Why We Limit Our Practice to Rhinoplasty and Cosmetic Surgery of the Face and Neck Exclusively

Why “Super-Specialization” Is So Important For You, The Patient.

Everybody wants the most specialized doctor – especially when it comes to his or her face. There are several reasons. I would like to share with you the reasons why I chose to limit my practice to cosmetic surgery of the face and neck, exclusively. It was a very important decision.

  • Plastic surgery of the human body is too broad and complex for any one doctor to master all portions of it.
  • In surgery, as in many disciplines in life – the best results occur when a team of highly skilled and specialized individuals perform the same procedure(s) on a nearly daily basis. Repetition breeds perfection, like a ballet or an orchestra.

Here’s what some leaders in surgery have said about the importance of “super-specialization” within surgery:

“Plastic surgery now has so many subspecialties it is impossible for anyone to do everything equally well.”
Robert M. Goldwyn, M.D.
Professor of Plastic Surgery, Harvard University
Writing in Beyond Appearance: Reflections of a Plastic Surgeon.

“Let us be thankful that the day of the all-around surgical specialist is done! Surgery is not advanced by that type of activity…no matter how talented the surgeon, he cannot do equally as good work in all of these provinces.”
Owen H. Wangensteen, M.D.
Professor of Surgery, University of Minnesota
In a paper delivered before the American College of Surgeons.

“It’s known that surgeons who do large numbers of a procedure get very good at that procedure.” Lloyd Nyhus, M.D. Professor of Surgery, University of Illinois

A Short History of “Super-Specialization”

The history of surgery is one of continual progress made through deliberate narrowing and specialization by surgical practitioners. Only 85 years ago, there were no specialties within surgery itself. All surgery, from brain to toe, was done by “a surgeon”. And at that time, the “surgeon” had no formal specialty training after completion of medical school. But the trend today in medical education is to train doctors who will be more skillful in a relatively limited portion of the body. A “jack of all trades” and, hence, “master of none” is not satisfactory in today’s highly specialized medical world. This is why, even within a recognized specialty such as plastic surgery, there are great benefits to the public when a surgeon narrows his scope and chooses not to perform most operations within the broad specialty. According to AMA News, several years ago, a survey of plastic surgeons showed that only 12% of their work was performed upon the face and neck for cosmetic purposes. Therefore, those who do limit their practice to cosmetic surgery of the face and neck represent a small portion of those who practice within the broad field of plastic surgery.

There are parallels to such “specialization within a specialty”, in other areas of surgical practice. For example, within orthopedic surgery there exist surgeons who perform only hand surgery and other surgeons who perform only spine surgery, and there are even orthopedic surgeons who specialize only in knee surgery! Everyone recognizes that eye surgeons have become extremely specialized since some perform only cataract surgery while others limit their practice to surgery of the retina.

In The 60′s, A Major Change In Medical Education

Over 35 years ago, as a medical student, it became obvious to me that modern medicine was expanding and improving very quickly, primarily because of specialization. Hand surgery, burn surgery, heart surgery, artery and vein surgery were beginning to be separated from other procedures and practiced as a “single specialty”. Then, I realized that if I were to excel at my chosen work, I would have to be as specialized as possible. It was easily recognizable that the more specialized the doctor, the greater the likelihood of good results for the patient. Hence my decision to pursue a course of education and training that would allow me to bring a high degree of skill to my patients. I did not want to be the “jack of all trades, master of none”. On the contrary, I wanted to excel in the performance of just a few procedures. In short, I wanted to be a “superspecialist” because it would be better for my patients.

That meant ultimately limiting my practice to six or fewer procedures within a specific region of the body. A select group of operations considering that one local hospital recognizes 136 different procedures that are considered within the realm of “plastic surgery”

A Personal Decision is Made

Since I enjoyed the face and neck work most, I decided to forego “body surgery”. No hand surgery, no breast or body sculpturing. No treatment of burns. No correction of birth defects or major cancer surgery. While these services were important, certainly my colleagues might likewise specialize in those.

As my plan evolved, I felt it was best not to perform accident or Emergency Room work, as they would detract from my best ability for those elective scheduled procedures that I preferred to perform. I didn’t want to be up all night in an Emergency Room and not be well rested for someone’s face lift the next morning. I would be left to do what I enjoy doing most – improving people’s appearance.

Patients Now Seek The Most Specialized

In summary, as I jokingly tell my patients: “I am sorry but we don’t do body and fender work”. And patients understand, instinctively, the importance of choosing a doctor whose focus matches their specific need. Now, with increasing frequency, we hear patients say: “I am glad I came to you. I wanted a cosmetic surgeon who doesn’t ‘do everything’, who specializes in only the face”.

The public has endorsed super-specialization by increasingly patronizing the more specialized and focused doctors, within the broad field of plastic surgery. For example: According to the American Society of Plastic and Reconstructive Surgeons*:

“Facial plastic surgeons perform 33% more facelifts than plastic surgeons”. The Society further noted: “Facial plastic surgeons seem to be the main rhinoplasty (cosmetic nasal surgery) positions, performing almost three times as many rhinoplasties as plastic surgeons…”.

So, patients “get it”. They sense, intuitively, that a “super-specialist” is more likely to perform – for them – at the highest level, rather than the “I do everything” doctor. That mastery comes only with focus, dedication and long study. No different than that required for greatness by a piano virtuoso or a football place kicker.

“Dr. Kotler, What If I Need A Procedure You Don’t Do?”

Having practiced in this community for over 31 years, I have a “Rolodex®” filled with names of practitioners who are as specialized in what they do as what we do. Patients appreciate being referred to the most highly qualified consultants. Often, as appropriate, we can work together, at the same surgical session, to provide all services necessary both efficiently and economically.