Who Should Perform Facial Cosmetic Procedures?: Turf Battle Between Core and Non-Core Physicians

Dr. Papel has not seen any serious complications in his practice. He said that the worst that could happen is that filler or Botox could be injected into the wrong place on the face, but if this happens, it resolves spontaneously within a few months without the need for further correction.

Problems can arise if the wrong filler is used, however. Filler companies market directly to physicians, and these companies don’t check the credentials of physicians who buy lasers, fillers, and other products, Dr. Baker said. Dr. Baker also emphasized the need to use quality products. Non-core physicians should take care to purchase Botox and fillers that are specified for human use from quality suppliers, he commented. He gave an example of a physician who used veterinary filler on his patients and one of them had to be hospitalized for acute care. That physician lost his license, Dr. Baker said.

Weighing in on this issue was Margaret Weiss, MD, a board-certified dermatologist in private practice at the Maryland Skin and Vein Institute, LLC, in Hunt Valley, Md., and Assistant Professor of Dermatology at Johns Hopkins Medical School, who has performed thousands of cosmetic procedures over the past 24 years. Industry’s actions are worrisome. They will sell filler or devices to physicians without checking how and where those products will be used, she said.

Invasive Procedures

Experts interviewed for this article agreed that invasive procedures represent unsafe territory for non-core physicians. Blepharoplasty, rhinoplasty, and surgical face lifts should be performed only by board-certified surgeons-either a facial plastic surgeon, otolaryngologist, or plastic surgeon, Dr. Papel said. He believes that the numbers of non-core physicians who try to do invasive procedures are small. It’s uncommon in my practice that we have to correct facial surgery gone awry, he noted.

Dr. Baker considers hair removal and peels as risky. He has heard anecdotes about complications from surgical face lifts and blepharoplasty performed by dermatologists, but has not had to correct these procedures himself. You need a residency in plastic surgery or otolaryngology to perform more invasive procedures, he said.

Dr. Moran believes that it is not that rare for invasive procedures to be done by nonspecialists without proper training. However, she also said that some facial plastic surgeons offer invasive surgical procedures for other parts of the body. I don’t agree with that either, she noted.

Remedial Measures

What, if anything, can be done to stem this trend? Dr. Hilger said the key is education-for both patients and physicians. Patients need to know about what cosmetic procedures entail and have reasonable expectations. They also should ask about the doctor’s credentials. He recommended a patient-physician consultation prior to undergoing a cosmetic procedure, giving the patient time to reflect and make a decision.