Plastic surgery is part of the ENT surgeon repertoire

Do ear surgeons perform facelifts? Absolutely!

And we perform nose surgery and throat surgery, too!

A recent article in the New York Times presented a scathing editorial on complications caused by poorly trained surgeons.  However, the implication of the title “Ear surgeons performing facelifts,” is misleading and overlooks the fact that a large portion of training in the specialty of ear, nose and throat surgery includes plastic and reconstructive surgery of the face, head and neck.

Otolaryngologists (ear, nose and throat specialists) are regional experts in the anatomy of the face and neck. After four years of college, four years of medical school, selection into one of the most competitive specialties in the U.S., and then another 5-6 years of surgical training, otolaryngologists are fully trained and qualified to perform cosmetic surgery above the shoulders.

The American Board of Otolaryngology – Head and Neck Surgery (ABOto)  is one of the oldest certifying agencies in the U.S., and one of 24 members of the American Board of Medical Specialists (ABMS). Twenty five percent of the examination is devoted to facial plastic surgery. Other topics include surgery of the ears, nose, throat and neck, except for the spine. This broad training in the basic anatomy and physiology of this area makes otolaryngologists as much experts in facial plastic surgery as are general plastic surgeons, who devote a good portion of their training to cosmetic and reconstructive surgery of breasts, hands and other body areas.

ENT surgeons with additional training and experience in facial plastic surgery may be additionally certified by the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS). Like many well-respected specialty societies, the ABFPRS is not one of the original 24 ABMS societies.  However, the two-day written and oral examination is as strenuous as the examination of any of the ABMS member boards. The ABFPRS as been recognized as equivalent to the ABMS societies in every state where use of the term “board certified” has been challenged.  The ABFPRS requires a minimum of two years experience after residency and a detailed peer review of over 100 facial plastic surgery cases before allowing candidates to take the examination.

In general, there are numerous specialties performing “plastic surgery.” Pediatric urologists correct botched circumcisions and reconstruct abnormal genitalia. Gynecologists lift sagging uteruses and tighten leaking bladders. Orthopedic surgeons perform delicate hand reconstruction. Oral and maxillofacial surgeons perform complex reconstructions of the facial skeleton. And yes, ear, nose and throat surgeons perform facelifts, eyelid surgery, and nose jobs.

Undoubtedly, there are surgeons reaching beyond their training and expertise. For an ENT physician to perform a tummy tuck, as mentioned in the New York Times article, is unconventional. The prudent consumer should consider not only board certification, but also training and experience when choosing a cosmetic surgeon. Ask for recommendations from friends and physicians. Ask your physician about his or her current experience with the procedure.  If you’re not comfortable, get a second opinion.

Mike Armstrong is an otolaryngologist at Richmond Facial Plastics.

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  • Gregory A. Buford

    Great article and very good points.

    I have a number of ENT/Facial Plastic Surgery colleagues who do very nice elective procedures in the head & neck.  And are they qualified to do so?  I would definitely say yes.  The problem is when they try and extend this expertise to the breast and body. 

    While I would agree that the number of ENT’s performing Tummy Tucks is relatively low, it is not zero.  Nor is the number of ENT’s performing breast augmentations.  And that is where the consumer should take heed. 

    This is not a turf war but merely an exercise in pointing out who is trained to do what.  A weekend course does not make an expert.  And while most of us emerge with a modicum of experience from our residencies and fellowships, we emerge with far more below our belt than those who simply observe another “surgeon” during these training sessions.

    As a national speaker and consultant, I have had the opportunity to train literally hundreds of medical professionals in various procedures including the safe and effective use of facial injectables.  And when I do, I emphasize to each and every one of them that a single course does not make them an expert and that the course is merely a starting point. 

    My suggestion?  I propose that there be far more transparency with regards to our training and expertise and that this be available to our prospective clients.  Caveat Emptor in this day and age and so it is only fair that the consumer knows just exactly how much of an expert we really are.

    Thanks again for your insight!

    Warmest regards,
    Gregory A. Buford, MD FACS

  • S.C.

    It really should be noted that that a general ENT surgeon will not likely have very good results when performing facelifts as they are not really adequately trained to do so in residency. There’s a good reason many ENTs pursue a craniofacial plastics fellowship. I dont believe the NYT article mentioned fellowship training and this article didnt make a clear that typically a fellowship is needed as well. Obviously the basic training is there in residency but rarely are non-fellowship trained ENT specialists performing extensive face-lifts.

    Personally, if I had to get a face-lift, I’d go to an ENT specifically trained in craniofacial plastics.

  • Kyle Keojampa

    I am surprised at the lack of research and verification of the statements of the article as suggested by the title.

    Lets get the facts straight.  There are two ABMS (American Board of Medical Specialties) boards that certify physicians in plastic surgery within the head and neck.  The American Board of Otolaryngology and the American Board of Plastic Surgery have a shared plastic surgery within the head and neck certificate.  

    Additionally, the ABMS description of Otolaryngology clearly states that facial plastic and reconstructive surgery is a fundamental area of expertise.  I agree that an Otolaryngologist has no business in doing tummy tucks or plastic procedures not pertaining to the head and neck.

    See the below information from the ABMS for more information

  • Melinh Pham Keller

    I wouldn’t even consider a facelift if I couldn’t do it with an otolaryngologist, so the question of whether they are “qualified” to do facelifts is really puzzling to me.  I’m not a doctor, but you don’t have to be to assume that the makeup of the face and it’s intricacies and complexities are extensive and a map of nerves and muscles.  I’d be personally weary of the plastic surgeon who can perform a tummy tuck then move on to my facelift.  Conversely, I wouldn’t see an ENT surgeon to get my tummy tuck, nor would I expect one to offer it to me.  If your plastic surgeon offers you a menu, I’d run. 

  • Dr. S Prendiville

    The comments posted by Dr. Buford (actually a classmate of mine at Georgetown) are representative of the good relationship between most Facial Plastic Surgeons and Plastic Surgeons.  Although I agree that an Otolaryngologist should never perform a tummy tuck, the article written by Ms. Murphy dug up a historical put-down of Surgeons trained in my profession.  Everybody in my generation of medicine knows that Otolaryngology residency spots went to high achievers, and everybody in Otolaryngology knows that Facial Plastic Surgery fellowships are extremely competitive.  Ms. Murphy uses the term “ENT” as if she were describing a chiropractor or dentist as opposed to a highly trained Surgeon. Her article should receive major corrections or even be retracted and I have sent a letter to the Editor requesting this.

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