I was recently asked by a patient, who was referred to me (by a plastic surgeon) for a droopy eyelid (ptosis), if I were a “board-certified plastic surgeon.” The question is, quite frankly, unsurprising. Over the years, the American Board of Plastic Surgery, which grants board certification to plastic surgeons, and the American Society of Plastic Surgeons have done a fantastic job, not only by ensuring that plastic surgeons are well trained, but also by launching an effective awareness campaign encouraging patients to seek a BOARD. CERTIFIED. PLASTIC. SURGEON. for all their plastic surgery needs.
FOCUS
However, while plastic surgeons are trained in plastic and reconstructive surgery of the whole body, oculofacial plastic surgeon (or oculoplastic surgeons, for short) focus their training and their careers only on the face, with greater emphasis on the eyelids, the brows, the tear drainage system, and the eye socket. For instance, in my practice, 90% of what I manage involves the cosmesis and reconstruction the eyelids, the brows, and the midface.
SURGICAL TRAINING
General plastic surgeons have varied training and experience with eyelid surgery. The American Board of Plastic Surgery’s official Training Requirements documentation states that a rotation in “oculoplastic surgery or ophthalmology” is not one of the “required clinical experiences,” but is rather a “strongly suggested clinical experience.” Most plastic surgery trainees, therefore, receive at most 1 to 2 months of training in ophthalmology, oculoplastics, and eyelid surgery. While there are some plastic surgeons who perform quite a few eyelid cases and are very adept at the surgery, there are others who focus more on the body, such as breasts and liposuction, and perform fewer eyelid procedures.
On the other hand, oculofacial plastic surgeons spend 3 years in ophthalmology residency training focusing on microsurgical techniques of ophthalmic and oculoplastic surgery, and then 2 additional years devoted exclusively to the face, focusing primarily on the eyelids, brows, and orbits (eye sockets). [I additionally spent my intern year training in general surgery at the beginning of my career]. During their training, oculoplastic surgeons perform hundreds of surgeries on the eyelids and brows, and thus gain an intimate knowledge of eyelid and brow anatomy. As such, oculoplastic surgeons are uniquely qualified to repair eyelid ptosis (droop) and to perform complex eyelid reconstructions.
BOARD CERTIFICATION
Oculofacial Plastic Surgery is a sub-specialty within ophthalmology. For various reasons, none of the sub-specialties within ophthalmology receive board-certification. Therefore, the highest level of board certification a surgeon may receive in any ophthalmology sub-speciality, including oculofacial plastic surgery, is certification by the American Board of Ophthalmology. However, the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), the foremost organization that oversees oculofacial plastic surgery in the United States, has recognized the need to distinguish those who have received the rigorous training and have achieved a level of competency to perform oculofacial plastic surgery from those who have not. To ensure quality training, ASOPRS accredits and oversees only a handful of fellowship training programs available to candidates each year. These programs must adhere to strict training requirements laid out by the organization. As a matter of fact, acceptance into one of these highly-coveted two-year fellowship positions is so stringent that an ASOPRS fellowship in Oculofacial Plastic Surgery has become one of the two (along with pediatric surgery) most competitive training programs in all of medicine. Therefore, in lieu of board certification, ASOPRS, for the past 50 years, has granted membership to a select cohort of surgeons who have demonstrated competency in oculofacial plastic surgery by completing extensive clinical and surgical training, by publishing scholarly research, and by passing rigorous written & oral examinations. While there are over 8,000 plastic surgeons certified by the American Board of Plastic Surgery, ASOPRS membership has been limited to only 650 members in the United States, and 100 members abroad. [And as the old adage says, “Quality over Quantity.”]
SUMMARY
Surgeons, in general, vary in their training, expertise, and level of comfort. In my career, I have had the pleasure of meeting (and learning from) plastic surgery colleagues who perform impeccable work on the eyelids, the brows, and the face. On the other hand, I have had to revise several unsatisfactory work done on the eyelids by other non-oculoplastic surgeons. For this reason, I do not perform procedures I have not had the adequate training to perform, such as rhinoplasties and other body work.
To the question, "are you a board-certified plastic surgeon?" I say: "No, I am not. I am an Oculofacial Plastic Surgeon. I am proudly board-certified by the American Board of Ophthalmology and a fellow of the American Society of Ophthalmic Plastic and Reconstructive Surgery."
I will end this with a befitting old Arabic Proverb: “Give your bread dough to the baker even if he eats half of it." When it comes to your health and your body, never compromise and always seek the services of an expert; it will be well worth your time and money.
Click HERE to learn more about my surgical training and credentials.
