a surgeon for aesthetic/ cosmetic surgery?
Whether or not to embark on cosmetic treatment is a big decision, with far reaching implications. Some bad cosmetic surgery results cannot be corrected. Divorce from a bad cosmetic surgeon and their handiwork will undoubtedly still leave you scars, so choosing your cosmetic surgeon in the first place is not a step to be taken lightly or unadvisedly!
Worldwide, the cosmetic surgery and services market is worth NZ$41 billion. Human nature being what it is, it is sadly not surprising to find that the “untrained” try and mix in with the “professional” in an attempt to cream off some of that money. Unfortunately, there is little protection for the public from unscrupulous practitioners so the burden falls on you to research and protect yourself. In the USA, people discuss their cosmetic surgery openly and GPs know a great deal about what is current and to whom they can refer patients – indeed many of them will have had cosmetic surgery themselves! Here in the NZ, we are still somewhat puritanical about our looks and cosmetic surgery is a less acceptable topic for discussion – still less, one favoured by over-worked, target-ruled GPs for a 6-minute consultation. So what can you do?
First establish that your prospective surgeon is on the Medical Council of New Zealand’s Vocational Register for Plastic and Reconstructive Surgery – this really is an absolute minimum, if they are not on the register, you can be sure that they have not completed a recognised training in Plastic Surgery.
Secondly, ensure you see your surgeon at least 2 weeks before your scheduled surgery and as many times after your first consultation as you (and your surgeon) require to be satisfied that you are making a reasoned, well-informed and correct choice.
Third, ask about the surgeon’s experience and training. You have all the information you need detailed above.
Fourth, ask about follow up arrangements and the surgeon’s availability. How will they make themselves available if you have a problem post-operatively? Be even warier of flying abroad for surgery, unless you can be sure of your surgeon’s abilities and that you will never have a complication – unless you can afford (and guarantee to be fit enough) to fly back, or stay there for months afterwards in case of problems.
Fifth, find out what would happen if you have a surgical complication? A surgeon who claims not to have complications is a liar. Even the best aesthetic surgeon occasionally has unsatisfactory results, despite having taken steps to minimise them (training, appropriate planning and patient selection). If such a result occurs after your surgery, you will be interested in knowing what steps the surgeon will take to deal with them when they do occur – so find out beforehand. Reputable surgeons re-operate free of charge for their time for a result they consider suboptimal.
Sixth, if you are shown photographs, ask whether they are unaltered photographs of the surgeon’s own patients. Beware of different lighting, exposure, positioning and make-up in pre- and post-operative pictures. Not all surgeons show photographs. That’s not necessarily a bad thing if they believe that some patients can be misled by them, or if the patients on whom they have operated previously have declined to let their photos be used so as to protect their privacy – many patients are delighted with their results, but want them kept private!
Seventh, expect to be given literature on the treatment being proposed. If a surgeon has taken time to write and produce reasoned, evidence-based literature that is tailored to their own patients and practice, that implies a great deal about the care he will give you, in comparison with a surgeon who dishes out mass produced leaflets from a professional organisation they are a member of, or worse – none at all. If your surgeon has a web site, look at the quality and breadth of information available there. I have give out extra information after consultations, but this site has been written by me with extensive detail. It is evidence-based and referenced to demonstrate that. I make it available to everyone in this way, not just my patients.
Finally, beware big advertising campaigns. Most reputable surgeons have web sites and advertise in directories and magazines. They pass on these costs to their patients by calculating their fees to cover their overheads, which will also include paying for consulting rooms and excellent staff. If you purchase your cosmetic treatment from a business that advertises nationally, pays banks of call centre telephonists, sales coordinators and salaried practitioners, think how much more their overheads are and how much profit they will require on top.
If you have a choice, why would you not choose a plastic surgeon?
