Letter from American Academy of Cosmetic Surgery to Sri Lanka Medical Council

Dear Sri Lanka Medical Council:

I am writing at the request of Dr. Gamage in regards to the matter of Re: Dr Kevin N Gamage CMC 8069.  He has requested that I send a letter explaining the extent of his qualifications to perform cosmetic surgery.  From reviewing his information, it is clear that he has had extensive experience in liposuction, lipo-sculpture as well as fat grafting.  I am attaching a letter detailing what I believe are the important differences between cosmetic and plastic surgery as well as their training, experience and education. IN addition I am including recent articles from the literature that confirm that plastic surgery education is deficient in cosmetic surgery training.  Becoming a cosmetic surgeon is a specific additional pathway to practice.


Re: Dr Kevin N Gamage  CMC 8069 (Dr Nimal Gamage)
31, Norris Canal Road , 
Colombo 10.
Tel:- 2691848  Fax :- 2674787 
E-mail: slmc@lankabellnet.com


To whom it may concern:
I have been asked, as an officer in the World Academy of Cosmetic Surgery, and the current president of the American Academy of Cosmetic Surgery to write an explication of the current state of the art regarding differences between cosmetic and plastic surgery training and the standards which might be applied to scope of practice in cosmetic surgery.
Plastic Surgery or Cosmetic Surgery, what is the difference? Who should be allowed to do cosmetic surgery?

Cosmetic Surgery is a unique discipline of medicine focused on enhancing appearance through surgical and medical techniques. Cosmetic Surgery can be performed on all areas of the head, neck, breast and body. Because treated areas function properly but lack aesthetic appeal, Cosmetic Surgery is elective.
Plastic Surgery is defined as a surgical specialty dedicated to reconstruction of facial and body defects due to birth disorders, trauma, burns, and disease. Plastic Surgery is intended to correct dysfunctional areas of the body and is reconstructive in nature.
How does the education differ between a cosmetic surgeon and a  plastic surgeon?

As there is no traditional residency program specifically focused on Cosmetic Surgery. Physicians who wish to pursue Cosmetic Surgery can have many different backgrounds. First, a physician must go through medical school and a residency program, preferably but not necessarily in a surgical specialty such as General Surgery, ObGyn, Otolaryngology, Ophthalmology, Dermatology or Plastic Surgery. Just as radiology has transformed itself into an invasive surgical practice, so may other fields be appropriate for becoming a cosmetic surgeon. After proving competent in anatomy, physiology, pathology and basic sciences, a physician may attain board certification in their specialty and then continue their post-residency training specifically in Cosmetic Surgery. This can be done through a fellowship program (a one-on-one observational and training program with an experienced Cosmetic Surgeon), as well as through workshops, seminars and lectures.
The World Academy of Cosmetic Surgery, a multinational multispecialty organization has also begun to develop board certification standards for cosmetic surgeons that will reflect their training, experience and education. Membership in the World Academy, or in the American Academy of Cosmetic Surgery is available to all those who are dedicated to cosmetic surgery, patient safety and the highest standards of the training and education necessary to become a competent practitioner. And training via mentorship, fellowship and hands on workshops are available.
Plastic Surgeons follow the same educational timeline as many Cosmetic Surgeons. After finishing medical school they complete a residency in Plastic Surgery, learning to treat defects of the face and body including tumors, cleft palates, deformities, hand repair and burn injuries. At this point, a Plastic Surgeon may take the same steps as a General Surgeon or Dermatologic Surgeon to gain experience in Cosmetic Surgery through a fellowship training program, workshops, seminars and lectures.

While worldwide there are now many plastic surgery organizations that are claiming priority for all aspects of aesthetic surgery, in fact, most cosmetic surgery operations have been developed outside the field of plastic surgery and only later incorporated into that specialty scope of practice. When cosmetic surgery training is multidiscipline in nature, the ultimate effect is a broad range of tools and techniques that can be mastered and practiced by the cosmetic surgeon. Although many surgical techniques are most appropriate for a surgical specialty there are many examples of outstanding cosmetic surgeons who have learned their skills through nontraditional training and education.
Scope of practice, especially in cosmetic surgery should be based on training, education and experience. This ought to include an evaluation of the actual practice being evaluated. What are the procedures being done by this particular cosmetic surgeon? What are the results or complications? Are these within the standard of care currently expected of each practitioner?
The cosmetic surgeon who can demonstrate expertise in their practice, and training and education in that procedure should not be disparaged by complaining that they are not a plastic surgeon. In fact, even plastic surgery has acknowledged that their training is deficient in cosmetic surgery, despite their claim that once certified, any plastic surgeon can do cosmetic surgery. References to this are included with this letter.


Jane Petro MD FACS
President of the American Academy of Cosmetic Surgery
Professor of Surgery New York Medical College
Editor in Chief, American Journal of Cosmetic Surgery
September 11, 2014