Several writers from a national newspaper recently took an in-depth look at the world of cosmetic surgery. What their report reveals is that the field is complex, not well regulated, in flux, and muddied generally by terminology and titles that obfuscate rather than clarify professional qualifications.

Unfortunately, much of the work that is done in-house at doctors' offices and at so-called medical spas rather than in hospitals and clinics with first-rate facilities also results in surgical error and medical harm to patients.

A few select comments immediately underscore that the debate that is emerging concerning the proliferation of cosmetic practitioners across the country and whether they should be more closely regulated is both impassioned and marked by widely varying attitudes and opinions.

"It's out of control," says Florida state Senator Eleanor Sobel, vice chair of a health regulations committee in a state where a comparatively large number of low-cost and highly marketed cosmetic surgeries are carried out.

Sobel doesn't mince words. "It's all about people doing a job they're not qualified to do," she says.

That view is overly damning, counters Michael Will, president of the American Board of Cosmetic Surgery, an organization that certifies its members without requiring that they undergo residencies in plastic surgery.

Will says that it is not necessary that doctors have special expertise in plastic surgery to be competent cosmetic surgeons. His organization certifies oral surgeons and other doctors for cosmetic surgery, and he notes that, "A favorable outcome is certainly possible and likely for the majority of patients" who are operated on by doctors trained only in general surgery prior to doing a cosmetic surgery fellowship.

Will's view certainly has critics. One plastic surgeon notes that "there is little oversight over who is qualified to perform complicated new procedures." Another says that "everyone's pretending to be a plastic surgeon."

Several botched cosmetic surgeries, along with details of numerous lawsuits, have been highly publicized recently and have led to a deepening discussion of board certification in cosmetic surgery and what that really means. We will address that subject in our next blog post.

Related Resource: USA Today, "Lack of training can be deadly in cosmetic surgery" Sept. 13, 2011