Training for a Board Certified Surgeon

Q: What sort of training does it take to become a Board Certified Facial Plastic Surgeon?

A: Five years of specialty training are required prior to board certification. Specifically, to achieve certification by the American Board of Facial Plastic & Reconstructive surgery, a surgeon must complete the following AAFPRS surgical training following successful completion of medical school:

  • Accredited residency training program after medical school that provides additional expertise in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and cosmetic surgery.
  • Previous certification by one or both of the basic boards in the field: The American Board of Plastic Surgery or the American Board of Otolaryngology.
  • An additional 2-day examination focused solely on facial plastic and reconstructive surgery.
  • Peer review presentation of at least 100 surgical cases in facial plastic and reconstructive surgery for each of the previous two years prior to applying for certification.

Anesthesia Questions

Q: What type of anesthesia is administered during surgery?

A: Dr. Macdonald thoroughly discusses anesthesia options with you at your consultation appointment. Monitored intravenous (IV) sedation—also called “twilight sleep”—is Dr. Macdonald’s preferred anesthesia for most aesthetic surgical procedures.

IV anesthesia is generally safer and is associated with fewer after effects (prolonged sedation, nausea) than general anesthesia. You are essentially asleep throughout the entire procedure with no recollection of it much beyond the starting of your IV. You are not paralyzed and a breathing (endotracheal) tube is not required.

For long, complicated aesthetic surgeries that entail complex or multiple procedures, Dr. Macdonald may recommend using general anesthesia. This commonly occurs in the case of facelifts, which are often combined with procedures such as brow lifts, eyelid rejuvenation, neck lift or liposuction. A general anesthetic is always available upon request; similarly, IV sedation may be requested for facelift surgery as well, if desired.

Typically, surgical cases where general anesthesia is used are performed in a hospital environment as 24-hour post-op monitoring is always recommended following major surgery.

Facial Aging Factors You Can Control

Q: What are the primary factors that contribute to the aging appearance of your face and what can you do to slow the process?

A: Your aging face is characterized by wrinkles that develop over time from three factors: gravitational (postural), animation (from emotional expression), and textural (from sun or other environmental damage).

Postural wrinkles develop as dermal connective tissue under the skin deteriorates over time. Animation wrinkles develop from commonly repeated facial expressions. Textural wrinkles arise as skin resilience and elasticity fades with the accumulating effects of sun damage.

The wrinkled effect on the skin of your aging face is exacerbated by a withering of your soft fatty tissue beneath the skin. Loss of soft tissue depletes the facial fullness representative of youth.

Further impacting the aged look of your face is the discoloration that often develops from an increase in pigmented lesions, veins spots, and potential skin conditions such as melasma or rosacea.

Cosmetic facial rejuvenation surgery can permanently improve skin wrinkling and volume loss associated with aging. In addition, deep laser resurfacing most effectively treats textural wrinkles, sun damage, and other skin discolorations.

If you prefer a non-surgical approach, both laser therapy and cosmetic injectables can effectively rejuvenate your face. The only downside to the non-surgical approach is that your benefits are not permanent and must be repeated to sustain the desired look.

The benefit of surgery is the permanence of its desired effect. Although your face continues to age in the future, you always look better than you would have otherwise if you had not done the surgery at all.