Clarifying the Distinction between Plastic Surgery and Facial Plastic Surgery Accurately and Respectfully

Dear Sir, Your recent article, “Plastic Surgery or Facial Plastic Surgery: Can the Public Tell the Difference?,”1 reignited some misrepresentations that we thought had been resolved years ago between the specialties of plastic surgery and facial plastic surgery. The article used a flawed online survey that was not constructed to give survey responders sufficient and accurate information to formulate an objective opinion about the specialty of facial plastic surgery. The article stated: “Although an FPS [facial plastic surgeon] typically completes a 5-year otolaryngology residency training followed by 1 year of fellowship training in facial plastic surgery, most PSs [plastic surgeons] complete a 6-year plastic and reconstructive surgery residency training, with or without additional training, and are licensed by the American Board of Plastic Surgery (ABPS). Furthermore, PSs are licensed by the ABPS, which is a member of the American Board of Medical Specialties, whereas FPSs are licensed by the relatively new American Board of Facial Plastic and Reconstructive Surgery.” The article concluded that survey responders would feel “misled” if they chose an otolaryngology trained facial plastic surgeon. The survey/article failed to mention that facial plastic surgery training is a mainstay in the otolaryngology core curriculum, as specified by the American Board of Otolaryngology/Head and Neck Surgery (ABO/HNS) and the Accreditation Council for Graduate Medical Education for otolaryngology residency training programs. Otolaryngologists have expertise in head and neck anatomy, and otolaryngology residents must pass the ABO/HNS examination, which includes testing knowledge of facial plastic and reconstructive surgery. The American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) has been in existence for 40 years and requires prior certification by either the ABO/HNS or the ABPS before surgeons are eligible to complete ABFPRS certification. The article/survey also failed to mention that surgeons who apply for ABFPRS certification are required to submit 2 years of facial plastic surgery experience in the form of at least 100 operative reports and pass a 2-day written and oral psychometrically validated examination dedicated exclusively to facial plastic surgery. ABFPRS diplomates must operate in an accredited facility, have proper licensure, and adhere to a code of ethics. Over 1350 surgeons have completed these requirements. In the United States, the state medical boards have evaluated the rigorous ABFPRS standards for certification, and ABFPRS is recognized as American Board of Medical Specialties equivalent in all 50 states. In addition, the article incorrectly states that practicing surgeons are “licensed” by the ABPS or the ABFPRS. The licensing of a medical professional in the United States is regulated by individual state medical boards. The ABPS and the ABFPRS certify surgeons for competence; they do not issue licensure. We have trained otolaryngology and plastic surgery residents for the past 30 years and would request that the demeaning of facial plastic surgery training and certification cease. Although specialties and trainings can overlap, who can say that one training is superior to another? Plastic surgeons and facial plastic surgeons should commit to a unified approach to ensure quality patient care and improved outcomes. DISCLOSURE Drs. Papel and Kontis receive royalties from Thieme Publisher.