Plastic Surgery vs. Cosmetic Surgery: What’s The Difference?

Before I started covering the medical aesthetics industry, I was a part of the overwhelming majority that is confused about the difference between a cosmetic surgeon and a plastic surgeon. And, needless to say, I knew even less about just how vastly different their credentials are. Finding the right doctor takes work, but knowing the questions to ask in order to ensure you find the most qualified provider will make the process a lot easier.

Cosmetic Surgery vs. Plastic Surgery

First and foremost, it is important to understand the difference between what constitutes “cosmetic surgery” and what is considered “plastic surgery.”

• Cosmetic Surgery: An invasive aesthetic procedure that has the goal of enhancing appearance (think: facelift, tummy tuck, breast augmentation). Because cosmetic surgeries treat otherwise functioning areas, they are considered elective and typically not covered by insurance.
• Plastic Surgery: Procedures meant to correct or reconstruct concerns stemming from illness, accidents, or birth disorders (e.g. burn repair, breast reconstruction surgery, congenital defect repair). In fact, the American Society of Plastic Surgeons (ASPS) was called the American Society of Plastic and Reconstructive Surgeons until 1999, when it elected to change the name to clarify that plastic surgeons and reconstructive surgeons are one and the same.

Cosmetic Surgeon vs. Plastic Surgeon

While the difference between cosmetic surgery and plastic surgery is fairly straightforward, the difference between cosmetic surgeons and plastic surgeons is a bit more complex.

“All board certified plastic surgeons are considered cosmetic surgeons,” says Richard Brown, MD, founder of Brown Plastic Surgery and author of The Real Beauty Bible. “But not all cosmetic surgeons are plastic surgeons.”

All board certified plastic surgeons in the United States are credentialed through the American Board of Plastic Surgeons (ABPS). If your surgeon cannot produce a certificate from the organization, they are not a board certified plastic surgeon.

The distinction boils down to experience. Plastic surgeons spend more time in residency training after medical school than cosmetic surgeons without a plastic surgery background. To be certified by the ABPS, plastic surgeons complete a minimum of six years in residency. The American Board of Cosmetic Surgery (ABCS), meanwhile, only requires one year of additional training post-med school and has no formal residency requirements.

“Many people call themselves ‘cosmetic surgeons,’ but that term is misleading as not everyone is a trained surgeon or trained in cosmetics,” says Melissa Doft, MD, founder of Manhattan’s Doft Plastic Surgery. “A better term is an ‘aesthetic surgeon,’ which refers to a plastic surgeon.”

As Dr. Doft explains, plastic surgeons spend six to eight years intensively studying surgery for five to seven days a week. “They are trained in general surgery, trauma surgery, reconstructive surgery, and aesthetic surgery,” she says of the specialty. “The certification requires a full-day written exam and a multi-day oral exam, as well as the presentation of every surgical case performed during their first year after training.”

Why Board Certification Matters

If you take one thing away from this article, let it be this: You, first and foremost, want to find a doctor who is board certified by the ABPS.

The ABPS is recognized by the American Board of Medical Specialties (ABMS), which is the gold standard for patient safety and health care in the U.S. The American Board of Cosmetic Surgery, meanwhile, is not an ABMS member board.

“The governing board above everyone is called the American Board of Medical Specialities. They are responsible for picking all of the sub-institutions that will then certify doctors in that specialty — meaning the American Board of Medical Specialties governs the American Board of Plastic Surgery, the American Board of Cardiology, the American Board of Internal Medicine, etc,” says Dr. Brown. “If those sub-entities are not a part of the American Board of Medical Specialities and someone tells you that they are certified by some other institution, they are not considered ‘board certified’ in America.”

Since state medical boards do not require doctors to be specifically trained in the surgical procedures they offer, any general practitioner (e.g. PCP, dermatologist, podiatrist, etc.) can obtain a "cosmetic surgeon" title. As such, their training can be as short as a few courses that cover a limited range of material because, as we’ve already learned, a residency is not required as part of the ABCS certification process.

“To me, this is one of the scariest areas of confusion,” warns Dr. Doft. “The American Board of Medical Specialities is the only board that is recognized by all doctors. It is the verification process to become an internist, surgeon, pediatrician, OB-GYN, and a plastic surgeon. This is the only board that counts. All others are not real, misleading, and not recognized.”

A cosmetic surgery certification alone will not guarantee a doctor has any plastic or reconstructive surgery background. And while it’s certainly possible for a non-board certified surgeon to place a breast implant or perform a rhinoplasty, it does not mean he or she will know how to do it well or be able to handle potential complications.

Nowadays, most hospitals will only accept plastic surgeons who have ABPS certification. “Because they are not recognized by the American Board of Plastic Surgery, ‘cosmetic surgeons’ do not have hospital privileges,” Dr. Brown explains. “If something happens to you in their office or center and you need to go to the hospital, they can’t take care of you because they do not have hospital privileges.”

How to Find a Plastic Surgeon

While board certification should be the first parameter you use to narrow down your search for a doctor, it’s not the only thing to consider. “Just because board certified plastic surgeons are board certified doesn’t mean they’re good surgeons,” Dr. Brown says. “Everyone who gets a driver's license isn’t a good driver, but they all pass the drivers test to get the license.”

It is important to find someone with proper training in cosmetic procedures — specifically the one(s) you desire. While plastic surgery residencies are rigorous, only a portion of the program is devoted to cosmetic surgery. Considering the provider’s fellowship training and clinical work will help determine who is right for you.

“Talk to people in the community that have been to that surgeon, or ask the surgeon’s office for clients that they can speak to,” says Dr. Brown. “Look at their before-and-afters. Meet with them and see if you like them and who they stand to be.”

While reviewing examples of their previous work is a good way to determine if the surgeon shares your aesthetic, Dr. Brown says the way a doctor (and his or her staff!) makes you feel is also important.

“Make sure they give you all the time you need to have questions answered. They should be humble, skilled, and have excellent bedside manner,” he shares. “Finally, their staff should also be amazing. The staff should be able to speak about the surgeon authentically and truly about who they are and the work they do.”

Dr. Doft agrees and says putting in the legwork to find the right provider will pay dividends. “A plastic surgeon is trained in the face and body,” she says. “I would only trust a plastic surgeon with a semi-invasive or invasive procedure. Do your research because surgical changes are permanent.”

The Takeaway

Because not all cosmetic surgeons are board certified plastic surgeons, it is important to check the credentials of your provider before proceeding with a treatment. Once board certification is established, taking the time to learn about a doctor’s experience, patient satisfaction rating, malpractice insurance, level of service, and overall aesthetic will ensure you receive the best care possible.