Who should I see – a dermatologist or a plastic surgeon?

The advice I usually here is to see a "cosmetic or plastic surgeon" rather than a dermatologist for many of the procedures you recommend. Besides being more costly, why wouldn't I see what seems to be a more skilled physician when I'm thinking about altering my face. I know that they do do botox, and laser resurfacing, etc. I'm quite confused about the best physician. Thanks, Janis

I think this is very confusing for people.  Dermatologists are specialists who are experts in the care of skin, hair and nails.  We do 4 years of college, 4 years of medical school, 1-3 years of internship/residency in internal medicine, pediatrics or surgery and then do 3 more years of dermatology training.  Now, that includes training in cosmetic procedures.  Some of us subspecialize in cosmetic dermatology spending extra time training in lasers, injectibles, leg vein treatments, etc.  Dermatologists are trained well to do skin cancer surgeries but not cosmetic surgeries like facelifts.

Plastic surgeons and facial plastic surgeons (often ENTs) are trained to operate.  Most of them are not very interested in, and are not trained to handle, non surgical skin problems.  They often add these procedures to their offices because there is demand for them and because they are hoping some of those patients will eventually opt for surgery.  Most of them hire nurses to do the lasers and injectibles and some surgeons do not actually know how  to do the lasers or fillers themselves.  How can they supervise someone then? There are exceptions to this.  I do know some plastic surgeons who are excellent at all of it and do it themselves.

"Cosmetic" surgery, in my opinion, is a questionable board certification.  It is a usually a 1 year training program after residency focusing on surgery.  It’s not nearly as extensive training as the plastic surgery program and seems to be an attempt to short cut the long, surgical training programs above. Some dermatologists go this route and frankly I wish this were better regulated.  I think this confuses the public and most people seem to think that "cosmetic" surgeons have the same surgical training as plastic surgeons and facial plastic ENTs which is just not true.  Dr. I

Dr. Brandith Irwin, MD

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