GRAVITYA FIELD GUIDE TO THE FACE

By Masoud Saman, MD · About the author & editorial process

How to choose a surgeon

The operation is only part of the decision. Most of the outcome is decided by who you choose and how the consultation goes. Here is how to read both.

The two credentials that mean expertise

Two groups of surgeons are trained to a genuine expert standard for this operation, and they arrive by different routes. Facial plastic surgeons come through otolaryngology, head and neck surgery, and then a fellowship devoted entirely to the face and neck. Plastic surgeons come through plastic surgery, training across the whole body, with aesthetic surgery a large part of it. These are distinct credentials with separate training pathways and separate certifying boards, and neither is shorthand for the other. Both sit at the top of the field. The line that matters is not the one between them. It is the line between these two and everyone else offering the operation.

Seal of the American Board of Facial Plastic and Reconstructive Surgery
Facial plastic surgeonCertified by the American Board of Facial Plastic and Reconstructive Surgery, following residency in otolaryngology, head and neck surgery, and a fellowship in the face and neck.
Seal of the American Board of Plastic Surgery
Plastic surgeonCertified by the American Board of Plastic Surgery, following residency in plastic surgery, with training across the whole body.
Facial plastic surgeonPlastic surgeon
ResidencyOtolaryngology, head and neck surgery (five years), training confined to the head and neckPlastic surgery (six years integrated, or general surgery then plastics), training across the whole body
FellowshipFacial plastic and reconstructive surgery, one year, entirely face and neckOptional; aesthetic, craniofacial, hand, microsurgery, and others
Certifying board (US)American Board of Otolaryngology, Head and Neck Surgery; additionally the American Board of Facial Plastic and Reconstructive SurgeryAmerican Board of Plastic Surgery
ScopeFace, head and neck onlyFace plus breast, body, hand, reconstruction

Both pathways produce excellent facelift surgeons and both produce mediocre ones. The point of the distinction is honesty about training, not a ranking. What you want is someone whose practice is concentrated on the face, whichever route they took to it. "Double board certified" in this context usually means the two otolaryngology and facial plastic boards above, or plastic surgery plus a second board; ask which.

What "board certified" does and does not mean

In the United States, any licensed physician can legally perform cosmetic surgery, and can call themselves a cosmetic surgeon. Board certification by a board recognized by the American Board of Medical Specialties (or, for facial plastics, the ABFPRS) means the surgeon completed an accredited residency in that specialty and passed its examinations. Certification by a board that is not recognized in this way, however official its name, does not tell you that. Look the board up.

Questions worth asking

  1. Which board certifies you, and in what specialty?
  2. How many facelifts do you perform in a year, and what proportion of your practice is the face?
  3. Which technique would you use for me, and why that one rather than the alternatives?
  4. What would you do differently for someone ten years younger or older than me?
  5. What is your own hematoma rate, and your own rate of nerve weakness?
  6. Where is the operation done, is the facility accredited, and who gives the anesthetic?
  7. What does my recovery look like week by week, and when would you judge the result?
  8. What happens if I need a revision, and what does that cost?
  9. Can I see photographs of patients with a similar starting point, at one year or later, not six weeks?
  10. What would you tell me not to do?

What a good consultation feels like

Warning signs