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									84                                                                             The American Journal of Cosmetic Surgery   Vol. 28, No. 2, 2011


Cosmetic Surgery: The Genesis and Evolution of a
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, a
The 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 Newman
The 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
• 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.

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