The special problem of specialization in plastic surgery

It’s a classic scenario: Soon after I am introduced to someone and they learn that I am a plastic surgeon, I am asked what I do most or what I specialize in. Breast augmentation? Facelifts? It’s a valid question of course, especially since plastic surgery is such a diverse field, but I am nevertheless a bit uneasy being “pigeonholed.” A patient I saw recently showed the disadvantage of defining one’s expertise too narrowly: She was a satisfied breast surgery patient, and had even brought a friend in to consult about a breast procedure. But she then commented that she was planning to have some facial surgery, but by someone specializing in the face. She had no idea that I also do a high volume of facial rejuvenation!
I am getting better at answering the question, but it still doesn’t come out the way people might expect. My specialty is cosmetic surgery of the face and body, along with some breast reconstruction, with an emphasis on a natural look and using the most advanced technology and techniques. But then I also have to add that my background as an artist not only gives me an advantage in visualizing the result, but drives an interest in creative problem solving. This has led to the development of innovative procedures that are particularly useful in correcting problems from surgical complications, and so now I have a high volume of revision surgery cases that come from across the country and even overseas. So my practice is a bit hard to “package” because it isn’t defined by a specific body part or operation that I am particularly known for.
The dilemma for the patient of course is the instinct to see the one who has a reputation for being the best at the specific procedure they are considering. They want the expert, not the “jack of all trades.” But it is the comprehensive nature of plastic surgery training that provides the foundation for expertise. Plastic surgery is defined differently than other surgical specialties, in that it is a collection of techniques for rearrangement of tissues, not specific to specific anatomic regions. The training in hand surgery, cleft lip & palate repair, microsurgery, and cancer reconstruction all inform cosmetic surgery. So for example a facial plastic surgeon does not necessarily have more expertise in facial plastic surgery than a plastic surgeon, it’s just that their training is limited to that. It’s when facial surgeons or dermatologists start offering breast augmentation that you should start to wonder.