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Do you think a line should be drawn to determine what aesthetic/cosmetic procedures ophthalmologists perform?
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Ophthalmologists draw their own line for best patient care
Yes, a line should be drawn. Oculofacial plastic surgeons have already drawn the line and will continue to do so. But the line we draw is not an arbitrary landmark on the face or a restriction to surgery on particular segments of the human body. The line we draw is to always maintain the highest regard for our patients, to strive to achieve the safest and best outcomes for our patients.
 Julian D. Perry |
Ophthalmologists not only currently perform the entire spectrum of facial aesthetic surgery, our group has pioneered many advances in this field as well. Ophthalmologists have contributed to better patient care along the entire spectrum of facial aesthetic surgery, including rhytidectomy, forehead lifting, cheek lifting, injectables, laser treatment and, yes, even blepharoplasty. Board-certified ophthalmologists routinely teach surgeons in a variety of disciplines on topics ranging from face-lift to rhinoplasty to blepharoplasty.
Ophthalmologists have access to some of the best facial aesthetic surgical training through American Society of Ophthalmic Plastic and Reconstructive Surgery-sponsored fellowships. The typical ASOPRS fellow acquires significant hands-on surgical experience in an array of oculofacial procedures.
Each surgeon should draw his or her own line at the level of their own particular qualifications, based on training, skills, expertise, experience and comfort level regarding a particular procedure or area of the body. Ophthalmologists have drawn this line boldly and firmly, to allow our patients access to safe and proficient care regarding all aspects of facial aesthetic surgery.
Julian D. Perry, MD, is an OSN Oculoplastic and Reconstructive Surgery Board Member.
Qualifications should be assessed on individual basis
This is a question asking for a yes-or-no answer on a subject that represents a continuum with multiple shades of gray. First, what is an “aesthetic/cosmetic” procedure? The main indication that a procedure is cosmetic in nature is the intent for which the procedure is being applied. For example, a midface-lift to rejuvenate the appearance of prominent nasolabial folds is cosmetic in nature. The exact same procedure done to address a paralytic ectropion exacerbated by midface descent is rehabilitative and preserves the health and functioning of the eye. Does this mean an ophthalmologist qualified to do the procedure should draw a line to only perform it for the latter indication?
 John D. Ng |
The source of the question posed likely comes from the overlap of training and common skills acquired across multiple specialties such as ophthalmology, otolaryngology, oromaxillofacial surgery, dermatology and plastic surgery. Designation of specialization and subspecialization is only one guide for an individual’s qualifications. The individual training and experience gained by each resident or fellow can vary greatly even within specialties to the point that training in a procedure in one specialty such as ophthalmology can far exceed the same training in a program of a specialty traditionally know to be qualified to perform said operation.
Therefore, in areas of significant training overlap, legislating or drawing lines based only on what an individual surgeon is labeled as being a specialist in is fraught with problems. Who is qualified to perform a procedure may be better determined on an individual basis by credentialing committees critically looking at that individual’s education, training, surgical experience and ability. Assessing appropriate training, experience, competence, motivation and compassion is a standard that can penetrate the obscurations of bypassing scrutiny through advertising or legislation to expand or restrict scope of practice to fulfill other motivations.
John D. Ng, MD, is an OSN Oculoplastic and Reconstructive Surgery Board Member.