Plastic surgery and cosmetic surgery: it’s no wonder that so many people are confused about these terms, given the dramatic overlap between them. But there are important distinctions you must understand before scheduling a consultation.
Many people, professionals included, will throw around the terms plastic surgeon and cosmetic surgeon almost interchangeably. However, there is a subtle but important difference between the two, one that will help you choose the right professional for your next procedure.
We’ve taken the time to unpack these two terms and explain what it takes to become a professional in these fields.
A Matter of definitions
Plastic surgery and cosmetic surgery are most easily distinguished based on their core mission. After all, these disciplines encapsulate many of the same procedures. It’s how these procedures are applied and the goal of the professional applying them that most distinguishes one from the other.
The operative word here is “cosmetic.” Cosmetic surgery is all about improving one’s appearance. As the American Board of Cosmetic Surgery (ABCS) puts it, this type of surgery is focused on “symmetry, aesthetic appeal, [and] appealing proportions.”
Cosmetic surgery may include major surgeries, like tummy tucks and liposuction, or nonsurgical cosmetic treatments like injectable fillers or laser dermabrasion. Other examples include:
- Breast lifts, breast augmentations, and breast reductions
- Cheek implants
- Face lift and brow lift
- Butt lifts
- Some facials (like the vampire facial)
- Body contouring (like liposuction)
What confuses some is that plastic surgery covers cosmetic surgery and more. The American Board of Plastic Surgery (ABPS), not to be confused with the American Society of Plastic Surgeons (ASPS), defines plastic surgery as the “repair, reconstruction, or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk, external genitalia or cosmetic enhancement of these areas of the body.”
In other words, plastic surgery seeks to improve both appearance and function. It’s not only about creating your dream nose, it’s also about repairing your nose after a serious accident. In this way, plastic surgery is an overarching term that covers both cosmetic and reconstructive surgery. Some plastic surgery procedures that don’t fall under the purview of cosmetic surgery include:
- Hand surgery
- Skin grafting for burn scars and skin repair
- Surgeries on congenital defects, like cleft lip
- Gender reassignment
- Any kind of reconstruction of damaged parts of the body
Some surgeries are clearly either cosmetic or reconstructive. If you have a perfectly healthy and fully-functioning nose and you decide you want it to look smaller, then you’re getting cosmetic surgery. If your hand is badly damaged in an accident and you want to repair it for as much functionality as possible, you’re getting reconstructive surgery.
However, let’s say you are going for a breast reduction. You want it partly because you feel self-conscious about the size of your double Ds, and partly because they’re causing you back problems. Now the surgery is somewhere in the gray area between cosmetic and reconstructive. The same can generally be said for post mastectomy breast reconstruction or scar revision surgeries.
It’s no wonder that so many people are confused about these terms given the dramatic overlap between them. It’s safe to say that plastic surgery refers to all of these surgeries regardless of whether they are reconstructive or cosmetic.
It is important to note that while certain cosmetic procedures, like Botox injections, do not strictly need to be conducted by a plastic surgeon, certain reconstructive practices, like hand surgery, must be conducted by a trained plastic surgeon.
Plastic surgeon vs. cosmetic surgeon: what’s the difference?
Here is where things get particularly tricky. There seems to be two major schools of thought when it comes to cosmetic surgeons, their training, and their qualifications.
On the one hand, you have the American Board of Cosmetic Surgery (ABCS) suggesting that cosmetic surgeons may sometimes be more qualified to perform cosmetic surgeries than their plastic surgeon counterparts.
At the same time, there is also suspicion in the plastic and cosmetic surgery community regarding the qualifications of some who have “training” in a cosmetic surgery procedure. This has led some to suggest that plastic surgeons are a safer bet for patients.
According to the ABCS, plastic surgeons are trained surgeons who complete additional surgical training in a plastic surgery residency that exposes them to six essential categories.
- Hand surgery
- Reconstructive surgery
- Trauma surgery
- Congenital defect repair
- Cosmetic surgery
During this time, they are expected to work on 150 cosmetic surgery cases and pass a board exam in order to become a certified plastic surgeon with the American Board of Plastic Surgery (ABPS).
The ABCS states that, on the other hand, cosmetic surgeons who are certified through the ABCS must undergo residency training in a related field, such as plastic surgery, before receiving additional cosmetic surgery training. This is necessary due to the lack of cosmetic surgery specific residency programs in the United States. These cosmetic students must get training in the following essential categories.
- Tummy tuck
- Breast surgery
- Face surgery
- Other Cosmetic Surgeries
They must work on 300 cosmetic surgery cases, twice as many as your standard plastic surgeon, and pass a board exam in order to become a certified cosmetic surgeon through the American Board of Cosmetic Surgery.
By this logic, cosmetic surgeons are more specialized and, therefore, more skilled at relevant surgeries. However, not every doctor or clinician practicing cosmetic surgery procedures is a certified cosmetic surgeon, and therein lies the issue.
Weekend experts and lack of oversight
As it stands, many individuals can train for as long as one year or as little as one weekend with certain procedures. They then administer those procedures despite having little to no training in surgery.
This is how you get spas administering liposuction, and butt lifts by technicians who have no previous medical or plastic surgery training. These can be dangerous choices for individuals looking for certain surgical procedures at a manageable price.
Of course, the consequences aren’t always so severe. Licensed physicians may take courses in cosmetic surgery procedures and start calling themselves cosmetic surgeons. While they may not have the expertise of a certified plastic surgeon, they are at least medical professionals with some of the essential background knowledge to appropriately administer one of these procedures.
In short, a plastic surgeon is a trained surgeon. However, if someone calls themselves a cosmetic surgeon, you can’t be certain what you’re getting. They might know their stuff, or they might be shallowly trained with prices that are too good to be true.
Understanding board certification
Can’t the American Board of Cosmetic Surgery put a stop to these poorly trained cosmetic surgeons? Not exactly. They can only set standards for what it means to be a certified cosmetic surgeon and encourage prospective patients to seek out certified cosmetic surgeons. There’s little else they can do, especially since the American Board of Medical Specialties (ABMS) has yet to recognize them.
Let’s be clear about one thing: boards and their certifications hold weight because people and organizations believe they do. There is no legal entity appointing the ABMS as the sole judge of all medical specialty boards.
That being said, the ABMS does command respect, having gradually added medical specialty boards to its ranks since 1933. It officially recognized the American Board of Plastic Surgery (ABPS) back in 1941, but has yet to extend the same courtesy to the ABCS, possibly because it views plastic surgery as already encompassing cosmetic surgery.
More importantly, most hospitals look to respected and widely recognized medical boards to inform hiring decisions and other policies. In fact, many only allow hospital privileges regarding cosmetic procedures to board certified plastic surgeons. This means that if you go to a plastic surgeon’s private clinic and something goes wrong, they can admit you to a hospital to continue treatment.
Which should you choose?
With the difference between plastic and cosmetic surgeons outlined, it’s now time for the big question: which one do you need for your procedure? Clearly, you’d find it hard to go wrong with a certified plastic surgeon. However, there are undoubtedly some genuinely qualified and talented cosmetic surgeons around. How can you determine who would be the best fit for you?
If you’re looking to have plastic surgery done, particularly reconstructive surgery, then by all means, find a plastic surgeon. However, if you’re looking to have a cosmetic procedure done, your options are a tad more varied. Focus on the procedure and not on the title of your prospective surgeon. Check their credentials, specifically their experience conducting this particular procedure. Choose someone who is skilled in exactly what you want performed.
Above all else, don’t focus too much on the cost. When it comes to cosmetic surgery, shopping around for the best price may land you in the office of an under qualified surgeon. Accept that plastic surgery is expensive, and if you can afford it, don’t be afraid to pay a premium for the best results.