The differences between plastic surgery and cosmetic surgery and why board certification matters
Lack of government intervention continues to cause confusion for patients on what constitutes a board-certified plastic surgeon

Let's face it, when most people think of plastic surgery, they think of procedures like Botox and breast augmentation. And while those enhancements make up a large number of cosmetic procedures – nearly 5 million according to 2020 statistics from the American Society of Plastic Surgeons – there's much more than meets the eye when it comes to plastic surgery.

"There is a lot of overlap between plastic surgery and cosmetic surgery," said Michigan-based plastic surgeon Paige Myers, MD. "Plastic surgeons, though, have a much broader focus than simply cosmetic surgery. Plastic surgery is a lot of reconstructive surgery," adding that some plastic surgeons do head-to-toe reconstruction, whether on the face, hands or even feet.

Between Botox parties, beauty bars popping up nationwide and social media influencers discussing their plastic surgery more openly, there can be some confusion on what constitutes plastic surgery and cosmetic surgery. To sort through the differences between plastic surgery and cosmetic, we've asked three ASPS Member Surgeons their thoughts.

The difference between plastic surgery and cosmetic surgery

You're not alone if you're confused about the difference between plastic surgery and cosmetic surgery. According to a 2017 report from Plastic and Reconstructive Surgery, 87 percent of the 5,135 people surveyed were confused between the terms "plastic" and "cosmetic" surgeons. But the confusion is misguided. Plastic surgery is broken down into two main categories – reconstructive and cosmetic. So, what exactly is the difference between reconstructive and cosmetic surgery?

Simply put, cosmetic procedures are performed to enhance someone's overall appearance by reshaping and adjusting an anatomy that is already there as a way to make something more visually appealing. This can look like a surgeon performing Botox to reduce wrinkles, liposuction to aid in the removal of stubborn fat and more.

Reconstructive surgery, on the other hand, is used to restore function and appearance to conditions like birth defects, the impacts from certain medical conditions like breast cancer and other types of cancer and trauma caused by accidents or injuries.

Oftentimes cosmetic and reconstructive surgeries go hand in hand. As a specialty, plastic surgery aims to maximize a patient's cosmetic result in either capacity, but this expertise doesn't just apply to the minimally invasive procedures you might see in the media.

Why correct board certification matters

Not only were the individuals in the 2017 study confused by the varying terms, but they also believed that surgeons must have appropriate credentials to legally advertise themselves as aesthetic, cosmetic or plastic surgeons. The truth? The government does not legally restrict anyone from calling themselves an aesthetic, cosmetic or plastic surgeon – any medical professional advertising themselves as a cosmetic surgeon, for example, is not required to complete formal plastic surgery training. So, it makes sense why there is so much confusion.

Risks grow when individuals choose to seek out non-board-certified persons to perform their elective procedures because "anytime you choose to go to someone who is lacking in experience, lacking in training and lacking in knowledge, you are basically taking your own life into your own hands," said board-certified plastic surgeon Aviva Preminger, MD.

"I think that also when we talk about all of the training that we've all gone through and years of anatomy and just understanding the human body, and that's what surgeons do, especially when we talk about plastic surgery," said Preminger. "We are experts in human anatomy... we know where the nerves are, we know where the blood vessels are and we have that all in mind every single time we go to do anything."

What does it take to be a board-certified plastic surgeon?

"There's a few different avenues you can get to become a board-certified plastic surgeon," said Myers. "Aspiring plastic surgeons could do five years of general surgery, followed by a two- or three-year fellowship in plastic surgery. Currently, there are integrated plastic surgery programs which range from anywhere to six or eight years of residency training. On top of that training, there are certain fellowships that people can specialize in to get a bit of extra training in their expertise."

And becoming a member of the American Society of Plastic Surgeons requires even more extensive training. ASPS Member Surgeons not only have to have a board certification from the American Board of Plastic Surgery (ABPS) or in Canada by the Royal College of Physicians and Surgeons of Canada, but they also have to complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training. They must pass oral and written exams, graduate from an accredited medical school and complete continuing education annually. ASPS Member Surgeons can only perform surgery in an accredited state-licensed or Medicare-certified surgical facility.

Currently, 92% of board-certified plastic surgeons in the United States are members of ASPS, which represents 11,000 plastic surgeons worldwide.

Why patients should visit a board-certified plastic surgeon regardless of the procedure

"I think that it really it boils down to the length of training, the expertise that people are board-certified plastic surgeons have and the process to become board-certified because that's really all about patient safety," said Ash Patel, MBChB, FACS, Professor of Surgery at Duke Plastic Surgery. "So, one way patients can do that is by seeing someone who is an ASPS Member Surgeon, because then they know that that person's going to have been board certified in plastic surgery."

Given there's no legal limitation on who can call themselves a plastic surgeon, it can be difficult to spot who is actually qualified to perform plastic surgery. Patel states that one of the best ways to spot a board-certified plastic surgeon is if you are on a surgeon's website or social media profile, ask yourself: do they specify what they're board certified in? Because if it doesn't say, you need to look into that and find out more information.

Myers agrees, adding that "board-certified plastic surgeons are appropriately designated by the American Board of Plastic Surgery through the American Board of Plastic Surgery logo. So, they will have that on their website, they'll have it on their business card, as this clearly pass the rigorous training and board certification to be able to advertise as such."

Regardless of which procedure you are getting, whether that be cosmetic or reconstructive, make sure you are going to a board-certified plastic surgeon in your area.

"I think that if you're trying to cut corners and trying to save a few dollars here or there, I think what you really need to think about is, is this something that I want to take a chance with when we're talking about my health and my safety and my life, especially if it's something like a surgical procedure," said Preminger.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.