• Where does the name "plastic surgery" come from?
• When is an operation considered "plastic surgery?"
• Exactly who is a plastic surgeon?
• What qualifications should I look for in a plastic surgeon?
• What is the difference between reconstructive plastic surgery and cosmetic plastic surgery?
• What is the difference between cosmetic surgery and aesthetic surgery?
• What does cosmetic surgery cost?

The name derives from the Greek word "plastikos" and the related Latin word "plasticus" which mean to shape or mold. The term first came into common usage for describing a surgical procedure in the mid 1800's when it was applied to rhinoplasty, sometimes referred to as a "nose job." The term plastic surgery was therefore in use long before chemical plastics came into existence, and has only a chance association with the plastic implants we sometimes use.

Plastic surgery encompasses such a broad range of procedures and crosses into some many other surgical specialty areas that there is no simple way of describing what is a plastic surgical procedure, except to say that any operation performed by a plastic surgeon is, in fact, plastic surgery. Other surgical specialists use plastic surgical techniques from time to time, but to be plastic surgery a procedure must be done by a plastic surgeon.

Plastic surgeons should have first completed a residency in plastic surgery approved by the Plastic Surgery Residency Review Board of the American Board of Plastic Surgery. There are eighty such programs currently in existence the United States and Canada. Residencies typically last two years and require from three to five years of surgical training following medical school and before beginning plastic surgical training. Approximately two years after completing residency, an aspiring plastic surgeon is allowed to take a very difficult day long written examination and if he passes can then at a later time take an oral examination. Once he has completed these two exams to the satisfaction of a group of twenty one senior scholars in plastic surgery from around the country, he is officially "board certified" by the American Board of Plastic Surgery, the only specialty board in plastic surgery recognized by the American Board of Medical Specialties. Because of the rigors required in qualifying for and passing the examination of the American Board of Plastic Surgery, many bogus boards have appeared which have virtually no requirements except the paying of a fee, for example the American Board of Cosmetic Surgery. This board and others like it have no credibility in mainstream medicine.

It also happens occasionally that a surgeon certified by a board recognized by the American Board of Medical Specialties, such as the American Board of Otolaryngology, American Board of Oral Surgery, or the American Board of Obstetrics and Gynecology will mention in advertising that he is a plastic surgeon and additionally board certified. The only board certification that qualifies one as a plastic surgeon is the American Board of Plastic Surgery. Prudent patients must be very specific in their questions to be certain that the surgeon they are consulting was indeed examined by the proper board to be considered a fully trained and certified plastic surgeon.

It may be surprising to learn that there is no legal governmental restriction placed on who may call themselves a plastic surgeon. In the State of Utah the license that a brand new medical school graduate receives before he has taken an internship or residency says that he is "licensed to practice medicine and surgery in all of its branches." There are certainly moral reasons not to claim specialty training and expertise that one does not have, but there are no legal reasons. A patient has reason to be cautious.

It is very reasonable to ask any physician you are seeing where he when to medical school. Is it a school that you have heard of? Also ask about where residency training was obtained and how long the training was. Most residencies are attached to large and well known medical schools and medical centers. Next, and most important, is the physician certified by the American Board of Plastic Surgery? He may also be certified by other boards recognized by the American Board of Medical Specialties. Each of these boards are as difficult to pass as the American Board of Plastic Surgery, and this extra training adds depth and experience to the surgeonís qualifications. Fellowships are periods of concentrated training in a smaller area of a speciality after residency is completed. Most fellowships last from six months to a year. Fellowships also add depth. Common areas in which to take a fellowship after plastic surgery residency are burns, hand surgery, microsurgery, cancer surgery, maxillofacial and craniofacial surgery. Ask about membership in national organizations. One of the principal benefits of society membership is continuing education. The premier organization in plastic surgery is the American Society of Plastic and Reconstructive Surgeons. Greater than ninety-five percent of all board certified plastic surgeons are members of this organization and attend a week long meeting each year where new ideas and approaches are discussed. For the convenience of members the American Society of Plastic and Reconstructive Surgeons sponsors regional societies which can have more frequent meetings. The Rocky Mountain Association of Plastic and Reconstructive Surgeons and the Utah State Plastic Surgery Society are two of these.

The line between cosmetic and reconstructive is disconcertingly hazy. A cleft lip deformity where from birth a patient has a misshapen and incomplete upper lip does not alter life expectancy, but is universally covered by insurance and is considered reconstructive. Prominent ears that stick straight out from the side of the head may subject a child to merciless ridicule and emotional trauma, but are seldom covered. The definition also changes from time to time. Several years ago insurance companies determined that breast reconstruction after mastectomy for cancer was unnecessary and cosmetic in nature. The United States congress became involved and now breast reconstruction is mandated by law. All insurances must now cover this very beneficial surgery. An experienced plastic surgeon knows the common practice of various insurance carriers and within a community and can advise you of the probable outcome of a prior approval request.

None, except for how fancy the name sounds! Even the cost is the same!

There are several components and several variables that determine the cost of a cosmetic surgical procedure. For convenience our office does quote prices for certain standard cosmetic procedures, such as face lift or breast enlargement, but in an individual case the actual fee can be slightly different from this figure. It is important to understand why these differences arise. The first component of the surgical cost is the surgeon's fee. In a standard procedure a certain number of steps are involved in performing the surgery. If all of these steps are appropriate in an individual person's case and no additional steps are needed, then the standard fee will be in effect. However in some cases not all of the steps are necessary and the fee will be less. For instance in the eye lid surgery to remove excess skin and fatty tissue to make the eye lids look younger (blepharoplasty) it is usual to operate on both upper and lower eye lids. However in some cases only the upper or lower eye lids require surgery, in which case the surgical fee will be less. It turns out the surgery for the lower eye lid is more complicated than the surgery for the upper lid, so that the fee for just upper lid blepharoplasty is less than the fee for just lower lid surgery. In another case it may be preferable to not only perform blepharoplasty but also reposition the eyebrows to restore the normal youthful position of the brow. This surgery influences how the upper lid blepharoplasty is done and so must be done before the upper lid blepharoplasty though a different incision. If the two procedures are done together, there is an additional fee for the extra surgery. Very rarely is exactly the same surgery done for two different patients. Each surgery is individualized for each patient depending on their particular needs and desires. The final determiner of what surgery is done is always the patient, based on the choices presented by and recommendations of the surgeon. Minor variations in a procedure do not require an additional charge, but major variations involving the additional of a totally different procedure incur an extra charge.

In addition to the surgeon's fee, there is a fee for the facility where the procedure is done. This usually is determined by how long the procedure is expected to last. As you would quess, short operations are less and long operations more. There is a separated charge for implanted materials and post operative garments. A common example is breast augmentation. Not all implants cost the same with some more expensive implants having favorable characteristics that make them more desirable in certain circumstances. The patient and surgeon usually decide together which implants to choose.

The fourth factor in determining the cost of surgery is whether the services of an anesthesiologist or nurse anesthetist is required and for how long. If the procedure can be done under local anesthesia with no sedation, there is no charge.

In some cases we can determine the costs of all components of the surgery exactly before hand and in some cases we can only estimate them, but you will always know in advance which situation applies and how close the estimate is likely to be, i.e. the likely range of charges.

Be certain you take the time to get all of your questions answered about how the cost of surgery is determined and all of the factors that when into the determination. You will be given a written summary of the estimate before surgery.