FEATURE

IN RESPONSE TO: and aesthetic medicine: specialties and specialists By Prof Andrew Burd

BY PIETRO PALMA, IMAN KHODAEI, IRINA VASILENKO

I read with great interest the article ENT surgeons perform , and do agree that many specialties are capable ‘Plastic surgery and aesthetic medicine: urologists treat hypospadias and other of performing aesthetic surgery, specialties and specialists’ by Professor urogenital reconstruction. When plastic and should be allowed to, there also has to Andrew Burd published in the Feb/Mar surgeons leave public service, they are be a governing body to regulate cosmetic issue of PMFA News. often still inexperienced in aesthetic surgery. Many maxillofacial and ENT surgery. Some attempt to be a part-time surgeons perform facial aesthetic surgery. Prof Burd brings up many valid points hospitalist and a part-time aesthetic Oculoplastic surgeons perform periorbital about the specialty of plastic surgery and surgeon. aesthetic work. Breast surgeons perform the future of the specialty with regards surgery and to specialisation in aesthetic medicine The truth being told is many aesthetic reduction mamaplasties. However, there and surgery not just in Hong Kong and and plastic surgeons do not learn their has to be a credentialing system in place. mainland China but around the globe. trade in the public hospitals. And when they decide to focus on private practice Speaking to many plastic surgeons As Prof Burd has pointed out very rightly, there is a discord of what is being taught and being in the specialty myself, completion of training in plastic and in surgical training and what they are market competition has driven many does not equate demanded of in private practice. However, plastic surgeons to be critical of that a practitioner has competency in many plastic surgeons are very intelligent other swpecialties. Many aesthetic aesthetic medicine / surgery. This is due and adaptable. Given their lengthy broad organisations have sprung up and offer to the emphasis of training in public based training and knowledge of anatomy ‘board certification’ in aesthetic medicine hospitals which is heavily slanted toward and surgical skill set; a significant number and even aesthetic surgery. These reconstructive surgery. Very few plastic successfully undertake aesthetic surgery organisations do provide quality teaching surgery units in the world actually offer with good results. and CME but we have to acknowledge hands on training under guidance for that they are also business and market- elective aesthetic surgery. Many plastic surgeons learn aesthetic driven. Some GPs and internists have surgery via several routes if their core taken short courses and suddenly become Prof Burd also comments on the residency programme has no significant ‘board certified in cosmetic surgery’ in monopoly within the specialty of plastic component of aesthetic surgery training. as little as three months having no basic surgery where some plastic surgeons are One is by partnering with a senior surgeon surgical training to begin with. Some really trying to give the impression that only experienced in aesthetic surgery who talented or ‘special’ (as Prof Burd terms it) those from the specialty are qualified to is also willing to show the ropes to the do good work and build a solid perform aesthetic surgery. This is indeed neophyte aesthetic surgeon. With intense aesthetic practice. But how can the public very true. competition in the marketplace, this be assured that all non traditional-route option is not always a viable one. The aesthetic surgeons are ‘special’? I do however believe that plastic and second route is to undertake a fellowship reconstructive surgery provides the best in aesthetic surgery, generally lasting Therein lies the dilemma – should the training background for any aspiring anywhere from three to 12 months, plastic surgeons ‘regulate’ the cosmetic aesthetic surgeon as the trainee will be where the trainee may learn the trade industry or would they be biased and self- exposed to a wide variety of subspecialties by assisting and rotating with different serving? Or should the industry be ‘self within the specialty and gain competency consultants. These fellowships, although regulated’? Are all ‘aesthetic surgeons’ in burns management, microsurgery, beneficial, do not offer hands-on operative created equal? , cleft and experience as the clientele are private craniofacial surgery,lower limb trauma paying patients. A third option is to attend Prof Burd’s article highlighted the cover and management, hand surgery as many congresses, workshops, courses wording of ‘crisis’ in Chinese characters and wound care. Plastic surgery is one as possible and to observe aesthetic – danger and opportunity; the very tenet of the last bastions of general surgery surgeons overseas before attempting to of yin and yang. Plastic surgery units where the practitioners are not con ned perform the cases oneself. The latter is can use this opportunity to implement to any particular anatomical area. But often how many older generation plastic formal aesthetic surgery training with this is also a double edged sword where surgeons obtained experience in aesthetic a core logbook of procedures within its the specialty has been encroached on by surgery. It is a trade secret that many a curriculum and not treat aesthetic surgery other specialties providing cross coverage. plastic surgeon will perform their first as a stepchild. Plastic surgeons have to For example, hand surgery is now on a private paying patient. remember that before attempting to predominantly orthopaedic based in many regulate other specialties within the realm parts of the world, breast surgeons elect The learning curve in aesthetic surgery of aesthetic medicine / surgery they first to undertake their own reconstruction, is steep regardless of what specialty one have to regulate themselves successfully. maxillofacial surgeons also provide comes from. The notion of 10,000 hours to cleft care and deal with facial trauma, achieve mastery holds true here. While I

pmfa news | APRIL/MAY 2015 | VOL 2 NO 4 | www.pmfanews.com