What’s the big difference between a dermatologist and a plastic surgeon? When they work as a team they can keep people looking and feeling their best.
Dermatology and plastic surgery are different specialties, but they do have one thing in common: the dedication to helping patients look and feel better.
“I think we represent a very powerful team when addressing skin care needs and cosmetic needs,” says Dr. Roger Kapoor, a dermatologist with Beloit Health System. “In general, plastic surgeons certainly own any type of reconstructive surgery and cosmetic surgery. That is their home-court advantage. There are dermatologists who also engage in cosmetic surgery, but generally, breast reconstruction, aggressive liposuction, tummy tucks, those types of things really fall into the category of plastic surgeons. Dermatologists, their home-court advantage is the diagnosis and treatment of diseases of skin, hair and nails, as well as office-based cosmetic interventions.”
Both dermatologists and plastic surgeons can provide Botox fillers, laser hair removal, injectables and peels, to varying degrees.
But it might be easiest to think of dermatologists as the arm that extends into the clinic and outpatient realm, and plastic surgeons as the arm that takes over anything leading toward a hospital stay – the more complicated reconstructive cases, Kapoor says.
Dr. Sarah Hagarty, a board-certified plastic surgeon who owns her own clinic in Rockford and is affiliated with OSF HealthCare Saint Anthony Medical Center and UW Health, largely agrees.
“Plastic surgeons and dermatologists ideally are a dream team, working together for your best care,” she says. “Dermatologists are really good at weird and wonderful rashes and skin conditions. They both can do minimally invasive cosmetic skin treatments.
“[But] plastic surgeons can reconstruct a face after a traumatic accident,” she says. “A plastic surgeon sees the whole picture, starting from the bone as the foundation, all the way out through the muscle, nerves, vessels, soft tissue and finally the skin. A plastic surgeon understands the entire structure and provides the most complete repertoire to correct or improve something; they’re not just looking at the surface.”
Plastic Surgery Procedures
Like those in many medical specialties, plastic surgeons are taking advantage of new technologies that achieve results through less-invasive approaches.
Liquid rhinoplasty, for example, is a nonsurgical way to reshape the nose.
“Sometimes, instead of cracking bones like in a traditional rhinoplasty, we’re putting in structural filler to correct irregularities,” Hagarty says. “As we age, the skin gets lax; you lose the elasticity of the skin, and bone also resorbs, so you have less structure holding everything up. Filler can be a structural support, as well as a soft tissue filler, and it can support the cheeks, the jawline, chin and nose.”
While fillers provide support, procedures like thread lifts also can help treat saggy skin in a less-invasive way.
Threads – made of suture-like material from the operating room – go under the skin and pull up the dermis of the skin to the underlying fascia, Hagarty says. The entire procedure is done under local anesthetic, with no incisions and no scars.
“The FDA-approved Suneva act like Velcro on the inside to pull the skin up,” she says. “You can see it right away. It’s not as much pull as a facelift but helps that in-between stage for people who need a bit of lift but aren’t ready for a facelift.”
A thread lift can last two to three years, while a facelift can last 10 to 15 years, Hagarty says.
But there are always underlying factors that can affect those benchmarks.
“If you stay the same weight for the next 10 years, it will keep well,” Hagarty says. “But if weight fluctuates in big swings, all bets are off.”
Plastic surgeons have many procedures that can help improve the skin by summoning the body’s natural healing properties.
“Laser, chemical peel, ablating the surface – all of those things cause a little bit of damage so that your body comes in and heals it,” says Hagarty. “The healing tightens the skin.”
Microneedling, for example, uses a device that has very small, sterile needles that puncture the skin as it oscillates.
“In half an hour, there are about 2 million tiny holes in a person’s face,” Hagarty says. “They’re very tiny, so they don’t leave a scar. The device can control how deep the needles penetrate, so in areas like the neck or the cheek where the skin is thicker, there is more penetration, and less penetration around the eyes or forehead.”
Patients’ skin becomes very pink and maybe even bleeds a little bit, but the skin settles down in a day or two, she says.
“It’s giving your body the message that there is something going on, some damage, and all sorts of growth factors and healing factors will be released into that area to heal those micro wounds,” she says. “These techniques are very good for improving overall skin texture.”
In combination with mirconeedling, a Vampire Facelift involves drawing a patient’s blood and separating out stem cells filled with platelet-rich plasma.
“This special portion of blood, PRP, has a lot of growth factors in it,” Hagarty says. “After needling, we coat it over the face. It’s clear – it’s not bloody – and it helps stimulate the skin rejuvenation even further.”
Hagarty loves her specialty because helping people feel better about themselves is very rewarding, she says.
“I work with patients who have pigment changes, sun damage, saggy skin, but I also have patients who come for facelifts because they lost weight, were sick or had chemotherapy,” Hagarty says.
“They’ll say, ‘When I look in the mirror I see that I look so different, and it reminds me of that tough time, and it makes me sad.’ I feel so rewarded when I help people have a sense of control over that, and it makes them happy and feel good.”
Far and away, the most popular dermatological procedures for both men and women continue to be Botox, fillers, laser hair removal and chemical peels, says Kapoor.
However, newer procedures are beginning to gain traction, as well.
Kybella is a natural substance injected under the chin area to eliminate a patient’s double chin, he says.
“The injection attacks the fat cells and liquifies them so the body can absorb that fat,” says Kapoor. “It’s remarkable; it’s life altering. It simply eradicates the double chin.”
Patients receive a few injections each treatment, which usually are spaced out about a month apart and only take about 10 minutes each time, Kapoor says.
“Afterward, you can get a little bit of swelling because we’re injecting a chemical, and sometimes there’s some bruising, but in less than six treatments we can totally sculpt the chin with an office injection,” he says. “The results have been really impressive.”
Another procedure that’s gaining traction is cool sculpting, Kapoor says.
“While Kybella liquifies fat, cool sculpting freezes fat away,” he says. “It was designed for love handles, but now it has been approved to treat the thighs, belly, bra area, the back and the underside of the buttocks.”
This laser treatment is the opposite of laser hair removal, in which light energy provides heat to inhibit hair growth.
Instead, the cool sculpting laser provides coolness to the body to freeze surface fat.
There are two types of fat in the body. Subcutaneous fat is the surface fat that rolls over the top of your jeans, Kapoor says. Visceral fat, meanwhile, lines the organs in the body and is the type of fat that contributes to the deterioration of one’s health.
“This laser won’t improve anyone’s health necessarily, but it will allow you to get back into your skinny jeans,” he says.
An application typically takes about 30 minutes, and there may be some redness, bruising, swelling and/or tingling, but “the results are pretty good after just one treatment,” Kapoor says.
“Results manifest in a three-month time frame, and sometimes we don’t even need to do a second treatment,” he adds.
Start with your GP
How do you know when to contact a dermatologist or plastic surgeon for your skincare needs?
Many times, a you can obtain a recommendation from your general practitioner.
Most family physicians are open to sending patients to a specialist, says Dr. Nandini Chattopadhyay, a primary care physician at OSF HealthCare.
“I generally tell patients to come to us for the discussion about if you need dermatology and we will give you all of the resources,” Chattopadhyay says. “I would be happy if you get taken care of by a specialist. Sometimes they can be a better option.”
There are basic skincare procedures that family practitioners can diagnose and treat on their own, like different biopsies or atypical moles or rashes, Chattopadhyay says.
Often, over-the-counter medications she prescribes can work for minor skin issues.
But if problems persist, it might be time to see a specialist.
“With all sorts of over-the-counter medications, as well as prescribed medications, after a point in time the skin becomes resistant to it,” Chattopadhyay says. “So, dermatologists are trying new things like laser treatments, radiofrequency and light therapy for patients with psoriasis or eczema – things we don’t do in family practice. Dermatologists become very important at that point.”
“When a patient says, ‘I have family history – my mom had it, my sister had it, and I have been noticing some skin changes,’ I do not take these lightly,” Chattopadhyay adds. “When they have a rash that has been there and has been kind of worked on by us for the past few months, I go by sixth sense: this is not resolving; I want a second opinion.”
While Chattopadhyay may not be the one to perform more difficult aesthetic procedures, she’s well aware of microneedling, plasma filtration for facelifts and other procedures that plastic surgeons use to aid patients, and she explains to patients what those options entail.
Most health care providers are good about sharing a list of specialists who accept a patient’s insurance, because insurance usually dictates everything, she says.
Some cosmetic services aren’t covered by insurance. But certain screenings – like many skin cancer screenings – are covered, and even if they’re not, they’re important for your overall health.
“I encourage patients to definitely go for a skin cancer screening after the age of 50,” Chattopadhyay says. “Especially if they’re working at farms or are out in the sun, or women who have been tanning, or those who have a family history. Your skin has undergone so many changes, it is very important to get that screening done. Better safe than sorry.”