Cosmetic Surgery: The Genesis and Evolution of a Specialty
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84 The American Journal of Cosmetic Surgery Vol. 28, No. 2, 2011
SPECIAL TOPIC
Cosmetic Surgery: The Genesis and Evolution of a
Specialty
E. Gaylon McCollough, MD, FACS
I n the mid 1960s, a group of visionaries gave birth
to 2 organizations, one of which would eventually
turn into what we know today as the American
appearance-enhancing surgery, strategically modeled
after the membership requirements of the prestigious
American College of Surgeons.
Academy of Cosmetic Surgery … but the journey to Shortly after the Caribbean meeting in 1964, the
this place and time has not been easy. group of founders was joined by a dynamic young
The 1960s was a time in history when no institution plastic surgeon from Boston, Mass, Richard Corliss
existed for teaching the unique skills and insights that Webster, an independent thinker who was born and
set “cosmetic surgeons” apart from reconstructive reared on the Mason/Dixon line. Webster was the
surgeons. However, following the truism, “necessity is protégé of the famed dental, oral, and plastic surgeon,
the mother of invention,” Drs Jack Anderson, Wally Dr V. J. Kazanjian.
Berman, Jan Beekhuis, Bill Wright, Ira Tresley, From personal experience, Dr Webster knew that
Richard Farrior, and John Dickinson Benito Rish, and although his own specialty (plastic surgery) had
a half dozen other facial surgeons created not 1—but originally expressed interest in creating a multispe-
2—organizations. cialty organization, after the aesthetic society was
One was the American Association of Cosmetic formed, plastic surgical leaders rejected the idea of
Surgeons, heretofore referred to in this presentation cross-specialty teaching. On the other hand, the founding
as “The Cosmetic Association.” The other was the fathers of the Facial Academy and its sister organization,
American Academy of Facial Plastic and Reconstructive the Cosmetic Association, embraced the idea.
Surgery, heretofore referred to as “The Facial So, the founders went to work. It took a little more
Academy.” As you will come to see, the creation and than 10 years for the Facial Academy to initiate its
evolution of the American Academy of Cosmetic 1000th member. The roster comprised otolaryngolo-
Surgery arose out of both of these grassroots gists, dermatologists, oculoplastic surgeons, oral and
organizations. maxillofacial surgeons, and a handful of plastic
The founders’ intent was to create a specialty surgeons.
devoted to cosmetic surgery and to do it in a staged Then, an unanticipated change in policy occurred.
manner. Attention would Þrst be directed to the Facial With a push from academic otolaryngology, a new
Academy. Once the numbers of cosmetically oriented wave of facial surgeons jockeyed themselves into
members justiÞed doing so, the founders of the 2 positions of authority within the Facial Academy.
sister organizations intended to take the Cosmetic Yielding to pressures being applied at home (from
Association off the shelf and have it represent a university-based plastic surgeons and from others
multidisciplinary assembly of “elite” surgeons, each within the American Board of Medical Specialties),
of whom possessed uncontestable credentials in academically afÞliated members of the Facial Acade-
my’s governing board moved to change its membership
Received for publication March 14, 2011. criteria, effectively excluding dermatologists and oral
From McCollough Institute for Appearance and Health, Gulf Shores,
Ala. surgeons.
Corresponding author: E. Gaylon McCollough, MD, FACS, McCollough Seeing the handwriting on the wall, Richard Web-
Institute for Appearance and Health, 350 Cypress Bend Dr, PO Box 4249,
Gulf Shores, AL 36547 (e-mail: DrMcCollough@McColloughInstitute.
ster (who had served as one of the Facial Academy’s
com). presidents) threatened to resign. In the early 1980s, aThe American Journal of Cosmetic Surgery Vol. 28, No. 2, 2011 85 handful of past and present ofÞcers met in a suite at I persuaded the Facial Academy and the Cosmetic the Breakers Hotel in Palm Beach, Fla, and came up Association to support my efforts in organizing the with an alternate plan. We would jump-start the Amer- National Council for the Medicine, Surgery, and ican Association of Cosmetic Surgeons. Rather than Dentistry of Appearance. Representatives from the creating a society of elitists, it would become the “Big various appearance-enhancing disciplines, including Tent” under which cosmetic surgeons from a variety psychiatry, held a series of meetings in Chicago, Ill. of specialties could share information and knowledge. The plastic surgery societies were invited to attend, The Facial Academy, on the other hand, would but refused. effectively become the plastic and reconstructive As the Council’s elected chairman, I was able to surgery arm of Otolaryngology. share—with other professionals—materials obtained by A letter, cosigned by Dr Webster and the most the Federal Trade Commission during its investigation of respected head and neck surgeon in the world (Dr anticompetitive practices on the part of the American John Conley of New York City, NY), was mailed out Society of Plastic and Reconstructive Surgeons to doctors from across the appearance-enhancement (ASPRS). spectrum, inviting them to join the American Association A Machiavellian-like “Cold War” strategy employing of Cosmetic Surgeons. Appropriately, Richard Webster “guerilla warfare” described how plastic surgeons became President. He was followed by Blu Stough, a intended to conduct a “Cold War,” during which they dermatologist from Hot Springs, Ark. The next President would “stall, frustrate, and destroy” physicians and was facial plastic surgeon, Trent Smith from Columbus, surgeons identiÞed as competitors. The document Ohio, who was followed by Dr Robert Wood, a plastic launching the “Cold War” was crafted in 1964 and surgeon from Houston, Tex. was later retrieved by the Federal Trade Commission Then, at the age of 37, I became the Association’s from the Þles of the ASPRS executive ofÞces in Þfth president. Three of the Þrst 5 presidents of the Chicago. Cosmetic Association had been—or presently were— From a handwritten note above its title, it came to ofÞcers and directors of the Facial Academy. I point be known as the Inter-Group Conßict Document. And this out only to demonstrate the close working the fact that plastic surgery organizations were found relationship that once existed between the leadership to be following the class warfare tactics it contained of the 2 organizations. convinced the Federal Trade Commission that the As the Cosmetic Association’s President, one of my document represented a strategy. Þrst initiatives was to create a Journal of Cosmetic The “Cold War” eventually became a heated war. Surgery. Published by EBSCO Media, the Journal So much so that—in addition to the FTC—the US was well received, but we were ahead of our time, and Congress became involved, calling all sides before a in those days, paid advertisements and grants were congressional hearing. The hearing provided a forum hard to come by. So after 2 years, the publisher decided whereby a team of facial and cosmetic surgeons to shelve the Journal. However, the specialty of provided evidence of anticompetitive and unlawful “cosmetic surgery” had driven a stake in the medical tactics being used against us. landscape, and its Journal would be revived after a Drs Frank Kamer, Ted Cook, Robert Simons, Regan critical merger that is to be addressed in another Thomas, and I made our case. The Federal Trade section of this article. Shortly thereafter, another Commission issued a “consent decree,” which meant cosmetic surgery association (The American Society that the US federal government found evidence of of Cosmetic Surgery) picked up on the idea of a unlawful, anticompetitive practices. journal devoted to cosmetic surgery. The next skirmish in the “Inter-Group Conßict” In the early years, facial and cosmetic surgeons followed the publishing of an article that was were hammered by a nationally coordinated smear constructed by Dr Jack Anderson and myself, entitled, campaign orchestrated by general plastic surgery “An Old Specialty Puts on a New Face … and Head … organizations. In response to the plastic surgeons’ and Neck.” clever twist on “board certiÞcation,” a group of The article was published in the Journal of The California-based surgeons—led by Drs Richard Southern Medical Association under Jack’s name. It Aronsohn and Robert Franklin—incorporated the was intended to inform the medical world that Otolar- American Board of Cosmetic Surgery. On another front, yngology had evolved beyond “Ear, Nose, and Throat,”
86 The American Journal of Cosmetic Surgery Vol. 28, No. 2, 2011
and had appropriately added the term “Head and Neck Academy and the Cosmetic Association, and the rest
Surgery” to its name. With the assistance of publicist, to Dr Anderson. But Jack Anderson never intended
Al Walter, Jack, and I spelled out the reasons why the to keep the money for himself. He quickly turned
name change was timely and appropriate. around and donated his portion of the judgment to the
Afterward, I consolidated the original article into a Education Foundation of the Facial Academy for the
1-page summary that was published in the Medical purpose of establishing a certifying board for Facial
Journal of the State of Alabama. Then, I sent my Plastic Surgery.
abbreviated version to key individuals around the More than the money, the verdict sent a message
United States, asking them to submit it to their own throughout the land. Assertions that only 1 group
state’s medical journal. of doctors possesses the talents and knowledge to
One of the Þrst to do so was Dr Bill Silver of perform appearance-enhancing surgery are not only
Atlanta, Ga. The article apparently infuriated mem- false and misleading, they are unlawful.
bers of the Georgia Society of Plastic Surgery, who The greater message that came out of the suit
immediately Þred off a stinging retort in the same was that facial and cosmetic surgeons would no longer
journal. Their response was entitled, “Things Are tolerate maliciously engendered attacks on our good
Never What They Seem, Skim Milk Masquerades names. And any individual—or any organization—that
as Cream.” The vitriolic rebuttal identiÞed general engages in such nefarious practices could expect to
plastic surgeons as “cream” and referred to Dr Jack pay a dear price.
Anderson, members of the American Academy of With case law coming down on the side of facial
Facial Plastic and Reconstructive Surgery, and mem- and cosmetic surgery, plastic surgeons around Amer-
bers of the American Association of Cosmetic ica backed off slanderous attacks and vitriolic
Surgeons as “skim milk.” campaigning. But the “Cold War” did not end in an
The plastic surgeon’s attack on the “good names” Atlanta courtroom. The battles to limit how surgeons
of those identiÞed solidiÞed an already good relation- can identify themselves in the public arena continue,
ship between the Facial Academy and the Cosmetic as witnessed by attempts to prevent the American
Board of Cosmetic Surgery from obtaining “equiva-
Association. The 2 organizations joined forces to right
lency” status in California.
yet another wrong. A lawsuit for slander and libel was
In the mid 1970s, another important development
Þled in the state of Georgia. The Facial Academy
occurred in the creation of the Cosmetic Academy.
agreed to pay all expenses for the 3 plaintiffs: Dr
Liposuction—a new cosmetic surgical procedure—was
Anderson, the American Academy of Facial Plastic
gaining widespread appeal in Europe, although on this
Surgery, and the American Association of Cosmetic side of the Atlantic, few surgeons were familiar with it.
Surgeons. According to Philadelphia, Pa, plastic and cosmetic
As the sitting Secretary of the Facial Academy and surgeon, Dr Richard Dolski, Yves-Gerard Illouz, a
a former President of the Cosmetic Association, I French gynecologist, began to remove fat from the
testiÞed at trial, explaining to the judge and jury the human body with suction-assisted techniques. The
fallacious charges levied against the qualiÞcations of technique was learned by Fred Berkowitz from Newport
members of the 2 organizations and one of my Beach, Calif, who traveled to Paris, France, to observe
mentors, Dr Anderson. Another one of this Academy’s Illouz, Fournier, and Ottei—3 European pioneers.
former presidents, Dr Bill Beeson, participated in the Upon his return to the United States, Dolski, Michael
demonstration. Elam, and Ottei organized a workshop on liposuction
The jury saw through the author’s malignant at The Graduate Hospital in Philadelphia. Dolski’s
attempts to discredit our 2 specialties in the eyes of surgical demonstrations marked the Þrst organized
our peers and returned a guilty verdict against the teaching of liposuction to America surgeons.
plastic surgeons. But the jury did more. It awarded the Shortly thereafter, Dolski and his colleague, Dr
largest judgment in history against a medical organi- Julius Newman (along with several colleagues),
zation, speciÞcally, the Georgia Society of Plastic created a Liposuction Society and began to attract
Surgeons, and the 2 local doctors who identiÞed them- other cosmetic surgeons into their newly formed
selves as authors of the “Skim Milk” article. The court organization, including one, Dr Richard C. Webster.
ordered the plastic surgeons to pay a total of $1.5 To avoid duplication of efforts and further division
million in punitive damages—$1000 each to the Facial among cosmetic surgeons, Dr Webster and Dr NewmanThe American Journal of Cosmetic Surgery Vol. 28, No. 2, 2011 87 decided to approach the governing boards of the (ACS). In keeping with its name/brand, the ACS limits Association of Cosmetic Surgeons, the American its membership to doctors who only perform surgery. Society of Cosmetic Surgery, and the Liposuction I know for a fact that the College has denied member- Society to initiate merger talks. In 1985, the merger ship to doctors who perform surgery and engage in was consummated, giving birth to the American medical therapies. The ACS takes the position that to Academy of Cosmetic Surgery. be considered a “specialist,” a doctor must focus on All the while, a separate—yet related—organization, whatever it is that he or she claims to be. To do the American Board of Cosmetic Surgery, grew in more—or less—makes the doctor a generalist. numbers and in credibility. Fellowships in cosmetic Here’s another question to ponder. Do temporary surgery began to be offered by an eclectic group of injectable therapies and superÞcial skin polishing instructors. procedures qualify as “cosmetic surgery,” or should Dr Richard Webster devoted the remainder of his these procedures be considered “cosmetic nonsurgery”? professional life to promoting the Academy (and the In the eyes of both the public and medical certifying Board) of Cosmetic Surgery, embracing the colleagues, it is counterproductive to brand oneself a “Big Tent” policies that both exhibit. And it is appro- “surgeon” and—at the same time—offer “nonsurgical” priate that this Academy remembers Dr Webster as procedures. In like manner, it could be counterproduc- I do. I knew Richard Webster. Richard was not only tive for an organization to identify itself as a “surgical” my teacher and colleague, he was my friend. He was organization and offer courses and seminars teaching a brilliant strategist and a relentless competitor—one “nonsurgical” treatments. on whose side you’d want to be in battle, or in the In the spirit of consistency, I’ve expressed these courtroom. same sentiments to my facial surgery colleagues, both Today, Richard’s vision is shared by many of us— verbally and in the Archives of Facial Plastic the vision that someday, all the specialties involved in Surgery.1 I have raised these issues only in the best appearance-enhancing surgery will recognize our interest of everyone who hears or reads my words. shared heritage and realize that we have much more At this stage in life, I see things from a rather unique in common than not. vantage point. From the shoulders of the giants that Clearly, a specialty of cosmetic surgery is—as I’ve been fortunate to know, I see cosmetic surgery as Victor Hugo—once said, “… an idea whose time has it has been, as it is, and as it can be. come.” Appearance-enhancing procedures are more As I gaze over the horizon before us, I see a bright popular than ever, with no end in sight. This presents future, provided that members of this Academy are both opportunities and challenges to this Academy willing to do the following things: and its members. Before I came to Phoenix, Ariz, to deliver this • Tell your story often and with conviction. Make address, I reßected on how other ßedgling organiza- those who don’t want to hear this Academy’s story tions evolved into formidable competitors. At the risk hear it anyway. of stepping on toes, I’d like to share a series of • Make your case for “equivalency” with indisputable strategic growth and development “ideas” with you. facts, incomparable clinical outcomes, and the best Having accumulated a patchwork of scars from the legal representation that is available. various cosmetic surgery battleÞelds, I feel qualiÞed • Refuse to accept pejorative labels that antagonists to engage in philosophical ruminations. would hang around your necks. For the 21st century, consumer names and labels • Reach out to clear-thinking leaders of other matter. A name or brand affects the choices that buyers societies and organizations that share common make. So, let us look at cosmetic surgery from outside interests. If there is a way to get along with others in, as a potential consumer might. If a group of in the appearance-enhancing professions, Þnd it and doctors brand themselves as “surgeons” and then pro- nurture it. ceed to offer “nonsurgical” treatments and procedures, • Be smart, be committed, aim high, and act wisely. the public becomes confused. Equally important, the • Work within the scope of your training and organization weakens its argument for a rightful seat experience. at the table of venerable surgical specialties. • Refuse to be seduced by the sirens of “change,” One of the world’s most prestigious surgical societies which would lure you toward the boneheaps of is the aforementioned American College of Surgeons history.
88 The American Journal of Cosmetic Surgery Vol. 28, No. 2, 2011
• In all matters, let your conscience be your guide. as—or better—than your competitors, irrespective of
Consider the consequences of the procedures and the certiÞcates hanging on their walls.
techniques that you advocate and/or offer to your • And, once you have mastered the procedures that
patients. you do best, in the most professional manner pos-
• Be honest in evaluating the quality of your work. sible, refuse to be characterized as anything less
• Do not claim to be that which you are not, nor than you are—a competent and caring “specialist”
undertake procedures for which you may not yet be in cosmetic surgery.
qualiÞed. Clearly, a specialty devoted entirely to cosmetic
• Focus on procedures that not only are safe and surgery is “an idea whose time has come.” And no one
effective, but that spend your patients’ money wisely. specialty or course of study has a monopoly on surgi-
Patients will respect you for it and will repay the cal skills and clinical judgment. Not only has the idea
favor, a thousand times over. come, it is here to stay, and so is the professional
• Investigate the safety and efÞcacy of so called “new” organization that protects its members’ right to compete
technology and procedures. Before you use them on in the marketplace.
your patients, be certain that you’d offer the same Be emboldened by the words of Edmund Burke:
procedures to a member of your family, or have “He that wrestles with us strengthens our nerves, and
them done on yourself. sharpens our skill. Therefore, our antagonist is our
helper.”
• Hear the advice of one who has been tested in the
Rather than feeling resentment toward our antago-
crucibles of cosmetic surgery for almost 4 decades:
nists, we should be grateful to them, for it is our
Different is not necessarily better. And “change” antagonists who are responsible for the genesis and
has consequences. It takes 5–7 years before a “new” evolution of this specialty and The Journal in which
technique, technology, or ideology can be said to be this monologue is published. It is our antagonists who
better than what is already available. Many doctors are responsible for the Academy, Foundation, Certifying
can attest to the fact that “too good to be true” Board, and postgraduate fellowships that represent
machines, procedures, devices, and promises are this specialty’s interest and further its dream.
just that—“too good to be true”; that “no down Be encouraged by the words of Martin Luther King,
time” means no lasting result; and that there’s who dreamed of the day “when a man would be judged
always a “new and improved version” of the equip- by the content of his character.” This should be the
ment you already own. dream of every surgeon: to be judged by his or her
• One colleague recently told me that he had a million character, the manner in which he or she cares for
dollars of equipment (that proved to be ineffective) patients, and the quality of work that emanates from
stored in a closet in his ofÞce. A million dollars is his or her hands, and not the label placed upon him or
a lot of money. So, be wise and investigate the her by others.
science behind emerging technology and the character As we stand on the precipice of the next era in the
and veracity of the people behind the “too-good-to- history of this Academy, let us reßect on an instruc-
be-true” claims. tional scene from an ancient Greek epic—entitled The
• Be leery of commercialized, assembly line, and Civil War.
“one-size-Þts-all” surgical procedures with seductive- Anxious to see the size of an enemy army that
waited just over the horizon, Didacus Stella, the Greek
sounding names. Before you invest your money and
general, said to one of his captains, “Put the dwarfs
reputation in trendy procedures or equipment, on the shoulders of the giants. From such a lofty
investigate the science behind the claims, and position, dwarfs can see farther over the horizon than
consider the long-term consequences. giants.”
• Keep in mind that a doctor who is trying to be a So my colleagues, the lesson that calls out from an
“Jack of All Trades” is not the “Master” of any of ancient Greek battleÞeld is this: If, today, we are able
the services he or she offers. to see farther and more clearly into a future of our
• Look at the broad Þeld of cosmetic medicine and own making, it is due neither to the greatness of our
surgery. Decide what you do best. If surgery is what own size, nor to the keenness of our own eyes, but
you do best—be a cosmetic surgeon. If cosmetic because we are borne aloft by that giant mass of
medicine and nonsurgery are what you do best—be a knowledge and wisdom passed down to us by the
cosmetic physician. Then, do what you do best as well giants who have gone before.The American Journal of Cosmetic Surgery Vol. 28, No. 2, 2011 89
My coach (when I played football for the University Surgery (AAFPRS), the American Society of Ophthal-
of Alabama, Tuscaloosa, Ala) was the legendary mic Plastic and Reconstructive Surgery (ASOPRS),
Coach Paul “Bear” Bryant. When he was laid to rest, and the American Society for Dermatologic Surgery
Bryant-coached teams had won more football games (ASDS)—seek, it would be wise to reach out to all
than any major college teams in history. organizations whose members provide cosmetic medi-
Coach Bryant attributed his success to the following cine and surgery to the public. Otherwise, the initiative
motto: “If you believe in yourself and have dedication appears to be self-serving and politically motivated,
and pride … and never quit, you’ll be a winner. The rather than consumer protection oriented.
price of victory is high, but so are the rewards.” Knowing what I know about this Academy and its
In cosmetic surgery, a lot of people have paid a dear new leadership, I feel sure that the AACS will do
price for the victories that, today, give us the right to whatever it takes to rise to the occasion and convince
practice our art and sit at the table with other venerable any unbiased tribunal that it is deserving of the
specialties. public’s trust and its colleagues’ respect. I know this
The American Academy of Cosmetic Surgery because I am a seasoned veteran of the plastic surgery
(AACS) has achieved full membership in the American “Cold War,” when the American Academy (and
Medical Association (AMA). Within the AMA, the Board) of Facial Plastic Surgery was looked upon as
academy has membership in the section on counsel on the “out group.” The AAFPRS and the American
plastic and oral maxillofacial surgery. It sits on this Board of Facial Plastic and Reconstructive Surgery
counsel as equal partners with the American Society (ABFPRS) refused to be denied, and so must the
of Plastic Surgery and the American Academy of AACS. The reason is this: “though the price of victory
Facial Plastic and Reconstructive Surgery. There is no is high, so are the rewards.”
second-class citizenship when the AMA comes to Thank you for the opportunity to share my thoughts
recognize the AACS in the provision of cosmetic on the genesis, evolution, and future of the honorable
surgery to the American public. specialty of cosmetic surgery.
But the “Cold War” still exists. It is unfortunate that
in the formation of the Physicians Aesthetic Coalition
(created to “promote patient safety in cosmetic Acknowledgment
medicine and aesthetic surgery through public and The author wishes to thank Dr Richard Dolski for
physician education initiatives”), the AACS was not sharing portions of his research on the history of
cosmetic surgery.
included. From everything I have witnessed, I am con-
vinced that the AACS is as concerned about patient
safety as any organization in American medicine. Reference
If it is truly “patient safety” that the founding members 1. McCollough EG. Minimally invasive–minimally
of the Physicians Aesthetic Coalition—the American effective: The paradigm shift toward mediocrity in
Society for Aesthetic Plastic Surgery (ASAPS), the facial plastic surgery. Arch Facial Plast Surg. 2007;
American Academy of Facial Plastic and Reconstructive 9(4):293–294.You can also read
