Aesthetic Surgery and Cosmetic Medicine in 2015: A Plastic Surgery Trainee’s Perspective

by Sammy Sinno, MD

While at my best friend’s wedding last weekend in beautiful Miami, I ran into an old college friend who had finished his residency in Emergency Medicine and was now practicing in Los Angeles. I asked him how was life after training to which he replied “the ER is OK but I am really killing it at the MediSpa.” He went on to inform me he is now a part owner of a MediSpa and is a “master of injectables.” He even claimed that he is so good that he believes “a facelift is an obsolete procedure.”

I would lie if I told you I was astonished or angered by his comments; the truth is that I wasn’t the least bit surprised. As evidenced by our recent manuscript in Plastic and Reconstructive Surgery, clinicians in the United States (and most likely in other countries) are performing procedures historically in the prevue of plastic surgery.1 As a training plastic surgeon, we spend countless hours in the operating room and library reading books learning this vast specialty, and of course it is disheartening to learn that others attempt to encroach on our field.

Of course, the issue of who has the privilege to perform a procedure is complex. Certainly, having training requirements for various procedures as outlined by the Accreditation Council for Graduate Medical Education (ACGME) is an obvious checkmark, but practitioners are still performing procedures they have not been trained to do in residency or fellowship.

Patient safety is and always should be the most important concern for patients looking to have a procedure done by a clinician who may have not have the training background to perform a procedure. Unfortunately, our news is bombarded by horror stories regarding patients with disastrous complications. Even during my own training I have unfortunately seen patients with horrible complications after treatment from non-plastic surgeons, often times at MediSpas. Patients similar to those seen on the hit E! television series BotchedTM are unfortunately not as uncommon as one would think. What can be done to overcome this trend?

These days whenever I am in a social event, family gathering, or with a large group of friends, when people hear I am training in plastic surgery I immediately get bombarded with questions. People want to know who I recommend for procedure A, have I heard of Dr. B, and “do you think I need X, Y, and Z?”.

I think all plastic surgeons, plastic surgery trainees, and anyone else reading this article should stress the following take home messages to people that ask us these questions, as this the most important issue facing our patients and specialty. First, do your homework. Know the qualifications and board certification status of your practitioner. Also, ask questions such as “how many procedures have you performed?” or “do you have any patient photographs?”. Most importantly, feel comfortable with your surgeon, and choose a clinician you feel wants to help you and not just take your money.

Plastic surgery is an immense field that continues to expand. The area of aesthetic/cosmetic surgery has and always will be one of great competition, attention, and controversy. However, we as plastic surgeons and plastic surgery residents can distinguish ourselves by the utmost attention to patient safety. We have the training, experience, skill, compassion, and attention to detail to truly help patients. After all, patients that seek aesthetic surgery typically are perfectly healthy, are made temporarily unwell, and eventually hope to have improvement of whatever they desired, which gives us great responsibility. We must continue to carry the burden of this great responsibility and commitment to excellence in our training years and beyond.


1. Barr JS, Sinno S, Cimino M, Saadeh PB. Clinicians performing cosmetic surgery in the community: a nationwide analysis of physician certification. Plast Reconst Surg. 2015. 135(1):92e-98e.

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