Eyelid Surgery (Blepharoplasty)

On Jan 30, 2012, Kate Murphy of the NY Times published an article whose title, “Ear Doctors Performing Facelifts? It Happens.” In this very misguided article, Ms. Murphy states that doctors trained in Otolaryngology (Ear, Nose and Throat) surgery have poor outcomes, citing a case where an otolaryngologist in Beverly Hills performed a facelift and a tummy tuck on a woman with bad scars both at her temples and her abdomen. The article goes on to quote plastic surgeons warning about other specialists who are not board-certified by the ABMS (American Board of Medical Specialties) in plastic surgery.

This article does a great deal of harm because of how extensively and flagrantly it misinforms the public about this issue. Instead of presenting both sides fairly and informing the public of the issues, it only presents one point of view. Here is what the article leaves out:

1. The name of the field for ear, nose and throat surgery is otolaryngology-head and neck surgery. That is because those board-certified by the ABMS in it must complete a 5-year rigorous training program in all of the head and neck (ear surgery is about 25% of this). Indeed, the ABMS’ definition of board-certified in otolaryngology-head and neck surgery includes 25% weight in facial plastic and reconstructive surgery. That is not to say that an otolaryngologist is competent at facelifts when he begins practice. It takes many years to achieve that type of expertise (10,000 hours if you believe Malcolm Gladwell). However, the underlying training and concepts are there. It merely takes focus to get there.
2. A sub-specialty within Otolaryngology is Facial Plastic & Reconstructive Surgery. As an otolaryngologist and a fellowship director in facial plastic surgery, I know how serious we take the burden of educating young surgeons in cosmetic surgery. Indeed, the relations within organized medicine between aesthetic plastic surgery (American Society of Aesthetic Plastic Surgery- ASAPS) and facial plastic surgery (American Academy of Facial Plastic & Reconstructive Surgery- AAFPRS) have never been better. We in leadership roles in these fields recognize that the two specialties have more in common than not. For example, we both strongly believe that only surgeons with region-specific training should operate on that region. This means that the AAFPRS does not support any member who operates out-of-field, outside of the head and neck region. Indeed, if a skilled facial plastic surgeon wants to become a fellowship director in the AAFPRS, he must attest that he does not perform body plastic surgery. Both ASAPS and AAFPRS decry plastic surgery by those not board-certified by an ABMS board to operate on an area. In other words, neither of us support gynecologists performing breast implants or otolaryngologists performing tummy tucks. This is in sharp contradistinction to the American Academy of Cosmetic Surgery, that welcomes all fields to perform cosmetic surgery.
3. The American Board of Facial Plastic and Reconstructive Surgery, of which I am a diplomat and sit on its Board of Directors, is a non-ABMS board. As the NY Times article mentions, several states (Texas, California, Louisiana, Florida) mandate that a surgeon must specify which Board he is certified by in advertising himself. What the article completely ignores is that in all those states, and several others, the ABFPRS has been recognized as ABMS-equivalent. This means that in every state in which that credential has been challenged, a facial plastic surgeon certified by the ABFPRS may call himself a facial plastic surgeon to the public. This has not been true for those certified by other non-ABMS boards. This is not some PR ploy, but an attestation to how serous the ABFPRS takes its certifying process: it is as rigorous as any ABMS board. In short, Plastic Surgery ABMS certification and Facial Plastic Surgery non-ABMS certification both have similar high standards in protecting the public against dangerous, unqualified surgeons.

Kate Murphy should be ashamed of this article. It misinforms the public, either due to poor research on this reporter’s part or simply ignoring half the story. It would have been just as compelling a story had Ms. Murphy told the whole story…not just the parts she thought would make the best read. The NY Times, if it is to uphold its high standards, should publicly apologize to all of us ear doctors who have the training and the board-certification to proudly call ourselves Facial Plastic Surgeons.
Minas Constantinides, M.D., F.A.C.S.
Director of Facial Plastic & Reconstructive Surgery
Dept. of Otolaryngology, NYU Langone Medical Center
GVP of Research, Awards & Development
AAFPRS
Director, ABFPRS

Facelift and Neck Lift Photos

See the before and after photos of one of Dr. Constantinides’ patients after rhinoplasty.

See Dr Constantinides’ patient, a woman with improved lower eyelid bags after Restylane.

Does handedness matter when it comes to facial plastic surgery, or any surgery for that matter? I think it does. Our training programs and surgical traditions bias against left-handed surgeons. Instruments are designed for right-handed surgeons. If you are left handed and learning how to operate, you are at a significant disadvantage.

I am actually not really right-handed. I have my great-grandmother to thank for being right-handed. I was left-handed when I was born. Most experts say that once your “handedness” has been determined by nature, it really cannot be changed. In my case, “most experts” were wrong.

My family immigrated from Greece to the U.S. when I was only one year old. When I was 7 years old, I visited Greece for the first time. There, my great-grandmother (my mother’s mother’s mother) panicked, saying “The boy, the boy!!! He is going to have heart trouble!” Apparently, since the heart is on the left, anyone left-handed is doomed to prematurely have a heart condition according to Greek lore. So, under her watchful eye, I was forced over the course of the summer to practice writing with only my right hand. Sure enough, by the end of the summer and much to my great-grandmother’s satisfaction, I was able to easily write with my right hand.

For years after that, I would write with my right but color with my left. Indeed, any sports activity that I learned before that age (like throwing a ball), I continued to do left-handed. But any new activity I picked up (tennis, batting, surgery), I would learn right-handed. I believe that this ability to use both hands still serves me greatly as a surgeon. It enables me to see things and do things from either side of the table. Combined with 20/15 vision (normal is 20/20), I have been blessed with qualities that translate into skills that others simply do not have in the operating room. For all this, I have my great-grandmother to thank, may God rest her soul.

So in this time of being grateful, I often think of my great-grandmother, who had unwittingly prepared me to excel at the field that I love so much: Facial Plastic Surgery. Minas Constantinides, MD

The nasal tip skin is very sebaceous and inelastic, making scar revision in this location frought with poor results. This is exactly opposite to how incisions heal in the columella, which is the skin that heals best on the whole body. A tip scar will most likely end up depressed unless it is concealed in lines of natural light and shadow. Dermabrasion, although it might help, will not be adequate. Your surgeon should be able to give you an estimate as to how much of an improvement you can expect. Be prepared for many weeks of the scar looking worse after surgery, and many months of redness and irregularity.

In Steve Jobs’ biography by Walter Isaacson, Jobs speaks about why great companies decline. He says, “The company does a great job, innovates and becomes a monopoly or close to it in some field, and then the quality of the product becomes less important. The company starts valuing the great salesman, because they’re the ones who can move the needle on revenues.”

This same thing seems to be happening in consumer-driven medical fields, of which facial plastic surgery is a prime example. Instead of valuing the surgeon that gets the best results, is most highly regarded by his peers and whose patients are the happiest, consumers are falling for the flash-in-the-pan salesmen. They are the ones with beautiful offices in the best parts of town that say they are “the best”, but outside of their words have little substance to show for it.

Consumer-targeted businesses must do everything well to be successful in competitive markets. They must look good, provide the best service at all levels and create great value for their clients. In facial plastic surgery, value is judged by surgical outcomes and patient satisfaction. But these qualities are difficult to discern by a patient looking for the best. Historically, medical outcomes evaluated by peers are a good way to discern value and quality of a surgeon. Looking for the place that a surgeon sits on the national stage of peer reputation is a good way to screen for the goals that Steve Jobs reached for: to create great and lasting value without falling for sleek salesmanship.