Cosmetic Surgeon vs Plastic Surgeon. What’s the Difference, Really?

As a Board Certified Plastic Surgeon, I frequently encounter patients who have either previously consulted with a “Cosmetic Surgeon” or who are thinking about it.  And their question is, “How do you tell the difference between a Plastic Surgeon and a Cosmetic Surgeon?”

To begin with, the clear and simple answer is that the term “Cosmetic Surgeon” can mean anything to the practitioner who defines himself by this term; but to the medical boards, this term means absolutely nothing.  As a Plastic Surgeon, I completed five years of General Surgery training followed by a two year residency in Plastic & Reconstructive Surgery.  Once I completed this last program, my next step was to pass both a written as well as an oral examination.  And once I did, I could officially call myself a Board Certified Plastic Surgeon.  The same is not so true with the Cosmetic Surgeon.  Seemingly anyone can call himself a Cosmetic Surgeon and, given changes in the American healthcare system and the intense growth in medical practices focused exclusively on elective procedures, they are.  And that is confusing the general client base.  But, often, the goal is to do just that.

To say that our medical system is strained is a gross over-simplification.  Because of a number of factors including increasing medico-legal exposure, declining insurance reimbursement, and tighter restrictions on medical professionals, many physicians are looking towards the elective cash-based practice as a means to survive.    With this growing popularity, several organizations sprang up within the last decade with the sole intent being to educate and train these people in the same procedures that we, as Plastic Surgeons, were trained on during our residencies.  But the difference is that these training programs may be as short as a single weekend and not several years as are the traditional surgical training programs.  Also, many of these practitioners come with little to no actual surgical experience before entering these programs.   And so one week Dr. Smith is an Emergency Room Physician and, suddenly, the next week he is officially a “Cosmetic Surgeon”.

Most people don’t know that  the medical profession is designed so that anyone with a medical license can literally perform any procedure they want…even if they have little to no training and even if they are not actually licensed to perform that procedure.  How?  They simply attend a brief course in that procedure (e.g.:  breast augmentation, liposuction, face lifts, tummy tucks), they receive a “certificate of completion”, and then instantly they become a “Cosmetic Surgeon” and are ready to see you for all of your Plastic Surgery needs.  And they generally do so within an office operating room because most of these physicians are blocked from getting actual hospital privileges.  Most hospitals and accredited surgery centers grant privileges only within a physician’s area of core competency.  And so experience from a weekend course simply doesn’t cut it.

The biggest concern here is that expertise can simply not be achieved over a weekend and the depth and breadth of a surgical residency cannot be absorbed just by attending a course.  Cosmetic Surgeons argue that traditional Plastic Surgery training does not focus on cosmetic procedures.  Many suggest that Plastic Surgeons actually begin practice with less experience that that achieved by a Cosmetic Surgeon.  And that is simply not true.  As demand for elective procedures has increased, so also has the response from Plastic Surgery training programs in educating their residents on the fundamentals of not only Reconstructive Plastic Surgery but also those associated with Cosmetic Plastic Surgery.    But residency training alone does not make any surgeon an expert.  True expertise takes years of performing a specific procedure and countless hours working within one area before true competency can be acknowledged.  As I often comment to my patients, I learned a great deal in my residency training but I have learned even more being in private practice.  But I needed the solid foundation of a core aesthetics residency in Plastic Surgery to get me started.  From there, the rest was simply a matter of time and getting enough cases under my belt to truly feel comfortable in any one area.

To protect the general public, many states are now passing legislation that will require any practitioner claiming to be Board Certified to designate which American Board of Medical Specialties (ABMS) Board they are certified by.  At this time, there is no formal certification in Cosmetic Surgery and so anyone claiming to be board certified in this area is actually recognized only by a self created organization (American Board of Cosmetic Surgery) and not an official licensing board.

And so the next time, a physician throws out the fact that he or she is a Board Certified Cosmetic Surgeon, I encourage you to ask him a few more questions.  Ask about his background training (what is he really certified in), ask him how many of these specific procedures he has performed, and ask him how many years he has been practicing.  You might be surprised at what he says…and even more by what he does not.


Gregory A. Buford, MD, FACS, PCEO is a Board Certified Plastic Surgeon and nationally recognized consultant, speaker, and trainer in the areas of breast augmentation, body contouring, facial injectables, and laser resurfacing.  He is also the author of “BEAUTY and the BUSINESS” for which he has received positive feedback from medical professionals around the world.  His plastic surgery practice is conveniently located in Denver, CO.