Multiple specialties perform safe
and effective cosmetic facial surgery. Plastic surgeons,
otolaryngologists, oral and maxillofacial surgeons,
dermatologists, ophthalmologists, oculoplastic surgeons and
various other specialists have all demonstrated competence in
this area. These disciplines have added to the cumulative
knowledge and skills needed to perform cosmetic facial
No single specialty "owns
the face." Yet, the public, in seeking care, is often
confused. They may believe that general dentists — instead of
board-certified oral and maxillofacial surgeons — are
performing facelifts. They may believe that oral and
maxillofacial surgeons only receive training in "dental"
surgery. This misinformation is exasperated by a turf battle
among specialties due to fear of competition rather than
concern for patient safety. There exists no evidence that one
specialty has better outcomes or fewer complications.
After dental school, all
oral and maxillofacial surgeons perform a four- to six-year
hospital-based surgical residency in which rotations are
performed alongside, and at the same level, of physician
peers. General surgery, medicine, medical ER, surgical ER,
anesthesia and pathology are included in these rotations,
which also may include neurosurgery, ENT, plastic surgery, and
others. Most training institutions split facial trauma call
among oral and maxillofacial surgery, plastic surgery and ENT.
Cosmetic facial surgery is taught in our residency programs,
is part of our boards, it is a section in our Parameters of
Care and Clinical Pathways and is covered by our malpractice
insurance. In short, it is a component of contemporary oral
and maxillofacial surgery.
Oral and maxillofacial
surgeons have always performed procedures that were medical
and dental in nature. All board-certified oral and
maxillofacial surgeons in my city have privileges at eight
local hospitals which include history and physical privileges,
ICU admission privileges, privileges to harvest hip and skin
grafts for facial reconstruction and privileges to treat
complex facial fractures including the orbit.
Currently, 50 percent of
oral and maxillofacial surgeons finishing residency will have
both a dental and medical degree. I am a proponent of the
dual-degree system, but there exist thousands of competent,
excellently trained oral and maxillofacial surgeons who do not
possess a medical degree.
Sixteen states have so far
successfully updated their dental practice acts to reflect the
contemporary scope of oral and maxillofacial surgery.
Competitive naysayers can cloud the issue, but when the public
and the legislators elected to represent them examine the
issue, victory has followed my specialty more often than not.
In many states, any person with an M.D. degree and a medical
license can legally perform cosmetic facial surgery. By this
logic, any pediatrician or psychiatrist could legally perform
a facelift, but a board-certified oral and maxillofacial
surgeon with four to six years of hospital-based medical and
surgical training cannot perform these procedures? Something
is wrong with this picture, this logic and this antiquated
A good, general rule for
all of us is to withhold judgment about the qualifications of
any specialty until we fully appreciate how they train and
what they do.