In your face!

By Benita Zahn:

Some 30 states have expanded what’s called “the scope of practice” for oral-maxillofacial surgeons, allowing them to do cosmetic procedures beyond the mouth area.  

That’s got plastic surgeons up in arms.

In depth: the arguments for and against this change and how it would affect your life.

Dr. Lucie Capek is a plastic surgeon whose work usually involves recontouring faces.

Donatella Versace Time Shankbone 2010

Image by david_shankbone via Flickr

Now, she’s drawing a line about who should and shouldn’t be allowed to do the work she diligently trained for.

It is troubling enough, says Capek, that doctors other than plastic surgeons are offering Botox, facial fillers, and liposuction,but now that highly specialized dentists known as oral-maxillofacial surgeons want to be able to do elective plastic surgery,enough’s enough.

Capek said “To me this is about patient safety, education.”

Capek says that in states that have expanded the scope of practice, problems with shoddy work are occurring, even in New York, as non-plastic surgeons branch out to expand their income stream.

Dr. Lawrence Busino is an oral-maxillofacial surgeon.

He’s spent his career reconstructing faces damaged by accidents or disease, and correcting congenital defects like this.

He says the battle over who can do what, is nothing new.

“This has been an issue in New YorkStatefor the past 20 years. And it is a turf war issue, absolutely.”

But times have changed, and Busino says, part of the problem is that New York’s Dental Practice Act hasn’t changed since the 1940’s.

Busino said “The training programs have kind of outstripped what New Yorkstate law allows us to do.”

And that, says Busino, is something the plastic surgeons and New York State Medical Society is missing when they tout their training, dismissing the O.M.S. training as inadequate.

“So you have 4 years undergrad school, you have 4 years of dental school and then you have 4 to 7 years of hospital residency training.”

Additionally, some OMS practitioners now get a joint D.D.S. and medical degree.

The sponsor of the bill generating this controversy is senator Jeff Klein from the Bronx.

He says, it’s really not about allowing OMS practitioners to do more, rather, it’s about where the work can be done.

In a statement he says: “This bill simply expands their scope to allow for these procedures to take place in an office setting, by those dentists who meet specific criteria and have the appropriate credentials in performing oral and maxillofacial surgery as is determined by the state education department and the dental profession.”

The Klein bill passed the senate last year, but was bypassed by the assembly which still seems loath to take it up.

In the meantime, Busino and Capek do share common ground, agreeing that general dentists who provide Botox or facial fillers to patients beyond mouth to frame dental work is not appropriate.

And, if the scope of practice is eventually changed, Busino is clear that he’s not interested in working on any body part other than the one he’s trained and experienced on -the face – adding, if any oral surgeon offers services beyond that – let the buyer beware.

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