Certification matters : What certifications?

[Debra]

So looking up docs on certificationmatters.org and seeing both Spiegel and Mardirossian are certified for otolaryngology. Looking that up, it seems to be ENT stuff. Is that what everyone refers to when saying craniofacial surgeon?

Also, looking up Deschamps-Braly, he is only certified for Plastic Surgery and not the ENT stuff. But everyone says he was trained by Dr. O. Looking Dr. O up, he's also only Plastic Surgery certified.

So which of these matter? plastic surgery or the ENT stuff? Shouldn't these docs have both or something?

[BellaSwan]

Basically, as I understand it, craniofacial surgery is a sub specialty of both plastic surgery and maxillofacial surgery, so Dr O being a plastic surgeon who went the dental route (correct me if I'm wrong) and sub specializing in craniofacial surgery makes him very qualified. If DB then studied under O, maybe that was his craniofacial residency? I'm not sure how these things work tbh. Someone correct me if I'm wrong, I don't want to make assumptions. However, one thing seems clear: the more aggressive surgeons produce more dramatic results. They don't seem to be worried about increased risks. They know what they are doing. They also seem to be craniofacial surgeons. The ones who produce less dramatic results or don't perform type 3 at all like to talk about the dangers of it and how unnecessary it is, claiming everything else is just as good etc.. They also coincidentally seem to be uniformly less qualified.

When it comes to making dramatic and attractive changes to the jaw, the surgeons seem to have some sort of maxillofacial background as well. You might disagree, but so many ffs surgeons leave the chin at a weird, tall angle from the mandibular angle resulting in a strange banana face effect.

Why is it preferable that your surgeon is either a maxillofacial and craniofacial aesthetic surgeon, or to visit different surgeons with different backgrounds for optimal results? This is why. In my opinion. But if you enjoy what someone like Spiege or Zukowski does, good for you. Go there. I don't have to like their ffs results for you to feel validated nor does anyone else. Of course some of their patients look good. I think Raiden Quinn (youtuber and Zukowski girl) looks female, completely. But I definitely feel, looking at her face from a critical perspective and knowing how expensive Ffs is, her money would be better spent elsewhere as I would never have paid the money I did for mine, just to look si liar to every other patient. But again, that's a preference.

[Lagertha]

Surgeons get craniofacial training (usually 1 year residency) through advanced craniofacial fellowship programs, with extremly high requirements for acceptance such as broad surgical expertise and years of adequate experience in general surgery and plastic-reconstructive surgery. Such programs are not to be confused with a lot more common oral&maxillofacial programs which could include some aspects of craniofacial surgery. These craniofacial programs are usually led in pediatric (80-90% pediatric 10-20% adult) environment treating high number of congenital craniomaxillofacial abnormalities, trauma reconstructions, etc.. through which a participant directly learn the advanced surgical (craniofacial, orthognatic, maxillofacial) skills on a case by case basis in the operating room.
You can find about surgeons qualifications through their website, and then use google to research what kind of program they went through...

[BellaSwan]

Lagertha how you know this? Why you so knowledge?

[Lagertha]

I just spend way too much time on the internet ...

[myfairlady49]

So looking up docs on certificationmatters.org and seeing both Spiegel and Mardirossian are certified for otolaryngology. Looking that up, it seems to be ENT stuff. Is that what everyone refers to when saying craniofacial surgeon?

Also, looking up Deschamps-Braly, he is only certified for Plastic Surgery and not the ENT stuff. But everyone says he was trained by Dr. O. Looking Dr. O up, he's also only Plastic Surgery certified.

So which of these matter? plastic surgery or the ENT stuff? Shouldn't these docs have both or something?

[ Way too much time on the internet ?  Yes ! ]

Debra, Bella & Lagertha - -

Frustrating at how convoluted it can be !

Lagertha's description is pretty good.

I have spent a lot of time studying the details in the web sites on the training, and then researching these credentialing issues.   There sure is a lot of smoke and mirrors stuff apparently designed as marketing hooks for the casual internet user.

My understanding of this is still limited,  but I think, as Lagertha suggests, that in order to do the normal full range of FFS procedures - - one needs to be trained in areas not fully covered by either regular ENT or Plastic Surgery programs.   

After medical school, plastic surgeon "residents" "see"  and "assist" in a limited amount of jaw surgery and they "see" and "assist" in a limited amount of cranial vault skull surgeries during their 5 or 6 year surgical training as "residents"  - -  but unless they go further and do a later full "fellowship" in those areas - -  their experience actually "doing" those surgeries is limited.   ENTs may not even see cranial vault surgeries during their training as ENTs.

Not sure, but it looks like the normal way to get trained as a craniofacial surgeon is that you have to first be formally trained as a plastic surgeon.  I do not think a max/fac dental background person can even apply for one of the currently recognized one-year long craniofacial programs (unless they also went to med school and did a plastic surgery residency.)

Dr. O describes the essential three areas of training in his book - -  A) plastic surgery; B)  craniofacial surgery and C) jaw (orthognathic) surgery.   His training history is set out in one page at the back of his book.
Dr. O had the jaw surgery training from dental / max fac training.  Then he switched and did medical school and plastic surgery.  Then went to Paris for a year of craniofacial surgery with the guy that invented craniofacial surgery. 

Dr. DB did the same training, but in a different sequence:  full plastic surgery,  then the full one year craniofacial fellowship at Children's hospital in Wisconsin,  then did more craniofacial and aesthetic surgery in Paris, and then did the jaw surgery training in Switzerland.

From his web site history,  that was all done before Dr. O asked him to take over O's  practice.   They both ended up trained in all three specialties, which is probably one of the primary reasons Dr. O asked him to take over his practice.

ENTs are trained in Ear -  Nose & throat surgery.   Mostly soft tissue surgery,  re-setting broken nose or correcting septum deviations, opening up sinus internally, and maybe some mandible surgeries.   That is not cranial vault remodeling of the skull and facial bones. The most complex stuff they commonly do are radical neck dissections for people with head and neck cancer.  Plastic surgeons are also trained to do those, but I think they generally defer to the ENTs who do those more commonly.

At present, I think the only way (at least in N America) to meet the minimum requirements to get admitted into one of the handful of formally recognized one-year long  craniofacial training programs (Fellowship) is to first be trained as a plastic surgeon.   

There really just are not any legitimate "short cuts"  to get the necessary training and experience.  THEN - - after all of that - - someone has to show you how to use all of that training to do the very unique and specific FFS stuff. 

[BellaSwan]

Thank you so much for that in depth description! I believe maxillofacial surgeons can do craniofacial residencies, but that's just according to my research online.

Anyway, yet another reason I'd only to go Doctors O, DB, VdD, DiMaggio, and Suporn. I'm not sure I'd even go to Suporn for anything but forehead (and srs, duh). And I'm not sure if I can remember Dimaggio's chin/jaw work to be of any particular standard. Anyone care to remind me of his abilities?

[Lagertha]

And I'm not sure if I can remember Dimaggio's chin/jaw work to be of any particular standard. Anyone care to remind me of his abilities?

Quite hard to judge chins and jaws because he likes to publish after photos taken 14 days after surgery (taken during last check-up).. if you ignore bruisings and bloody eyes, you can still have a fairly good idea of upper facial area.. but it's a little more tricky to tell about still very swollen chins and jaws.
There are pics that are taken later by patients themselves... where you likely need to take into account selfie-pic lense deformation because of close distance... patients sending the surgeon pics they like the best.. etc...   

[Debra]

Thanks for all the good info everyone.

So if someone only has ENT experience / certification and not Plastic Surgery, is that a red flag ? For FFS?

[Lagertha]

Thanks for all the good info everyone.

So if someone only has ENT experience / certification and not Plastic Surgery, is that a red flag ? For FFS?

No. If they have adequate training in either oral-maxillofacial surgery or orthognatic surgery and years of working experience in plastic surgery, they can be more than enough competent in performing standard procedures regularly used in FFS. They can be far more competent than an average local plastic surgeon who spent his career injecting botox, fixing eyelids, raising eyebrows, augmenting boobs and removing fat under the chin.

[BellaSwan]

But honestly, I would shy away from any surgeon who kept warning about the dangers of a type 3 procedure, or who says you look female enough for it to not "warrant the risk" whatever. Truth is, 90% of us need type 3. That's is not a random number - that is how many of Dr O's patients need them. I know some surgeons and patients want to say that's all about money, but I think their results speak for themselves.

Dr Suporn states he uses Type 3 in around 85% of the cases. In situations where other would burr, this is what he does:

Forehead Contouring/Resetting. This procedure involves contouring by shaving across the forehead and brow bossing/orbital rims followed by performing a controlled fracture of the anterior wall to realign (reset) it to a more posterior position. This proprietary technique, developed by, and exclusive to Dr. Suporn is applied in about 10% of cases.

Why the evolved technique? Because while burring alone, in the few cases where it's preferable, is still sub-optimal. Just do yourselves a favor and at least recognize this.

[radialan]

Plastic Surgeons are MD specialists who perform medical procedures designed to alter or restore the body's shape or form.  Though cosmetic or aesthetic surgery is the most well known kind of plastic surgery, plastic surgeons are also trained in reconstructive surgery, craniofacial surgery, hand surgery, microsurgery, and in the treatment of burns.  In most countries, plastic surgeons must complete medical school followed by a residency in general surgery and finally a residency in plastic surgery.  Due to these two separate residency requirements, a doctor can't be a board-certified plastic surgeon until several years have passed after medical school.

Oral & Maxillofacial Surgeons specialize in treating both the hard and soft tissues of the mouth, jaws, and face.  In the United States and Canada, oral and maxillofacial surgery is considered to be a subspecialty of dentistry.   Oral surgeons are most familiar to Americans as the doctors who surgically remove wisdom teeth and implant certain types of dental hardware. But, they are also trained in other procedures such as treating the misalignment of the jaws & teeth as well as correcting cleft lips & palates.  Doctors who pursue this specialty must first complete dental and/or medical school, depending on the country, followed by an oral & maxillofacial residency program.  In the United States, both dentists and doctors may train to be board-certified oral & maxillofacial surgeons.

Craniofacial Surgeons treat deformities of the jaws, head, neck, face, teeth, and associated areas.  These surgeons are typically plastic surgeons, oral & maxillofacial surgeons, or otolaryngologists (ENT's).  Once they are board-certified in one of these specialities, they then choose to practice as a "fellow" under another surgeon or surgeons who already specialize in craniofacial surgery.  The length of the fellowship varies and most countries do not have a board that oversees this.

[BellaSwan]

Thank you for that informative post, radialan! I still stand by what I said though in my post above yours

[Debra]

lots of good info. Thanks everyone!

[myfairlady49]

Plastic Surgeons are MD specialists who perform medical procedures designed to alter or restore the body's shape or form.  Though cosmetic or aesthetic surgery is the most well known kind of plastic surgery, plastic surgeons are also trained in reconstructive surgery, craniofacial surgery, hand surgery, microsurgery, and in the treatment of burns.  In most countries, plastic surgeons must complete medical school followed by a residency in general surgery and finally a residency in plastic surgery.  Due to these two separate residency requirements, a doctor can't be a board-certified plastic surgeon until several years have passed after medical school.

Oral & Maxillofacial Surgeons specialize in treating both the hard and soft tissues of the mouth, jaws, and face.  In the United States and Canada, oral and maxillofacial surgery is considered to be a subspecialty of dentistry.   Oral surgeons are most familiar to Americans as the doctors who surgically remove wisdom teeth and implant certain types of dental hardware. But, they are also trained in other procedures such as treating the misalignment of the jaws & teeth as well as correcting cleft lips & palates.  Doctors who pursue this specialty must first complete dental and/or medical school, depending on the country, followed by an oral & maxillofacial residency program.  In the United States, both dentists and doctors may train to be board-certified oral & maxillofacial surgeons.

Craniofacial Surgeons treat deformities of the jaws, head, neck, face, teeth, and associated areas.  These surgeons are typically plastic surgeons, oral & maxillofacial surgeons, or otolaryngologists (ENT's). Once they are board-certified in one of these specialities, they then choose to practice as a "fellow" under another surgeon or surgeons who already specialize in craniofacial surgery.  The length of the fellowship varies and most countries do not have a board that oversees this.

Radialan,   I may be wrong,  but at least in the U.S., so far as I can tell from researching the net, the two formally trained craniofacial people doing FFS both came out of approved plastic surgery programs. Do you know of any that came out of  max/fac or ENT programs that completed one of the recognized one-year craniofacial fellowship programs ?

[Paula1]

This is a fascinating read, very educational but also very scary.

Gee, we girls sure are a bright lot although sometimes I doubt my intelligence ...  LOL ... 

The surgeon that I went to in London in October 2014 is a world renowned craniofacial facial surgeon and a delightful man.

But his ideas on FFS were different to say the very least and as a result I need further surgery.

Just goes to show this whole area was ( back in 2004 when I researched FFS ) and still is - a minefield ...

[radialan]

Radialan,   I may be wrong,  but at least in the U.S., so far as I can tell from researching the net, the two formally trained craniofacial people doing FFS both came out of approved plastic surgery programs. Do you know of any that came out of  max/fac or ENT programs that completed one of the recognized one-year craniofacial fellowship programs ?

FFS is a niche set of procedures performed by a small group of surgeons around the world.  We can almost name them all if we sit down with a pen and paper.  I think that you are correct that the two U.S. based FFS surgeons using the craniofacial title came from the plastic surgery side.  It is a little more difficult to determine who is entitled to call themselves a Craniofacial Surgeon because there is no board that defines what merits the title.  There is, however, a medical society in the United States that grants membership to Craniofacial Surgeons based on certain criteria that they have established, but it's not really board certification and they don't appear to offer a searchable database of members.  But, I think that a one year fellowship in an approved program is among their requirements.

As some here have pointed out, board certification should play a role in your decision.  But, which certification?  As a general rule of thumb, patients seeking FFS should probably start with verifiable board certification in plastic surgery and then consider a variety of other factors in arriving at a decision.  These other factors could include:  FFS experience (number of years performing FFS on a regular basis), references, before/after photos, location, pricing, and any additional speciality training that you consider important.  Each patient will have to determine for themselves how much weight to give to each of these qualifiers based on her own needs.

[StartingOver]

Truth is, 90% of us need type 3.

In other words, "if you're MtF and you haven't had this procedure done, there's a 9/10 chance that you won't pass"?  Can you not see how insulting and untrue this is?

We need to stop spreading this "fact".  It's true only in relation to Dr. Ousterhout's practice and experiences, and in no way accurately reflects:

1 - the needs of the MtF community as a whole; there's clearly no way that 90% of us "need" to have this procedure performed, although many of us may benefit from it;

2 - the aesthetic abilities of other competent plastic surgeons, many of whom can produce feminine results without performing such an invasive procedure on almost every patient; and

3 - the clear facial characteristics of cis women, most of whom have nothing even coming close to the foreheads produced by the type 3 procedure.

Spreading this "fact" is detrimental for numerous reasons.  It causes people who otherwise pass rather nicely to doubt themselves because they haven't had a type 3 forehead procedure.  It causes some people to undergo invasive surgery which isn't actually necessary.  It causes great stress for many a beautiful MtF girl who can't afford the surgery and who thinks it's necessary because of the "90% of us need it" fallacy.  It invalidates the fine work of FFS surgeons who don't typically perform the procedure.  It makes MtF girls who have had FFS but not a type 3 procedure feel like they have made the wrong choice.

Is it a powerful technique for those of us who have prominent brows?  Absolutely.  Is having it done a "need" for 90% of those of us in transition?  Of course not.  While I have no issue with the idea that a type 3 procedure is sometimes the only way to reduce a prominent brow enough to get it into female ranges, it's time to stop taking the 90% statistic out of context and pretending that it applies across the board when in reality its scope is rather limited.

I have no issue with stating that 90% of MtF girls could benefit from a type 3 forehead procedure (even though observation suggests otherwise, but that's another post for another day).  It's the way that it's being portrayed as an absolute need that is clearly untrue.

[AnonyMs]

This may not be directly related to the discussion, but I know someone who was turned down by Dr Suporn for FFS. He said she didn't need it and refused to do it. It does suggest that whatever he does do is "necessary", and that he has decent ethics.

[deeiche]

Regarding the 90% quote.  Are you sure it's not 90% of the patients who came to Dr O needed Type III?  I would find that more accurate.  MtF who don't need FFS don't see surgeons for evaluation.