Facial Plastic Surgeons are otolaryngologists

by | May 3, 2024 | Nose and Sinus Blog

rhinoplasty and facial plastics in australia

Our society has been advocating for the regulatory body in Australia (AHPRA) to recognize the inherent training of all otolaryngologists in facial plastic surgery. In fact, otolaryngologists are one of, if not the main, providers of facial plastic surgical care to the Australian Community. However, in response to the complaints of a minority of plastics surgeons,  we assume under some false sense of turf-protection, AHPRA has interpreted the national law in a way that prevents otolaryngologists accurately advertising their skills and training. Otolaryngologists are proud of their unique training and even when they make their primary specialist training clear and unambiguous, AHPRA still has issue with us using the term “facial plastic surgeon’.

This is personal for me, as I often need to reconstruct the nose, teeth, upper jaw, face and forehead as part of my work to remove tumours and reconstruct noses. But closer still, I had a brother-in-law who struggled to see the right specialists due to the inability of otolaryngologists to clearly advertise their training. My brother’s general practitioner was also equally confused. This story was reported on February 7th, 2024 in a publication “Strict rules leave patients confused” from the Australian press: https://apple.news/ABUS6ztxDRzC8FJHUm17itQ

 

Otolaryngologists are ‘facial plastic surgeons’ and need to ensure that the Australia public know that when they seek expertise and training from a surgeon skilled in this area, then otolaryngologists should be identifiable.

My colleagues published an outstanding history of facial plastic surgeons in the AJO recently and can be downloaded here.

 

  1. Otolaryngologists (OHNS) have “as good” or better understanding of head,neck and facial anatomy than any other speciality group

 

  • There are no other speciality groups that cover the knowledge, anatomy, understanding of disorders and the surgical management of conditions of the Head, Neck and Face as OHNS.

 

  • There are 8 modules in the OHNS curriculum, 3 deal with Universal professional skills, patient management & social determinants of health.  All the 5 surgical modules are focused on Head, Neck and Face.

 

  1. Otolaryngologists are one of main contributors to facial plastic and reconstructive surgery societies around the world
  • International Federation of Facial Plastic Surgery Societies (IFFPSS) is an organization that represents and supports facial plastic surgeon societies around the globe
    • Key to certification is: Have earned prior certification by the National Examining Body in Otolaryngology/Head and Neck Surgery or Plastic Surgery.
  • Facial Plastic Surgery is nationally and internationally recognised, and a well-defined training path,  as a surgical specialty in its own right (https://www.abfprs.org/, https://eafps.org/ , http://www.iffpss.org/) and encompasses many international societies, not limited to:
    1. American Academy of Facial Plastic and Reconstructive Surgery
    2. ASEAN Academy of Facial Plastic and Reconstructive Surgery
    3. Australasian Academy of Facial Plastic Surgery
    4. Canadian Academy of Facial Plastic and Reconstructive Surgery
    5. Colombian Society of Facial Plastic Surgery and Rhinology
    6. Ecuadorian Society of Rhinology and Facial Surgery
    7. European Academy of Facial Plastic Surgery
    8. Facial Reconstructive and Cosmetic Surgery (India) FRCS(I)
    9. Pan Asia Academy of Facial Plastic and Reconstructive Surgery
    10. Taiwan Academy of Facial Plastic and Reconstructive Surgery
    11. The Brazilian Academy of Facial Plastic Surgery
    12. The Korean Academy of Facial Plastic and Reconstructive Surgery
    13. The Mexican Society of Rhinology and Facial Surgery
    14. Venezuelan Society of Rhinology and Facial Plastic Surgery

 

  1. Otolaryngologists are one of the main contributors to facial plastic and reconstructive surgery research

 

Of the list from Google Scholar on all “plastic” journals includes 3 of the top 20 dedicated to facial plastics and the majority of these by OHNS authors . OHNS contributing significantly  to two others.  Note this list includes everything including maxillofacial, ophthalmic and dermatology, thus the ‘facial plastic surgery’ by OHNS weighting is very large:

 

Publication h5-index
1. Plastic and Reconstructive Surgery 63 81
2. Journal of Cosmetic Dermatology 48 66
3. Aesthetic Surgery Journal 46 64
4. Plastic and Reconstructive surgery. Global Open 42 56
5. Journal of Plastic, Reconstructive & Aesthetic Surgery 41 50
6. Aesthetic Plastic Surgery 38 48
7. Dermatologic Surgery 37 49
8. Journal of Craniofacial Surgery 34 47
9. Annals of Plastic Surgery 34 44
10. Clinics in Plastic Surgery 30 43
11. Ophthalmic Plastic & Reconstructive Surgery 30 43
12. JAMA Facial Plastic Surgery 29 40
13. Journal of Reconstructive Microsurgery 28 33
14. Facial Plastic Surgery Clinics 27 37
15. The Cleft palate-craniofacial journal 27 32
16. Microsurgery 25 38
17. Seminars in Plastic Surgery 25 35
18. Facial Plastic Surgery 23 34
19. Journal of cosmetic and laser therapy 23 33
20. Annals of Maxillofacial Surgery 22 40

 

  1. There is cross speciality collaboration as general plastic surgeons invite otolaryngologists to speak and provide education at their meetings about facial plastic and reconstructive surgery

 

  1. https://aestheticplasticsurgeons.org.au/event/2019-asap-conference/ (Jacono)
  2. https://www.plasticsurgeryhub.com/blogs/asaps-conference-australasian-society-of-aesthetic-plastic-surgeons-annual-conference/ (Davis)
  3. https://www.surgeryforfacialaesthetics.com.au (Jacono) again in 2024

(and otolaryngologists often invite plastic and reconstructive surgeons to speak at our conferences)

  1. NSW public hospitals recognize plastic and reconstructive surgery of the head/neck and face as part of the “core” scope of practice for otolaryngologists:

 

Model Scope of Clinical Practice – Otolaryngology – Head and Neck Surgery

 

Core training includes: “plastic and reconstructive surgery of the nose, face and ears along with the skin of the head and neck”

 

https://www.schn.health.nsw.gov.au/files/attachments/final_model_socp_for_otolaryngology_1.1_-_26_sep_2023_0.pdf

 

  1. The father of modern day facial plastic surgery is Sir Howard Gillies – an otolaryngologist from New Zealand

 

The Australia Society of Plastics Surgeons list him as such in their book(1):

“Outstanding among surgeons who honed their skills at that time was Harold Delf Gillies, an ear nose and throat surgeon originally from New Zealand, who would eventually become known as ‘the father of plastic surgery’.

This is why the field of “facial plastic surgery” is entrenched in otolaryngology both in Australia and internationally.

 

  1. Sir Howard Gilles, the recognised father of facial plastic surgery and the subsequent discipline of plastic surgery, was an otolaryngologist

 

Sir Howard Gilles, is the recognised father of facial plastic surgery and his understudy Benajamin Rank established contemporary Australian Plastics Surgery as its own discipline.(2)

 

  1. The otolaryngology surgery curriculum is dedicated to surgery of the head/neck and face

 

All 5 surgical competencies of the ONHS curriculum deal with surgery of the head/neck and face. In the OHNS curriculum,  one section is entiurely dedicated to “Facial Plastic (and reconstructive) Surgery” but all sections have plastic and reconstructive components to their subjects.

 

  1. Plastic surgeons attend events by otolaryngologists to learn about facial plastic surgery

 

Plastics surgeons are one of the main groups of attendees that register for the AAFPS events:

https://www.aafps.com.au/education/

In North America and Europe, Plastics and Otolaryngologists work together to provide the education, trained and care in facial plastic surgery.

Other examples of different surgical groups working together include “Spine Surgeons” who have contributions  from both orthopaedic and neurosurgical trained surgeons. Another example is “Hand Surgeons” who come from both plastics and orthopaedic training background.

Otolaryngologists see plastic surgeons and maxillo-facial surgeons as collaborators in the provision of care to the Australian community and not as competitors. This collaboration is what will provide outstanding care to the Australian public.

 

  1. The American college of surgeons, Royal College of Surgeons England and the Royal Australasian College of Surgeons recognise that otolaryngologists are trained in facial plastic surgery

 

For the American College of Surgeons: “Head and neck oncology and facial plastic and reconstructive surgery are also fundamental areas of expertise for the otolaryngologist.”

(https://www.facs.org/for-medical-professionals/education/online-guide-to-choosing-a-surgical-residency/guide-to-choosing-a-surgical-residency-for-medical-students/faqs/specialties/#:~:text=The%20American%20College%20of%20Surgeons,surgery%2C%20otorhinolaryngology%2C%20pediatric%20surgery%2C)

For the Royal College of Surgeons England: “ENT surgeons also deal with cancers in this region of the body. Many will undertake plastic and reconstructive work on the face”

https://www.rcseng.ac.uk/careers-in-surgery/trainees/foundation-and-core-trainees/surgical-specialties/

Royal Australasia College of Surgeons – have multiple statements including the attached media release : “Facial cosmetic surgical procedures are also a component of surgical training in Ear, Nose and Throat Surgery (Otolaryngology Head & Neck Surgery (OHNS)).” (https://www.surgeons.org/News/media-releases/College-of-Surgeons-welcomes-review-of-cosmetic-surgery)

And RACS media statements about poorly trained ‘cosmetic practitioners’ usually includes plastics and OHNS equally represented (https://www.surgeons.org/en/News/media-releases/Media-statement-from-RACS-and-specialty-societies-on-cosmetic-surgery)

Figure below: The structure of surgical training and societies in Australia (the specialist societies (ASPS and ASOHNS are responsible for training):

 

otolaryngologists are facial plastic surgeons

 

 

  1. Beasley M. Australian Society of Plastic Surgeons 1971-2021. Hornsby, Australia: Ice Cold Publishing; 2022.
  2. Solish MJ, Roller JM, Zhong T. Sir Harold Gillies: The Modern Father of Plastic Surgery. Plast Reconstr Surg. 2023;152(1):203e-4e.