Richard A. Baxter, M.D.

The Art Behind Plastic Surgery

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Apr 13

Dr. Baxter

Cosmetic surgery, plastic surgery, aesthetic surgery: Who is most qualified?

Posted by Dr. Baxter

A couple of weeks ago I did an Instagram takeover for a day for the American Society for Aesthetic Plastic Surgery (ASAPS) and it got me thinking about how I would explain what “aesthetic surgery” means. Is there a difference between cosmetic plastic surgery and aesthetic plastic surgery, and does it matter? I believe the answer is yes, and here’s why:

As plastic surgery becomes increasingly popular, it seems everyone wants to be a plastic surgeon. Because medical licensure does not specify what procedures a doctor is qualified to do, it is proper in a legal sense for any doctor to call himself or herself a plastic surgeon, a cosmetic surgeon, or even a brain surgeon for that matter. It is driven to some extent my economics: Elective plastic surgery is a cash business, so it is natural that doctors of various backgrounds would want a slice of the pie in an era of declining insurance reimbursements and less time for actual patient care. The result is an array of confusing claims about board certifications, questionable qualifications, and bogus bona fides. I wish I could explain it by simply saying that people considering plastic surgery should see a board-certified plastic surgeon, but it’s not so cut and dried.

Why aesthetic plastic surgery was not always as accepted as it is today

Broadly defined, plastic surgery encompasses both reconstructive procedures and elective alterations and enhancements. In the U.S., the American Board of Plastic Surgery (ABPS) is the original and most widely recognized standard, requiring accredited residency training and stringent examinations. Time was that this was never in question, with every specialty having its respective board; you need a tumor removed from your brain, you see a surgeon board certified in neurosurgery. Elective plastic surgery was not really a thing in the beginning, but a little more than 50 years ago a group of visionary plastic surgeons got together and decided that there was more to it than reconstructive. Operations to improve one’s appearance were being developed, but that side of plastic surgery was not well respected. To a large extent it was hush-hush, back room stuff. It has now become so mainstream that many forget that it used to be all about reconstruction. This group formed ASAPS, and I think it was right that they called it “aesthetic” surgery because aesthetics is the study of beauty.

The word “cosmetics” on the other hand seems more about concealment. It implies a more superficial approach, and that may be a reason why the term “cosmetic surgery” is so often associated with vanity. The ASAPS founders wanted to bring their full set of reconstructive surgery skills to bear on this relatively new subspecialty, aligning with a more comprehensive understanding of beauty. But it would be a while before plastic surgeons embraced it, some even scorning the notion of dedicating so many years of training in surgery for what they considered selling out. Aesthetic surgery became the poor stepchild.

So for others wanting in, the terms “plastic surgeon” and “aesthetic surgeon” were taken unless you wanted to go for the full 6+ years of intensive surgical residency after medical school. “Cosmetic surgery” was available however, and plastic surgeons were not all that interested. So an enterprising group decided to just form their own board. The American Board of Medical Specialties, the umbrella organization for all of the recognized specialties, wouldn’t have it though; they pointed out that this was still plastic surgery, and there was already a board for that. Truth be told, there are great surgeons of all stripes, but for my money I would go to an ASAPS member for anything elective. That way you know they are certified by the ABPS and have a special focus on aesthetics.

My ASAPS Instagram takeover was so much fun!

The Instagram takeover was a hoot. The idea was to portray a day in the life of a plastic surgeon, and because of this theme of aesthetics and beauty I tried to share my perspective as an artist. We did some video at the University of Washington art department, where I go for life drawing sessions. ASAPS recognizes the importance of cultivating the artistic side of plastic surgery, and there is even a popular all day course at the annual meeting on life drawing (from a live model.) We weren’t able to include my evening out Argentine tango dancing – we’ll save that for another time.



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