Ever Wondered How a Cosmetic Surgeon Acquires Their Skills? Here’s Why Cosmetic Surgery Fellowship Is a Critical Step.

Did you know there are no cosmetic surgery-focused medical residencies in the US and that fellowship training is how board certified cosmetic surgeons learn their craft? The reasons for this are twofold: first, US-based medical residencies are focused on medically necessary procedures. Secondly, cosmetic surgery is a constantly evolving field, and fellowship training in a busy cosmetic surgery practice is the best way to receive training in all the latest surgical techniques and medical aesthetic technology.

But not just any doctor can apply for an American Academy of Cosmetic Surgery-certified fellowship: surgeons must have already become board certified in another surgical speciality, such as otolaryngology or general surgery, to prove their mastery of standard surgical protocols and techniques. They must also commit to a year or more of full-time cosmetic surgery training to gain the experience required for ABCS board certification.

Now that you know why we have cosmetic surgery fellowships in the US, let’s hear from Dr. Sobel about his experience with his own cosmetic surgery fellowship.

What drew you to pursue a cosmetic fellowship?

My otolaryngology (head and neck plastic surgery) residency provided surgical training that could help me later develop as a cosmetic surgeon; however, it offered little practical experience in cosmetic procedures themselves. I enthusiastically assisted in the few cosmetic procedures required to graduate, but the bar was somewhat low and the allowed level of participation was peripheral. Similarly, on in-service and board examinations designed to test my knowledge, there were few questions dedicated to cosmetic surgery.

My concern over the inadequacy of cosmetic surgery training in hospital-based residencies was not unique. Many surgeons felt the same. For some, the solution was to simply limit their planned scope of practice to include only the reconstructive procedures in which we were fully trained. Alarmingly, others proceeded to offer cosmetic procedures even though they were patently underqualified to perform them.

A resident a few years ahead of me in my training program sought additional cosmetic training from faculty outside the hospital system, but this was frowned upon and required them to take vacation time. Still, my curiosity was piqued. Following in this resident’s scant footholds, I found myself instantly and deeply devoted to pursuing the tremendous volume of cosmetic surgery education, training, and experience available outside of the conventional hospital system.

With my eyes opened to the availability of extraordinary, high-quality postgraduate training in cosmetic surgery via American Academy of Cosmetic Surgery (AACS) programs, I completed my residency program with my vision trained on the future. After achieving my initial board certification, I applied to a strong cosmetic surgery training fellowship.

My pathway is far from unique: the very reason the AACS exists is to fill the cosmetic surgery training and education void left by the US residency training system. There was no dedicated academic society for ongoing education in cosmetic surgery, and the organization has helped fill that gap, as well. AACS fellowships and programs greatly benefit the public as they help ensure more patients have access to safe and effective cosmetic surgery.

Which cosmetic procedure most interested you during your fellowship, and why do you think that was?

Rhinoplasty was the first cosmetic procedure to enthrall me. My affinity for it started very early in residency training as I was learning functional, or airway-improving, rhinoplasty. One of the first meetings I attended during residency training was the Advances in Rhinoplasty Course in Chicago. This is one of the quintessential annual meetings in rhinoplasty very much steeped in the Dr. Eugene Tardy tradition. This was one of my favorite meetings ever and what so strongly caught my attention were the style of presentations. On each topic, surgeons would present their expertise and experience. This not only gave me great perspective on the nuances of each topic, but also a sincere excitement for the volume of personal development that would be required for me to excel at this collection of procedures.

During fellowship, I quickly realized that I would love every cosmetic surgery procedure as much as rhinoplasty and many procedures, indeed, share so much in common with rhino plastic principles. For example, the otoplasty procedure is predicated on similar functional and aesthetic dynamics as well as the composite needs of tissues that are based on cartilage and bony support. Even breast procedures, like the combined augmentation mastopexy, share geometric principles with rhinoplasty as well as adding the complexity associated with the need to obtain or maintain symmetry.

This not only gave me great perspective on the nuances of each topic, but also a sincere excitement for the volume of personal development that would be required for me to excel at this collection of procedures.

Who was your mentor, and what was their strength as a surgeon?

I had so many mentors; as many as 37 during residency, and five during fellowship. Chief among these, during fellowship, was my training director, Dr. Robert Alexander. Dr. Alexander was a pioneer in cosmetic surgery and renowned among dual-degree oral maxillofacial surgeons for excellence in cosmetic surgery.

I don’t use the word pioneer lightly: Dr. Alexander was one of the early experts in fat grafting procedures, delivering exceptional results back when these procedures were harshly criticized and even condemned by the American Society for Plastic Surgery as malpractice. Several plastic, facial plastic, dermatologic, and oral maxillofacial surgeons, among others, continued to develop this procedure safely and effectively despite such strong criticism. Dr. Alexander was in great company alongside those such as Dr. Sydney Coleman and Dr. Mel Bircoll. The ASPS has since reversed their position and fat grafting is considered an essential tool for facial rejuvenation, as well as body contouring.

Dr. Alexander was also a very early adopter of the use of platelet rich plasma and continues to be one of the world’s foremost experts in this important treatment option.

Simply stated, Dr. Alexander was, and continues to be, a genius in the field of cosmetic surgery. He is extraordinarily renowned for his depth and breadth of knowledge as well as his contributions to the specialty which continue today. Dr. Alexander continues to inspire me and I feel fortunate to have had such a stellar mentor.

After your previous medical training, what was the adjustment like to working with patients seeking cosmetic enhancement, from the consultation to post-operative visits?

My adjustment to the cosmetic consultation came about rather easily as I had strong mentors to lead me by example during my fellowship training program. I must say that, 13 years later, I continue to try to develop my consultative skill. As I explain to my patients, the procedures are quite straightforward, safe, and reproducible—however, it is the consultation where the true work of the procedure happens.

When executed effectively, cosmetic consultations feel good for both patient and cosmetic surgeon and open the door to an exceptional patient-surgeon relationship that is both rewarding and requisite for excellent results.

In consultations for purely functional medical procedures there is a back-and-forth, give-and-take, of information, explanation, and questions. In cosmetic surgery, the emphasis must be on an initial exhaustive and curiosity-driven listening to the patient’s motivations, desires, and expectations. Any treatment planning that happens prior to this paramount understanding is foolhardy and potentially dangerous. However, when executed effectively, cosmetic consultations feel good for both patient and cosmetic surgeon and open the door to an exceptional patient-surgeon relationship that is both rewarding and requisite for excellent results.

What surprised you about your cosmetic surgery fellowship year? What did your mentor do to prepare you to run your successful practice?

What surprised me most about my year immersed in cosmetic surgery fellowship training was how fast the time went. I was also impressed with the amount of rich information that could be imparted in that time—as an otherwise qualified surgeon, the pace of a fellow’s education can be fast, diving immediately into procedural nuances. (When you consider the breadth of cosmetic surgery, there is a lot to cover and it takes a well-designed fellowship program to do so; the AACS helps ensure this is the case with their fellowships.) My love for the subject also ensured the time sped by.

It is true that in the 13 years since, my practice has enjoyed much success, but I feel I am still learning how to run a practice. As I learned from my mentors, cosmetic surgical practices must be adaptable and always improving. As medicine should be practiced in an evidence-based manner, so should business. Cosmetic practices are not different from other small businesses and must learn to meet the needs, as they change over time, of the patients they serve. This is an aspect of cosmetic training that is hard to teach and something that I would have benefited from learning more about during training, so I make it a high priority for the fellows I train.

What I did learn during fellowship was to build my practice by first focusing on a narrower set of procedures with which I was most skilled and enjoyed the most. I now coach my own fellows to do the same: by obtaining safe, reproducible, and excellent results in favorite procedures, you derive a foundation of expertise to further develop your scope of practice as well as your reputation for excellent outcomes. From this foundation, each surgeon can develop a business centered on what they do and enjoy best. The reflection of the quality and enjoyment of your work will be plainly visible in the patients that you’ve had in your care.

What was it like to take the ABCS board exam after this hands-on fellowship?

I enjoyed the ABCS board exam thoroughly secondary to my preparation through fellowship and diligent reading. I felt it was a fair opportunity to demonstrate my knowledge of cosmetic surgery and a justly broad and deep oral and written examination format. I felt that the examination was a sincere welcome to a society of individuals committed to doing excellent ongoing training, education, and work in cosmetic surgery.

It has made me so proud over the years to hear my prior fellows share similar sentiments on completion of their examinations.

People often cite the benefit of a “community” among ABCS surgeons. How has this community supported you?

The American Board of Cosmetic Surgery and the American Academy of Cosmetic Surgery are two of the most friendly and welcoming organizations with which I’ve had the benefit of involvement. Nowhere else have I found the degree of pride matched with humility that engenders the inclusion of such diversity. Our camaraderie affords me the opportunity to pick up the phone and seek the expert advice of the highest quality surgeons worldwide anytime I should need it.

Aside from the exceptional meetings, educational content, and high bar of expectation, this community constantly reminds me that I am always working alongside others passionate in this field and that I am a small, but important, piece of a long and powerful tradition built on a need for excellence in cosmetic surgery. I am confident that we will together continue to lead the way in the field.