A cosmetic surgery superspecialist will typically limit his practice

WHY SUPERSPECIALIZATION Is So IMPORTANT

Secret: The doctor you want is called a superspecialist he practices cosmetic surgery exclusively.

IT'S EASY TO APPRECIATE THE VALUE OF NARROW SPECIALIZATION.

Our society lives in a time of increasing specialization in all endeavors. Professionals in every line of work exemplify this trend. A football tackle would probably make a lousy quarterback, a position that requires a different mindset and other skills. The classical violinist seldom features bluegrass as part of his repertoire. Would you hire an electrical engineer or a chemical engineer to build a highway?

Dear Dr. Johnson: Like yourself, I am a physician. I direct a national referral center in Ann Arbor, Michigan. My patients come from throughout the world, as do yours, and suffer from severe and painful conditions. Many of our patients have obstructive nasal deformities. Some require functional reconstruction and cosmetic attention to the deformity. Your work had been known to me for years, and I elected to send several individuals to you for necessary surgery.

I am writing to tell you that I am delighted with the results. In addition to relieving symptoms, you were able to achieve an incredibly natural look. These individuals do not look as though they have had reconstructive surgery. More specifically, they do not look as though they have "someone else's" face or nose. They are pleased, and so am I. As medicine has become more complex, there is a need for advanced training, even within the specialties. Superspecialization seems to be a trend that is unavoidable. A need to acquire more knowledge and greater technical skills has mandated this change. The work you have done on those I have sent you illustrates the benefit of your superspecialization.

Congratulations. Sincerely, Joel R. Saper, MD, FACP, FAAN Founder and Director of Michigan Head Pain & Neurological Institute Ann Arbor, MI

In surgery, as in many disciplines, the best results are realized when a team of highly skilled individuals perform the same procedure(s) on a daily basis. Not unlike a soccer team or an orchestra. Repetition makes for perfection. In this instance, the team is built around the surgeon. So, selecting the most highly specialized surgeon to lead the team is the single most important step in achieving satisfaction from cosmetic surgery.

Plastic surgery now has so many subspecialties, it is impossible for anyone to do everything equally well.

-Robert Goldwyn, MD Harvard University Medical School author, Beyond Appearance: Reflections of a Plastic Surgeon

Similarily, in the surgical world, focus on a given region of the body has been the trend: hand surgery, foot surgery, chest surgery, and eye surgery. Such specialization has narrowed even further via subspecialization. Now, there are eye surgeons who limit their practice to the retina and chest surgeons who perform only open-heart procedures.

The fine honing of specialization in modern medical practice is known as superspecialization: a narrow, focused, "boutique" practice. Great benefits to the patient are realized when a surgeon narrows his scope and concentrates on a limited selection of procedures.

The patient's question might now become, "How do I differentiate between specialist, subspecialist, and superspecialist?" The following graphic, The Hierarchy of Modern Medical Superspecialization will help you understand the medical profession's stratification. The same applies to all specialties; some internists subspecialize in endocrinology; then a limited number of endocrinologists superspecialize in thyroid disorders only. The pyramid narrows as specialization narrows. The number of practitioners decreases commensurate with the further specialization.

Cosmetic Surgery Hierarchy

Level 1: Specialist. Some cosmetic surgery but most time spent on reconstructive surgery for disease or accident. Board certified. No fellowship training.

Level 2: Subspecialist. Practices both reconstructive and cosmetic procedures, but not the full scope of the parent specialty. Typically board certified plus fellowship training beyond his residency.

Level 3: Superspecialist. Practices cosmetic surgery exclusively. No reconstructive surgery. Typically board certified and fellowship trained, the most specialized of all practitioners. In the world of cosmetic surgery, these doctors are at the apex of sophistication, training, and skill.

The board awards a certificate or diploma to successful applicants signifying the new doc has met all the board's prescribed standards. He is now considered a qualified specialist in the eyes of the specialty and the medical profession has met all the board's prescribed standards. He is now considered a qualified specialist in the eyes of the specialty and the medical profession.

Because residency is such an intense and concentrated period of study and experience, the young specialist, who just passed his exams, will never be more knowledgeable about the entire spectrum of that specialty.

We live in an age when medical and scientific progress is unfolding at such an enormously rapid pace that it is difficult for one individual to keep track of, let alone master, developments in even a small area of medicine.

-Kurt J. Wagner, MD, Gerald Imber, MD, authors, Beauty By Design

My specialty is too broad." That introspective, objective, and ethical doctor-specialist realizes that to be competent, he must focus on just one aspect of his practice. At the same time, he must continue to learn more techniques and skills. This is known as subspecialization or regional specialization.

One finds one's life evolving and interests evolving, and the more I became acquainted with aesthetic (cosmetic) surgery, I recognized that it was far more challenging. There was much less (tolerance for making) an error in aesthetic surgery than in reconstructive procedures.

- John Grossman, MD Interview, Cosmetic Surgery Times

Ophthalmology, the oldest medical specialty, long ago divided itself into recognized subspecialties even though the eye and auxiliary structures occupy only a few cubic inches of the body: surgery of the retina, corneal surgery, plastic surgery of the eyelids and orbits, and pediatric ophthalmology.

Ophthalmology is a field that is characterized by subspecialization. Comprehensive ophthalmologists (generalists who do not focus their practice on an ophthalmic subspecialty) continue to represent the majority of practicing ophthalmologists. Nationally, one-fourth of graduating ophthalmology residents go on to fellowship training, and at academic programs, it is not unusual for the majority of the graduating class to pursue subspecialty fellowship training.

Especially in urban areas, ophthalmic subspecialties often limit their practice to their subspecialty and do not take care of general problems such as cataracts. Even within the ophthalmic subspecialties, there is a tendency for further specialization. For example, some cornea fellowships and cornea specialists focus exclusively on refractive surgery (LASIK is an example of refractive surgery). Orbital, facial, and ophthalmic plastic surgery is a broad discipline and there has been a tendency towards additional specialization in aesthetic (cosmetic) surgery, lacrimal (tear duct) surgery, and orbital surgery.

Oculoplastic surgery is a relatively young subspecialty…. The field has exploded… and is evolving into a broader discipline. There are now more than 400 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. Fellowships are two years long with many fellows taking additional subspecialty training after two years of fellowship.

– Norman Shorr, MD, FACS, Robert Alan Goldberg, MD, FACS and Todd Cook, MD "What's New in Ophthalmic Plastic Surgery," Journal of the American College of Surgeons, November 2001

A select number of plastic surgeons limit their practice to this young and very narrow superspecialty. The importance of fellowships cannot be underestimated. The refinement and focus of subspecialty education will continue to narrow as we recognize that to achieve surgical excellence it requires depth of knowledge that is more valuable than width. Typically, subspecialty fellowships are developed and monitored by specialty or subspecialty societies.

They are not directly governed by the boards of the parent specialties. The American Academy of Dermatology, the continuing education arm of that specialty, oversees fellowships in skin cancer surgery and pediatric dermatology. The American Academy of Facial Plastic and Reconstructive Surgery provides fellowship opportunities in cosmetic and reconstructive surgery of the face, head and neck. The American Society of Plastic Surgeons offers fellowships in head and neck tumor surgery, pediatric surgery, and full body cosmetic surgery.

By now you should have no doubt that the more specialized the doctor, the greater likelihood of good results for you, the patient. You now know that if you are considering a facelift, you should seek a board certified specialist who focuses on cosmetic surgery and ideally has done a cosmetic surgery fellowship. A cosmetic surgery superspecialist will typically limit his practice to fifteen or fewer procedures mastered after lifelong study, focus and dedication.