You don't like the way you look. Or at least you're not as attractive as you think you could be. To whom do you turn for help?
That depends on whom you ask.
Until recently, if you called the Orange County Medical Assn. and asked to be referred to someone who does face lifts or nose jobs, you would have been put in touch with a plastic surgeon certified by the the American Board of Plastic Surgery Inc.
Today if you call the association, you are as likely or more likely to be referred to a doctor certified by the American Board of Otolaryngology or the American Board of Cosmetic Surgery. This seemingly subtle change of policy is the result of a $8.6-million lawsuit filed by three Orange County physicians against the Orange County Medical Assn. in May of 1985 and quietly settled out of court for considerably less last summer.
"What we have is a turf war based on politics, economics and ego," said Dr. George Brennan, a plaintiff in the suit against the county association.
The controversy centers on who is best qualified to perform elective, or "unnecessary" plastic surgery--the kind that attempts to make someone within the range of normal appearance look better or younger.
Cut to the bare bones, the warfare involves three types of surgeons.
On one side of the battlefield are doctors represented by the American Society of Plastic and Reconstructive Surgeons--surgeons who deal with all aspects of plastic surgery throughout the body.
On the other side, though there is no formal alliance, are doctors represented by one or both of two other organizations, the American Academy of Facial Plastic and Reconstructive Surgeons and the American Academy of Cosmetic Surgery. The first group does plastic surgery of the face (either repairing deformed or injured faces, beautifying normal faces or doing both). The second loosely knit army of physicians does cosmetic or "appearance" surgery throughout the body.
"The cosmetic surgeon of the face will run circles around the general plastic surgeon," said Brennan, who serves as vice president of the American Academy of Facial Plastic and Reconstructive Surgery--an organization of otolaryngologists (ear, nose and throat specialists) general plastic surgeons, ophthalmologists, dermatologists and others who specialize in facial plastic surgery.
"My training and my vast amount of clinical experience make me and someone like me much better qualified (to do cosmetic facial surgery) than someone who does two noses a month. . . . General plastic surgeons are trying to usurp territory that simply does not belong to them," Brennan said.
Dr. Garry Brody, a Downey-based plastic surgeon and immediate past president of the California Society of Plastic Surgeons Inc. (the California branch of the American Society of Plastic and Reconstructive Surgeons) disagrees.
"We don't consider this a turf battle . . . ," Brody said. "What it amounts to is who regulates whom. They're suggesting that quantity relates to quality. But you can do the same thing badly a million times, and it doesn't mean anything. . . ."
Brody pointed out that a board-certified plastic surgeon is regulated by the American Board of Plastic Surgery, which in turn is a member of the American Board of Medical Specialties, an organization affiliated with the American Medical Assn.
The Academy of Facial Plastic Surgery is "a reputable group," and his group has no quarrel with it because it does not claim to credential people," Brody said.
But a "so-called" cosmetic surgeon, he continued, claims to be certified by the American Board of Cosmetic Surgeons, a "self-designated" board unrecognized by the American Board of Medical Specialties.
"Anyone can go to Sacramento and establish the American Board of . . . left-toe surgeons," he said. "I have no way of knowing, nor does the public, how carefully the American Board of Cosmetic Surgery is monitored or self-monitored. Whereas anyone can know how well the American Board of Plastic Surgery is monitored."
Another criticism is that the Cosmetic Board certifies "after-the-fact training," said Dr. Frederick Grazer, a Newport Beach plastic surgeon and the immediate past president of the American Society for Aesthetic Plastic Surgery--an affiliate of the American Society of Plastic and Reconstructive Surgeons.
Cosmetic surgeons respond that recognition by the American Board of Medical Specialties is "absolutely irrelevant." "No new board is recognized," said Dr. Frederick Berkowitz, an Orange County otolaryngologist, cosmetic surgeon and plaintiff in the county association's case.
In fact, Berkowitz contends that the Cosmetic Board's certification process is more stringent in some ways than the Plastic Surgery Board's.