Q: Dr. Eppley, I am confused about the distinction between different doctors who perform cosmetic surgery/medicine. I know plastic surgeons have historically performed cosmetic surgery but today it seems many different types of doctors do it. How is it legal that so many doctors do it even though their training and specialties are obviously different. This same situation doesn’t exist, for example, in heart surgery so why is it so for cosmetic surgery?
A: Your confusion is understandable and the rise of some many different doctors with widely discrepant cosmetic procedure training is fueled by many factors. The most significant contributing element is its fee for service basis, making it lie outside the boundaries of insurance-reimbursed medicine where the controls are much more rigid due to hospital and federal regulations. While cosmetic surgery is not new, the number of available treatment options has exploded in the past two decades and the law has yet to catch up with these medical procedures that continue to rapidly evolve and expand. That being said, future changes may be in the offing. I have just read that Puerto Rico last year passed a law that restricted the practice of cosmetic procedures to those doctors who are board-certified in either plastic surgery or dermatology. This precedent law was based on the desire for improved patient safety. In essence, base training in the rudiments of the medical procedures should make for better outcomes and lower complication rates. While such a law may be easier to pass and enforce on an island with a small population, it is not clear what impact this will have if any on any other state. Hopefully someday we will have better definition as to what constitutes adequate training to perform the various cosmetic procedures. Unfortunately, this will undoubtably be created by the law and not by any group of doctors or medical governing body
Dr. Barry Eppley