Plastic Surgery: What a Primary Care Physician Should Know William A. Wallace, MD FACS April 30, 2015

Disclosures Lattice Biologics Scottsdale, AZ Scientific Advisory Board Member

Key Points Plastic Surgeon misconceptions Plastic Surgery Scope of Practice Common patient complaints warranting a Plastic Surgery evaluation

Plastic Surgeons

Misconceptions A Cosmetic Surgeon is a Plastic Surgeon Board Certifications/Memberships are all the same

Plastic Surgeon American Board of Medical Specialties recognized Certification Board American Board of Plastic Surgery Only ABMS specialty recognized to perform cosmetic procedures Maintenance of Certification required Requires minimum of 3 years of General Surgery Training Additional 2-3 years of Plastic Surgery Training American Society of Plastic Surgeons Membership requires Plastic Surgery Board Certification Focuses on all aspects of Plastic Surgery American Society of Aesthetic Plastic Surgeons Focuses on Aesthetic Plastic Surgery

“Cosmetic” Surgeon American Board of Cosmetic Surgery Not Recognized by ABMS Require only one year of “surgical training” Limited Apprenticeships observing other Cosmetic Surgeons Limited examination Generous application fee Due to pressure are increasing requirements for new members American Academy of Cosmetic Surgeons Require Board Certification by any board deemed appropriate by AACS Trustees

(It’s quite a lot actually) Scope of Practice (It’s quite a lot actually) http://www.plasticsurgery.org/for-medical-professionals/legislation-and-advocacy/health-policy-resources/plastic-surgery-clinical-privileges.html

Misconceptions 2009 Poll of residents in Internal Medicine, Pediatrics, Family Practice 1117 respondants Asked to pick which specialist(s) performed which surgery Eyelid: (1st Plastic Surgery, 2nd Ophthalmologist) Cleft Lip/Palate (1st OMFS, 2nd Plastic Surgery) Facial Fracture (1st OMFS, 2nd Plastic Surgery) Hand Surgery (1st Orthopedic Surgery, 2nd Plastic Surgery) Rhinoplasty (1st Plastic Surgery, 2nd ENT) Skin cancers of the face (1st Derm, 2nd Plastic Surgery) Plastic Surgeons perform all these procedures and more

Skin Neoplasms, Diseases, and Trauma Benign and malignant lesions of the skin and soft tissue Reconstructive grafts and flaps Laser therapy for vascular lesions Hemangiomas et. al. Scar revision Keloids Hypertrophic scars Unsightly scars Skin Resurfacing for acne, rhytids, traumatic scarring Chemical peel Laser skin resurfacing Mechanical dermabrasion

Surgery of the Breast Breast reconstruction Breast reduction Breast biopsy Congenital anomalies (Poland’s disease, et. al.) Mastectomy (subcutaneous and simple) Breast augmentation

Treatment of Facial Diseases and Injuries Maxillofacial fractures including the mandible Acquired or congenital deformities of nose, ear, jaw, eyelid, lips, palate Eyelid/Eyebrow Ptosis Prominent Ears Cleft Lip/Palate Craniofacial surgery Skull base surgery Facial deformity and wound treatment Tumors of the head and neck

Surgery of the Hand and Extremities Soft-tissue wounds and congenital abnormalities of the hand and upper extremity fractures Congenital abnormalities of the bones of the hand, wrist and distal forearm.  Carpal tunnel syndrome (endoscopic and open) Dupuytren's contracture Surgery for rheumatoid arthritis Tumors of the bones and soft tissues

Reconstructive Microsurgery Microvascular flaps and grafts  Replantation/revascularization of upper & lower extremities & digits Reconstruction of peripheral nerve injuries Hand/arm transplants Face transplants

Reconstruction of Congenital and Acquired Defects of the Trunk and Genitalia Chest and abdominal wall reconstruction Sternal necrosis s/p CABG Component separation for loss of abdominal domain Surgical closure of pressure ulcers Vaginal reconstruction Repair of penis deformities Gender reassignment

Complex Wound Healing and Burn Treatment Initial burn management Including Emergency Room Assessment and Critical Care management Acute and reconstructive burn treatment Early debridement and grafting Reconstructive scar revision

Aesthetic Surgery Body contouring Facial contouring Including Post Bariatric Facial contouring Breast augmentation Breast lift (mastopexy) Aesthetic rhytidectomy Aesthetic rhinoplasty Aesthetic blepharoplasty Subcutaneous injections/Botox/filler material Skin peeling and dermabrasion Vein injection sclerotherapy Liposuction Endoscopic cosmetic surgery Laser therapy for vascular and cutaneous lesions

Common Conditions/Complaints Warranting Plastic Surgery Referral

Skin Scar Conditions Neoplasms Keloids Hypertrophic Scars Burn Scars Lipomas/Sebaceous Cysts Skin Cancers Suspicious Moles

Breasts Reduction of Macromastia/Gigantomastia Back Pain, Neck Pain, Shoulder Pain Headaches Shoulder grooves from bra straps Improvement in 90% of symptomatic patients Reconstruction after mastectomy or lumpectomy Immediate Delayed

Post Bariatric Body Contouring Increasing criteria by insurances