We appreciate receiving a recent letter to the editor from Nuveen et al. in response to our article “Public Perception of Cosmetic Surgeons versus Plastic Surgeons: Increasing Transparency to Educate Patients” (Plast Reconstr Surg. 2017;139:544e–557e).1 We appreciate the authors’ viewpoint and respond to their concerns below.
In reviewing the authors’ letter, we are afraid that the ultimate conclusions of our article were missed, or potentially ignored. The purpose of the article is about the safety of our patients. We are not concerned with, nor did we want to debate, a physician’s scope of practice. Instead, we are unequivocally focused on improving transparency, patient education, and ultimately patient safety for the public interest and welfare. We state this in plain terms within the article:
The fundamental crux of this study should not focus on the debate of a physician’s scope of practice. It would be convenient, oversimplified, and incorrect to state that those trained in plastic surgery are the only providers capable of performing aesthetic surgery—there are those trained in other specialties capable of producing satisfactory outcomes. … The focus of this study, instead, should be concerned with increasing patient education, eliminating misconceptions, and ultimately, improving patient safety.
The reviewers state that “to provide data to support the truth of the premises of this article and its conclusions, we would need a study that evaluated patient safety and outcomes,” but ironically, they make no mention of the data that are actually published within the article. The data are clear in their message: all parties need to educate the public about all facets of aesthetic surgery. As we state in the article:
[The data] demonstrate that, above all else, prospective patients are confused by the choices with which they are presented. Because of the lack of transparency in our medical marketing system, patients cannot ascertain the differences between their potential providers. With the current system, physicians can capitalize on confusing jargon to convince patients that they are appropriately qualified to perform the procedures they advertise their expertise in. This lack of transparency may lead a patient to make a decision they would not have otherwise made if provided a clearer picture.
The reviewers make statements with hyperbolic language that is again, ironically, unsupported by data or fact. They state:
- “In addition, the authors state, ‘there are many physicians who name themselves plastic surgeons, irrespective of their credentials.’ Citations from lay press and scientific journals are included as evidence of this risk to the public. In totality, these assertions are preposterous.”
- “It is substantiated with sensational articles in the lay press using mottled and limited statistics in the references cited.”
We do not agree with the opinion that the cited assertions are “preposterous” or unsubstantiated. The assertions are simply the truth—there are, in fact, numerous physicians who name themselves plastic surgeons, irrespective of their credentials. Citations from the lay press accurately demonstrate this fact and further delineate how a lack of transparency may have contributed to the untoward outcomes suffered by the patients at hand.
The authors agree wholeheartedly with the suggestion that cooperation will be the only successful method to achieve improvements in our current system. The authors state this within the article:
The authors note that the Core Cosmetic Medicine Alliance has made strides toward achieving such a goal. The American Society for Aesthetic Plastic Surgery, the American Society of Plastic Surgeons, and the four core American Board of Medical Specialties cosmetic medicine specialties (i.e., dermatology; oculoplastic surgery; ear, nose, and throat facial plastic surgery; and plastic surgery) have connected in performing true cosmetic medicine while being respectful to their scope of training. Their emphasis is on patient safety, aesthetic outcomes, patient education, and collaborative efforts to improve the quality of patient care. Coordination and cooperation among specialties will be essential in devising methods to improve patient safety in aesthetic surgery.
Ultimately, the reviewers’ desire to focus on a physician’s scope of practice is contrary to the purpose of the article, and their one-sided interpretation of the data clouds the clear fact that patients are confused about who is qualified to perform aesthetic surgery procedures. Although we may have disagreements and differences of opinion, we must all agree that the broader message provided by the data is paramount—our patients are confused, and their safety and education cannot be overlooked.
Dr. Rohrich receives instrument royalties from Eriem Surgical, Inc., and book royalties from Thieme Medical Publishing. No funding was received for this communication. All other authors have no commercial associations or disclosures that may pose or create a conflict of interest with the information presented within this communication.
Ajul Shah, M.D.
Anup Patel, M.D., M.B.A.
John Smetona, M.D.
Section of Plastic and Reconstructive Surgery
Yale University School of Medicine
New Haven, Conn.
Rod J. Rohrich, M.D.
Department of Plastic and Reconstructive Surgery
University of Texas Southwestern Medical Center
1. Shah A, Patel A, Smetona J, Rohrich RJ. Public perception of cosmetic surgeons versus plastic surgeons: Increasing transparency to educate patients. Plast Reconstr Surg. 2017;139:544e557e.