One of my colleagues recently showed me an excerpt from another doctor’s website. This doctor is an OBGYN who specializes in vaginal rejuvenation and urinary incontinence (a urogynecologist). This doctor’s website has an entire page explaining how OBGYN’s who did a fellowship in urinary incontinence have superior training to plastic surgeons as it relates to cosmetic vaginal rejuvenation and labiaplasty. I have worked with a number of urogynecologists over the years and I’ve trained along urogynecology fellows and assisted them on complicated surgical cases. In 20 years I’ve never heard a urogynecologist discuss cosmetic surgery such as vaginal rejuvenation or labiaplasty. But I’m not very territorial. I feel that an OBGYN has just as much right to perform these procedures as a plastic surgeon. I do take issue when those same doctors disparage our plastic surgery training, and they do so with blatant ignorance. The page from this OBGYN website contains a lot of false information about plastic surgery training and I’d like to clarify a few points.
I have great respect for OBGYN’s and it is a shame that decreasing insurance reimbursement and worsening liability has pushed many OBGYNs away from delivering babies. I understand the financial pressures of running a medical practice but I also firmly believe that doctors should stick to their training. I cannot comment on the specifics of OBGYN training but from what I recall from medical school and residency 99% of their training involves obstetrics, reproductive medicine, gynecologic cancers, and other gynecologic disorders such as endometriosis, uterine fibroids, and hormone imbalances. I’ve never associated OBGYN’s or urinary incontinence specialists (Urogynecologists) with cosmetic surgery or cosmetic procedures. In Atlanta I’ve encountered numerous OBGYN’s who perform tummy tucks, breast lifts, and even breast augmentation and facial procedures including Botox, injectable fillers, and laser skin rejuvenation. I’ve also repaired a number of botched cosmetic procedures by these OBGYN’s, including tummy tucks with the incision placed at or above the belly button, and liposuction with terrible contour deformities. It is unfortunate that they feel the need to step so far out of their “realm of practice” (the specialty in which they trained) in order to make money.
The OBGYN website to which I’m referring states: “Plastic Surgeons – usually spend 3 years in general surgical training learning various surgeries including bowel surgery, chest surgery, appendix removal, gallbladder removal and then another 2-3 years in plastic surgical training where they spend most of their time doing wound treatment for ulcers and burns…” This statement is 100% false. I don’t know the source of their information (no sources are cited) but my training was typical of many plastic surgeons so allow me to take a walk down memory lane. I completed 8 years of residency in surgery and plastic surgery. The entirety of my training from the moment I graduated from medical school was devoted to surgery and the careful handling of tissue. As a result of completing a full general surgery residency, like many of my peers, I have operated on every structure and tissue type in the body from head to toe. I’ve performed these operations in both elective and trauma settings and I’ve literally participated in lifesaving surgical procedures, whether it be a stab wound to the heart, a ruptured aorta, a severed limb, or a log through the neck (yes, a 6-inch log through the neck, in a patient who arrived in the ER at 2am one night, and after a 4 intense hours of surgery and a few days in the hospital that man went home in good condition). For five years, day after day, night after night, my colleagues and I learned proper tissue handling, wound healing principles, and surgical skills by operating constantly. I’m from what you call the “old school” in that I trained before the limited 80-hour workweek. Most of my weeks in surgical training extended 7 days and well beyond 100 hours and I never complained because this training prepared me for every possible surgical situation.
All of that training landed me in a world-class plastic surgery residency program at UT Southwestern Medical Center in Dallas, Texas. The focus of plastic surgery training is again on handling delicate tissues, wound healing, and refined surgical skill. Without getting into the gory details, the field of plastic surgery encompasses cosmetic and reconstructive surgery of all parts of the body. If a physician wants to become an expert in cosmetic surgery, whether that is breast augmentation, eyelid lifts, labiaplasty, or vaginal rejuvenation, then that physician will receive superior training as a plastic surgeon. Likewise, if a physician wants to do Botox and injectable fillers should that physician become an OBGYN, or would she be more suited as a plastic surgeon or dermatologist?
With regard to reconstructive surgery, an important aspect of plastic surgery training involves reconstruction of the vagina and vulva after removal of cancer. Malignancy can often leave large defects and terrible deformities in these areas. Using combinations of muscle flaps, skin and tissue grafts, and autologous fat transfer techniques, plastic surgeons can completely reconstruct these defects and deformities so that the patients can enjoy normal cosmetic vaginal appearance and normal sexual function. Many of the cosmetic and functional techniques of labiaplasty and vaginal rejuvenation were in fact designed by plastic surgeons and these techniques were derived from the larger, more complicated reconstructive procedures.
To sum it up, I do not perform urinary incontinence surgery because I am not a Urogynecologist. I am not an OBGYN so I do not deliver babies. If a doctor wants to perform cosmetic surgery then the proper route for training is plastic surgery. If a doctor wants to fix urinary incontinence then the proper training route is OBGYN and Urogynecology. That is not to discredit the training of a urogynecologist – I have witnessed these surgeons perform very elegant procedures for very complex problems. Again, I’ve worked with OBGYN and Urogynecology department chairmen and experts in the field and I’ve never heard them mention cosmetic surgery as part of their training. I’m sure that their skills can allow them to become adept at cosmetic procedures but it’s a pretty big leap to directly say on a website that plastic surgery training is somehow inadequate.
Why do I perform labiaplasty and vaginal rejuvenation surgery? These are cosmetic procedures for which I was specifically trained as a plastic surgeon. My extensive background in general surgery and plastic & reconstructive surgery have more than amply prepared me to perform these procedures. A major focus of my practice is also correcting “botched” procedures performed by other doctors or in other countries. Corrective or revision surgery of the labia and vaginal canal requires expertise in reconstruction as I discussed earlier. I’ve refined a number of labiaplasty and vaginal rejuvenation techniques and I rely on my plastic surgery training and my surgical experience to consistently achieve excellent cosmetic and functional results.
For more information about procedures offered by Dr McCluskey and the Plastic Surgery Institute of Atlanta, visit: