Choosing Between a Plastic Surgeon and a Cosmetic Surgeon: Why Training Matters

When it comes to enhancing your appearance through surgery, choosing the right surgeon is one of the most consequential decisions you will make. Many people use the terms plastic surgeon and cosmetic surgeon interchangeably, but there are significant — and legally meaningful — differences between these two types of professionals, particularly regarding their training and qualifications. Understanding these differences is not about discrediting any individual practitioner; it is about knowing what questions to ask and what credentials to verify before trusting anyone with a surgical procedure.

Understanding the Distinction

Plastic Surgeon: Plastic surgeons are trained to perform both cosmetic and reconstructive surgeries. They complete a rigorous educational pathway that includes medical school, a general surgery residency, a dedicated plastic and reconstructive surgery residency, and often a fellowship to specialize in a specific area such as aesthetic surgery, hand surgery, or craniofacial surgery. This extensive training covers a wide range of procedures that restore function and appearance to various parts of the body — including post-trauma reconstruction, cancer reconstruction, and congenital abnormality repair, in addition to elective cosmetic procedures.

Cosmetic Surgeon: "Cosmetic surgeon" is a marketing term, not a medical specialty. It is not recognized as a defined specialty by the American Board of Medical Specialties (ABMS). The path to calling oneself a cosmetic surgeon can vary significantly — practitioners may be trained in dermatology, ophthalmology, otolaryngology (ENT), obstetrics and gynecology, or even internal medicine, and then pursue additional training in cosmetic procedures. Under current law, any licensed physician may legally perform cosmetic surgery regardless of their residency training. The depth and relevance of that additional training varies widely and is not standardized.

This distinction matters most when the procedure is complex, when complications arise, or when a revision is needed. A surgeon whose residency training centered on surgical anatomy and tissue handling at the level required for rhinoplasty, facelift, or abdominoplasty is not equivalent to one who completed a weekend course or a short observation fellowship after training in an unrelated specialty.

What the ABPS Board Certification Process Requires

The American Board of Plastic Surgery (ABPS) is the only board recognized by the American Board of Medical Specialties (ABMS) for the specialty of plastic surgery. To become ABPS board certified, a surgeon must complete the following:

• Complete a four-year medical degree
• Complete a general surgery residency (typically 5–7 years total, integrated or independent)
• Complete a plastic and reconstructive surgery residency (2–3 additional years)
• Pass a written qualifying examination administered by the ABPS
• Practice independently for a minimum of two years
• Pass an oral examination that includes case presentations reviewed by senior board-certified surgeons

The total training pathway from medical school to certification typically spans 13–15 years. During that time, residents perform surgery on trauma patients, cancer reconstruction cases, burn patients, and hand injuries — not only elective cosmetic cases. This breadth of experience develops the surgical judgment and tissue-handling ability that transfers to aesthetic procedures.

"Cosmetic surgeon" is not a defined specialty with standardized training requirements recognized by the ABMS. A physician can legally perform rhinoplasty, liposuction, or breast augmentation after completing a residency in internal medicine or family practice. The ABPS certification process does not allow surgeons from unrelated specialties to bypass its requirements — and patients who confirm ABPS certification are confirming exactly that standard has been met.

Why Choose a Plastic Surgeon?

1. Comprehensive Surgical Training

Plastic surgeons undergo training that spans cosmetic, reconstructive, trauma, and pediatric surgery. This breadth develops surgical judgment that cannot be acquired through cosmetic-only training. Understanding how tissue heals, how scars form, and how the body responds to surgical stress — across thousands of cases and many different patient populations — is the foundation on which safe, high-quality cosmetic outcomes are built.

2. Board Certification and Fellowships

ABPS board certification requires meeting rigorous standards of education, ethics, and peer-reviewed examination. Many plastic surgeons, including Dr. John Aker and Dr. Di Beckman, complete additional fellowships in aesthetic plastic surgery after residency — further specializing their technique in exactly the procedures their patients are considering. A fellowship in aesthetic surgery is an elective step taken after board eligibility, not a substitute for residency.

3. Range of Procedures and Complexity

Board-certified plastic surgeons are qualified to perform a full spectrum of procedures — from minimally invasive treatments to major reconstructive surgeries requiring multi-hour operations and careful post-operative management. When a patient's case involves prior surgery, anatomic variation, or complications from a previous procedure, a surgeon with broad training is better positioned to manage the complexity safely.

4. Accredited Facility Standards

Plastic surgeons operating under ABPS certification are expected to perform surgeries in accredited facilities — operating rooms or ambulatory surgical centers that meet standards for equipment, staffing, and emergency response. Procedures performed in non-accredited office operating suites carry meaningfully higher complication risks, regardless of the surgeon's credentials.

Questions to Ask Before Choosing a Surgeon

1. Are you board certified by the American Board of Plastic Surgery (ABPS)? This is a binary yes or no. "Board certified" alone means nothing — there are dozens of non-ABMS boards. Ask specifically for ABPS.
2. Where did you complete your plastic surgery residency and how long was it? A legitimate plastic surgery residency is accredited by the ACGME and runs 2–3 years following general surgery training.
3. How many times have you performed this specific procedure? Volume matters. Surgical outcomes improve with repetition. A surgeon who has performed a procedure hundreds of times has encountered and managed its complications in ways a lower-volume surgeon has not.
4. At what facility will the procedure be performed, and is it accredited? Ask for the name of the facility and verify its accreditation status independently (AAAHC, Joint Commission, or state health department certification).
5. Who will be present during the procedure — you, a resident, or a PA? In a private practice setting, the consulting surgeon should be the operating surgeon. Delegation of key surgical steps to others without the patient's knowledge is a red flag.
6. Can I see before-and-after photos of patients with similar anatomy to mine? Generic galleries of ideal results do not reflect the range of outcomes. Ask to see cases that resemble your starting point.
7. What is your protocol if a complication occurs? Every surgeon has complications. A confident, experienced surgeon will describe their process clearly — post-operative monitoring, emergency contact procedures, and how revisions are handled.

Why MPSG Surgeons' Credentials Matter

Dr. John Aker is board certified by the American Board of Plastic Surgery, and Dr. Di Beckman is aesthetic fellowship-trained and board-eligible. Dr. Aker is additionally a Fellow of the American College of Surgeons (FACS) — a designation requiring peer review of surgical cases, demonstration of ethical standing, and commitment to surgical education. Together, they bring decades of combined surgical training from accredited programs — Dr. Aker from the University of Buffalo, Penn State, and NYU; Dr. Beckman from Rutgers.

Neither surgeon delegates surgical procedures to assistants. Patients meet and consult directly with the surgeon who will perform their operation — and that surgeon is present and performing the procedure from incision to close. At MPSG, the credentialed surgeon you choose is the surgeon who operates on you.

Related: Meet Dr. John Aker  ·  Meet Dr. Di Beckman  ·  Schedule a Consultation