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

2. Disclosures Lattice Biologics Scottsdale, AZ
Scientific Advisory Board Member

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

4. Plastic Surgeons

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

7. 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

8. “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

11. (It’s quite a lot actually)
Scope of Practice
(It’s quite a lot actually)

12. 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

13. 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

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

15. 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

16. 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

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

18. 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

19. 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

20. 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

21. Common Conditions/Complaints Warranting Plastic Surgery Referral

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

23. 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

24. Post Bariatric Body Contouring
Increasing criteria by insurances