Eyelid Surgery and the
Myth of "Board-Certification"
In perusing on-line and printed material from practices promoting cosmetic eyelid surgery, you will undoubtedly encounter the term "Board Certified." In reference to selecting a blepharoplasty surgeon, how important is this?
Likewise, you will occasionally run across a doctor claiming to be "Board Certified in Ophthalmic Plastic Surgery," which may sound even better. Is it?
To make sense of such issues requires that you first understand at least a little about the requirements for a physician to become "Board-Certified."
There are twenty-four officially recognized American "Boards", all of which are sanctioned members of their venerable parent organization known as the American Board of Medical Specialties (ABMS). Any other non-ABMS "Association" or "Society" of doctors is not a true "Board" in the formal sense, even if the group chooses to incorporate that word into its name (in medical circles, such groups are sometimes referred to as "bogus-boards").
While certification requirements vary widely Board to Board, for a physician to become certified by an ABMS Board, he or she must first complete an approved residency in the applicable specialty, receive recommendations attesting to professional and ethical competence from professors, pass written and oral examinations, and have already been in practice for a year or two. How hard is this? Unlike the "Bar examination" for new attorneys, the overwhelming majority of physicians who complete a residency achieve Board-Certification status on the first attempt.
In essence, then, the designation "Board Certified" means that a physician possessed a passable level of competence in a particular medical specialty at the commencement of his or her career. While some Boards now require "recertification" after a given period (for instance, ten years), the process is not particularly rigorous. For the majority of physicians now in practice, however, the title holds for life.
So, what does being "Board-Certified" really say about the current levels of competence and skill and aesthetic judgment of a cosmetic surgeon now ten or twenty years out of medical school? The answer seems rather obvious.
Of course, the real subject at hand is cosmetic eyelid surgery, and so the logical next question is: What are the requirements for certification and recertification by the American Board of Ophthalmic Plastic Surgery. The answer: None. Why not? Because no such Board exists.
Okay, but then what are the requirements for certification by the American Board of Cosmetic Eye Surgery? Answer: Ditto. Why not? No such ABMS Board exists.
But wait a minute! What about all of the doctors offering to perform cosmetic eyelid surgery who claim to be "Board Certified"? Are they misstating their credentials?
Not in most cases. Once a doctor has achieved Board-Certification status in the specialty of Allergy, Dermatology, Neurosurgery, Family Practice, or any one of the twenty-four ABMS Boards, he or she is indeed "Board Certified," and it is perfectly legal to so advertise.
One main point should now be clear. In reference to cosmetic eyelid surgery, a non-specific claim of "Board Certified" means precious little. What matters more is WHICH Board certified the physician (and even this means less and less with time in practice).
At this point, the raging waters in the river of cosmetic surgery grow rather, well--murky. What has emerged from this murk is a "turf war."
The American Board of Plastic Surgery (and assorted other organizations that require ABPS certification) would have consumers believe that its members are pre-eminently qualified to perform any and all types of cosmetic surgery on any and all parts of the body. Other ABMS Boards (and their related professional associations) beg to differ with this concept and contend instead that their particular members can do just as well (or even better) in performing the cosmetic procedures that are a part of their respective specialties. Some attorneys would point out, however, that only physicians certified by the American Board of Plastic Surgery are formally recognized by the ABMS as having the qualifications and skills necessary to perform "cosmetic surgery".
Such strict interpretation creates a dilemma (and, in our opinion, is not at all consistent with the reality of the situation). In fact, much of the major innovation in the field of modern cosmetic surgery has come from practitioners who were not plastic surgeons. For example, face lift was invented by a dermatologist, liposuction by a gynecologist, and many of today's more advanced facial procedures by ear-nose-throat specialists. Who knows more about the skin than a dermatologist? So, which set of "Board-Certified" physicians should you favor when looking for that special someone most qualified to perform a cosmetic laser resurfacing of your face?
There is no pat answer to such questions, except to say that using "Board Certification" as your sole (or even major) criterion in selecting a cosmetic eyelid surgeon may not be your best strategy.
Returning to the subject of cosmetic eyelid surgery, most people would agree that the two most applicable ABMS Boards are the American Board of Plastic Surgery and the American Board of Ophthalmology. However, other Boards also have relevance as well--for instance, the American Board of Dermatology and the American Board of Otolaryngology, both of which have some members well trained in cosmetic eyelid surgery.
To muddy the muddied waters even more, you may wish to know about an organization named the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). The ASOPRS is not an official Board by any means. Still, to achieve "fellowship" status in the ASOPRS requires far more eyelid-specific training than that required by any ABMS Board. While the ASOPRS screens its members carefully, it too has limitations worth noting. For instance, only Board-Certified ophthalmologists may be admitted, a policy that excludes the other specialties (including plastic surgeons) and seems inappropriately exclusionary if the organization wishes to represent the crème de la crème in the world of cosmetic eyelid surgery. Also, the main requirements (as far as we can tell) for continued membership seems to be attendance at an occasional meeting and the payment of annual dues. As with ABMS Boards, the issue of continuing competence after a surgeon finishes training and progresses through his or her career is not addressed.
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