Dr. Oscar Trujillo, MD, the director of Cosmetic Facial Plastic Surgery at Columbia University Medical Center on what you really need to know about facial plastics:
Facial plastic surgeons are medical doctors who undergo many years of surgical training, licensure by the state where they practice, and certification by medical boards to provide the safest and best results for their patients. Dermal fillers, Botox, and superficial treatments can be administered by other providers and in some cases nurse practitioners, but only surgeons with the proper training, certification, and experience can deliver the long-term, lasting results of surgery.
The first step is to find a qualified health care practitioner appropriate for the procedure you have in mind. Yes, your surgeon should be “board-certified,” but that’s not the whole story. There are lots of medical boards that certify medical professionals. In the case of facial plastics, the American Board of Facial Plastic & Reconstructive Surgery (ABFPRS) certifies medical doctors who have received their board certification in otolaryngology—head and neck surgery (ENT) after successfully completing an accredited 5-year residency program, and who have also successfully completed a one-year post-residency fellowship program in facial plastic and reconstructive surgery, which requires additional specialized surgical training. So, as a double ENT and ABFPRS Board-Certified facial plastic surgeon, I’ve had extensive experience in nasal surgery, rhinoplasty, and complex face and neck surgery. You may have also heard of the American Board of Plastic Surgery (ABPS). That board certifies all surgeons who are eligible after successfully completing a plastic surgery residency, and those surgeons may be able to perform rhinoplasty and face/neck surgery, but most people don’t realize that the training is separate and entirely different.
The most important thing is really to find a doctor that you trust, who will take their time to evaluate your concerns, explain any course of treatment, and answer all your questions. You really want to feel comfortable with your surgeon and have a good connection. I think that makes a big difference for the patient’s experience.
Q: What do facial plastic surgeons do?
Facial plastic procedures generally fall into three categories: 1) corrective, 2) restorative, or 3) beauty-enhancing.
Corrective procedures fix damaged or defective aspects of a given area of the face. For example, rhinoplasty (surgery of the nose) is used to repair a collapsed nasal valve and/or deviated nasal septum so that the patient can breathe through the nose, in some cases for the first time. Fillers and minor corrective procedures can also be used to treat scar tissue and similar facial defects.
Restorative procedures are aimed at treating the effects of aging by restoring a natural, youthful appearance of features that existed when you were young. The aim is not to change your facial features into someone else’s, but to reverse the clock of aging using a variety of surgical procedures:
Beauty-enhancing procedures aim to enhance the patient’s own facial features to create improved facial balance, symmetry, and contour. Examples of these procedures include rhinoplasty, chin augmentation, and otoplasty (surgery of the ears). Rhinoplasty is unique in that it may be used to enhance beauty as well as to serve the functional goal of improved nasal breathing.
Surprising to many, I only use general anesthesia for rhinoplasty and full face/neck lifting, as these procedures require the use of a breathing tube. All other procedures can be performed in my office with only oral sedation (no IVs) and local anesthetic, including my mini face/neck lift, upper and lower eyelid surgery, lip lift, browlift, chin implant/augmentation, and face/neck liposuction contouring. Of course, general anesthesia is always available, but most of my patients choose to have these procedures in my office, for many different reasons.
First, there are risks associated with general anesthesia, and elderly patients in particular are concerned about the risk of cognitive effects. Local anesthesia also means that the patient will return to their normal function much more quickly. Another benefit is that an in-office procedure is faster and more flexible than the operating room, so my patients can schedule their procedure when it works best for their life. My patients also feel safer with local anesthesia because they can skip all of the risks associated with IV sedation and because they are able to remain awake (although many fall asleep on their own!). Finally, the cost of an in-office procedure under local anesthesia is much lower than one in an operating room or surgical facility that requires monitored general anesthesia. Patients appreciate having a much more affordable option.
