Why a "board-certified cosmetic surgeon" isn't a plastic surgeon, and what that means for you

Cosmetic surgery is not just another way of saying plastic surgery. Doctors who advertise themselves as certified by the American Board of Cosmetic Surgery (ABCS) don't measure up to meet the criteria required for board-certified plastic surgeons.

In a study published in the November issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS), Brian C. Drolet, MD, of Vanderbilt University Medical Center, Nashville, Tenn., and colleagues reviewed online information to assess residency training history and advertised scope of practice for 342 ABCS-certified physicians. "Our review of ABCS diplomate training backgrounds revealed nearly ten percent of ABCS members were not even trained in a surgical discipline," the researchers write.

According to the study, over half (62.6%) of ABCS diplomates advertised surgical operations beyond the scope of their ACGME or CODA residency training. Specialties with the highest prevalence of practicing beyond scope of training were internal medicine (n=2, 100%), general surgery (n=69, 95.8%), obstetrics and gynecology (n=17, 85%), otolaryngology (n=65, 59.1%), dermatology (n=16, 51.6%), and oral and maxillofacial surgery (n=30, 50%).

The most commonly offered out of training scope procedures were liposuction (59.6%), abdominoplasty (50.0%), breast augmentation (49.7%) and buttock augmentation (36.5%).

Procedures considered "out of scope" by specialty:

• Otolaryngology—Aesthetic surgery below the neck (e.g. breast augmentation, abdominal liposuction, abdominoplasty, buttock augmentation)
• Ophthalmology—Aesthetic surgery outside of periorbital region (e.g. rhinoplasty, full face lift, neck lift)
• OB/GYN—Any aesthetic surgery
• General Surgery—Any aesthetic surgery
• Dermatology—Surgical procedures not including Mohs surgery or skin lesion
• OMFS—Any aesthetic surgery below the neck
• Internal Medicine—Any surgical procedure

"When selecting an aesthetic surgeon, many patients place trust in knowing their surgeon is a 'board-certified' plastic surgeon," Dr. Drolet and coauthors write. "Many patients falsely assume all surgeons must be board-certified in plastic surgery in order to perform cosmetic procedures."

As the authors write, the unregulated growth of the aesthetic marketplace may make it difficult for patients to find a qualified cosmetic surgeon. Misleading marketing and overtly false advertising are widespread in many large markets. One metric commonly used to select a qualified surgeon is board-certification; however, that distinction has become obfuscated, blurring the lines for patients.

A board-certified plastic surgeon must have at least six years of surgical training, including completion of an accredited plastic surgery training program. They must perform thousands of cosmetic and reconstructive surgery procedures of different types, pass rigorous written and oral examinations, and commit to continuing education and assessment throughout their careers.

However, an ABCS-diplomat is asked to complete only one year of surgical training, experience 300 procedures, and one written and oral examination completed during a single weekend, with no continuing medical education requirements.

These differences are so pronounced that in 2018 the Medical Board of California concluded ABCS certification is not equivalent to ABMS Board Certification, and that ABCS diplomates cannot advertise themselves as "board-certified."

The high demand for cosmetic surgery—1.8 million procedures performed in 2019, according to ASPS statistics—underscores the need for regulation and education to help patients make informed decisions. ASPS offers patients tips on how to select a board-certified plastic surgeon.