Plastic Surgery: Beyond the Hype

Thursday, December 2, 2010

Board Games

A lot is made of board certification in medicine, and especially in plastic surgery. But what does board certification even mean? Boards are organizations that develop educational and professional standards for physician specialists. The “parent” board is the American Board of Medical Specialties (ABMS) and it oversees the 24 medical-specialty member boards (Plastic Surgery, Dermatology, Radiology, OBGYN, etc.). To be “board certified” means that the physician has met the criteria of the medical-specialty board and is a “specialist” in that particular field. Currently any physician can perform cosmetic surgery procedures without the need to be “board-certified”. For that matter, I could perform neurosurgery if I could find someone who would let me! Which I never will.

Board certification means the physician has gone the extra mile in their training, and has attained a certain level of expertise in that specialty. Where things get confusing for the public, is that there are currently three boards out there “certifying” cosmetic surgeons: The American Board of Plastic Surgery, The American Board of Facial Plastic and Reconstructive Surgery, and The American Board of Cosmetic Surgery. The American Board of Plastic Surgery is the only one of the three that is recognized by the ABMS.

Bored yet? I didn’t think so. How did I know that? Because THIS is the stuff YOU need to know. If the entire world is a board, do they all carry the same credibility when selecting a physician? I will break it down for you and let you decide…

To be certified by the American Board of Plastic Surgery, a physician must have completed a minimum of 6 years of surgical training, of which 2 to 3 of those years are spent in plastic surgery alone. They also have to pass both a written and oral examination.
Only physicians certified by the American Board of Plastic Surgery may become members of the American Society of Plastic Surgery, which is why I mentioned earlier that all plastic surgeons are cosmetic surgeons, but not all cosmetic surgeons are plastic surgeons!

To be certified by the American Board of Facial Plastic and Reconstructive Surgery, a physician must be board certified in either Otolaryngology (ENT: Ears Nose and Throat), have a minimum of 5 years of surgical training or plastic surgery, and had 100 operative reports accepted by a peer-review committee. They also have to pass a written and oral examination.

To be certified by the American Board of Cosmetic Surgery, a physician must be certified in one of many medical specialties (OBGYN, Radiology, Anesthesiology, or Oral Surgery for example), completed 300 Category 1 CME Credits in Cosmetic Surgery (equals 300 hours of training - about 6 weeks), and passed a written and oral examination.

Being a surgeon involves a lot more than knowing which end of a scalpel to hold. It involves technical skills and judgment, which is not easily mastered in a matter of hours or weeks. It is also my opinion that board certification is only a start, and not an end point.

Monday, November 22, 2010


Greek Statue
I get asked all the time what kind of plastics I use in plastic surgery. The answer is none! The “plastic” in plastic surgery actually comes from the Greek word “plastikos,” which means to shape or to mold. This is what plastic surgeons do. We shape or mold tissue. We spend our entire surgical training learning how to manipulate tissue whether it is with a scalpel, a syringe, or a laser. The surgical techniques and principals learned apply equally to cosmetic or reconstructive surgery. There are those that would have you believe that cosmetic surgery is a unique surgical discipline, but that is disingenuous at best and misleading at worst. To put it simply, it’s not true. The distinction between cosmetic and reconstructive surgery is largely an artificial one, initiated by the insurance companies to determine what a covered benefit is. Remember, from a previous episode that insurance companies are in the business to make money, not to take care of YOU.
If your needs happen to get met, consider that a bonus.

Cosmetic surgery is considered surgery on “normal” body parts and therefore, not covered by insurance. On the other hand, reconstructive surgery is surgery on “abnormal” body parts and therefore, is covered. But try telling the boy with excessive breast development, or the child with the protruding ears, who both get teased unmercifully by their classmates, that their “condition” is cosmetic, while the sagging upper eyelids on their grandmother is reconstructive.

The surgical principals and techniques that go into lifting a sagging breast (not a covered benefit), are the same ones used in reducing a large breast (a covered benefit, at least for now). There are some insurance plans out there that no longer consider breast reduction a covered benefit. But try telling that to the woman with the 38-DD breasts, who has chronic neck and shoulder pain, gets heat rashes, can’t exercise and can’t find a comfortable bra, that her condition is considered “cosmetic”! How can this be? It is because the insurance companies are run largely by men, and ENTIRELY FOR PROFIT.

Putting a face back together after a car accident and rejuvenating a face require the same knowledge of anatomy and principles of tissue manipulation. Plastic surgery is more than abnormal vs. normal; it’s about making people feel better about themselves. People often ask me why I went into plastic surgery. I am often also asked what my favorite procedure is, and my answer is always the same: the one that makes someone happy!

Monday, November 15, 2010


Pick Me

What happened? How did we go from Marcus Welby, M.D. to Dr. House? From Dr. Kildare, to mediagenic doctor clowns in “muscle” scrubs? From the fun-loving “MASH” doctors whose bottom line was taking great care of our soldiers, to “Nip/Tuck” and cocaine-filled breast implants? What’s next? Doctors in loud suits looking like used car salesmen? What happened?

Let’s look back 20 years when “managed care” came on the scene. Yes, it has been 20 years since managed care came about with the promise of affordable, quality healthcare. Not only is it less affordable than ever, but YOUR out-of-pocket expenses are higher than ever with increased deductibles and higher co-pays.

So where does all that money go? To the healthcare providers, right? To the doctors that are treating YOU? Nope! I am paid roughly half of what I was paid 20 years ago for performing the exact same surgical procedures. Doctors are working twice as hard to stay “even”. However, the bulk of the money goes to the middle men! The CEO of Anthem Blue Cross’ salary is over $13-million! By and large, doctors are relatively smart people and are increasingly turning to alternative ways to make a living. That is why your family practice doctor wants to do to your laser hair removal, your dermatologist wants to do your facelift, and your OBGYN wants to do your mommy-makeover! “Managed care” has forced them to give up the jobs they were medically trained for, and pushed them out into the field of cosmetic surgery where they can make more money hustling YOU for procedures their original medical discipline never trained them to do. The dilemma for you is should you let them perform procedures on YOU?

Reason number 2: the recession! Money is tight. Fewer people can afford health insurance, which translates to less people going to the doctor or putting off non-life threatening procedures like hysterectomies or colonoscopies. People who are worried about their jobs are not out getting nipped and tucked! With a smaller financial pie to work from, some doctors are going to greater lengths to get your business! Desperate times bring out desperate behavior and guess who gets stuck holding the bag…YOU!

And lastly, let’s face it. Another reason things have gotten this way is because of you. You want to believe and trust that the doctors out there want what is best for YOU! The sad reality of things is that MEDICINE IS A BUSINESS where profit margins all too often trump patient needs. Don’t believe me? Think about how often a doctor tried to talk you out of something, rather than into something.

Wednesday, October 27, 2010

Plastic Surgery: Beyond the Hype Intro

Welcome to Plastic Surgery: Beyond The Hype. I'm Dr. Marcel Daniels, a Board Certified plastic surgeon and I practice at Image Plastic Surgery in Long Beach, California.Wild West!

I love what I do for a living. But I hate the business I'm in. Sound like a contradiction? Hardly. I take my obligations to my patients very seriously. However, far too many of my peers, do not. In my nearly 20 years of private practice, I have seen the field of plastic and cosmetic surgery devolve into a "Wild West" of "gunslingers" all claiming to be the "fastest draw," and who routinely over promise and under deliver. All at the expense of you, the trusting, public!

Well, to paraphrase the Peter Finch character in the movie "Network," "I'm mad as hell and I'm not going to take it any more!" This blog is written with the intent of helping to educate you, the public, on: who is selling you what, how they are doing it, and what steps you can take to ensure you get quality plastic surgery for your hard-earned money. The views expressed here are entirely my own and are not endorsed by the American Society of Plastic Surgery or the American Board of Plastic Surgery... but they should be.

Plastic surgery used to be discrete; something only rich and famous people had, and certainly not something anybody talked about. As I mentioned before, now it's full of colorful "gunslingers" bragging about how many notches they have on their scalpel. It's an increasingly crowded field where pretty much anybody can call themselves a cosmetic surgeon. The cries of "pick me!" get louder, and the marketing is often deceptive and misleading. It's the Wild West all over again and YOU, the public, are the townsfolk getting rustled and hustled!

Monday, October 25, 2010


Dr. Marcel Daniels

Welcome to Plastic Surgery: Behind the Hype. This video blog is courtesy of world respected plastic surgeon, Dr. Marcel Daniels, and is aimed at the re-education of America as it relates to understanding and undergoing plastic surgery procedures. Plastic Surgery: Behind the Hype focuses on enlightening people on how to pursue plastic surgery wisely and safely.
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