We Talked to Plastic Surgeons About Their Jobs — and Their Days Aren’t What You’d Assume

Illustration of surgical tools

For many, what we know about plastic surgeons we’ve learned through reality TV shows, which as you probably guessed, don’t exactly depict “reality.” Not to mention, it’s rare for such shows to shed light on what it takes to actually become a plastic surgeon — or even what a plastic surgeon’s true daily workload looks like. Eager to sate curious minds, and to show appreciation for the rigorous field of work, we spoke to three plastic surgeons who were happy to enlighten us. 

The Long, Long Road of Schooling

As is the case for any aspiring medical doctor, the journey to become a board-certified plastic surgeon requires many years of school and numerous intense exams, and is fraught with peer competition. At times, the journey can seem like more of a near-impossible quest than an education. “To say the schooling to become a plastic surgeon is grueling would be like saying climbing to the top of K2 is a challenging, inclined hike,” says Dr. David Rosenberg, a board-certified plastic surgeon based in Beverly Hills, California. (Translation: incredibly difficult.)

And then there’s the sheer number of years it takes. After high school, aspiring plastic surgeons attend a four-year college, where they take med-school prerequisites. Ideally, they’ll graduate with a GPA of 3.7 or higher. As if that isn’t stressful enough, candidates also need to take the notoriously difficult MCAT exam — and pass with flying colors. This score determines where they’ll be able to apply to medical school — if at all.  Additionally, plastic surgery is extremely popular — making it that much harder to work your way in to. 

“While in medical school, [students] must again distinguish themselves at the top of their class because, like dermatology, radiology, or ophthalmology, plastic surgery is one of the most competitive specialties to gain entrance into,” says Dr. Rosenberg. “The average plastic and reconstructive surgery residency is six years long, and consists of 80-hour hospital work weeks in addition to preparing presentations, performing clinical research, and passing yearly performance academic exams.” Talk about climbing mountains. Should everything stay on track, plastic surgeons spend about 14 years total in school (not including high school) before they’re released into the bright lights of the operating room to formally begin their practice. 

One indicator that a plastic surgeon is highly qualified and specialized is if they are a board- certified plastic surgeon. This means the doctor completed their residency specifically in plastic surgery, as well as an additional written test and oral test needed to obtain the seal of approval from the American Board of Plastic Surgery®. A board certification in plastic surgery must be renewed every 10 years.

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Becoming a Plastic Surgeon

One thing is for certain: you know that a plastic surgeon has fought incredibly hard to get to where she or he is. That said, the underlying incentive to work so diligently varies from person to person. Curious about what drew these doctors to the field, we asked them to provide some insight into their own personal journey.

“The funny thing about my path to plastic surgery is that I actually never wanted to be a surgeon, but when I entered the operating room during one of my electives, I instantly knew that surgery would be the career for me,” says Dr. Gregory A. Buford, a Denver-based, board-certified plastic surgeon. “[Then], when I rotated on plastic surgery, I really embraced the combination of science and artistry and chose to proceed down that path.”

For Dr. David Alessi, a Beverly Hills based board-certified plastic surgeon, that decision happened more gradually. He was ultimately faced with deciding between neurosurgery or head and neck surgery.

“Head and neck surgery is wonderful because it includes removing large tumors, ear, nose, and throat, fixing facial fractures and burns, as well as doing reconstructive and plastic surgery,” says Dr. Alessi. “It also involves a lot of cosmetic surgery, too. When I was in my head and neck residency, I realized that I loved to do cosmetic surgery.” That realization lead him to specializing in facial plastic surgery, specifically, where he currently focuses on nose reconstruction, facelifts, and facial implants.  

This sort of hyper-focus on a certain area of the body has become quite common in plastic surgery, and it benefits the patients, as well. Dr. Rosenberg notes, “Many plastic surgeons choose to focus on a single type of surgery — usually one they particularly enjoy or show extra aptitude in. Some are the ‘nose guy’ or the ‘lipo queen.’ Some specialize in gender reassignment surgery or burn care. There are many different paths to pursue within plastic surgery.”

For Dr. Rosenberg, he says that he was drawn to the field of plastic surgery from the get-go, largely because he didn’t want to work in a field where life-threatening scenarios were the norm.

“Also,” he adds, “the field made me realize I could use my aesthetic eye and talented hands to help create beautiful work in the operating room. I knew I wanted the option to be able to treat children, and most surgical fields make you choose to either treat only adults or only children. I didn’t want to be restricted.”

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A Day In the Life of Plastic Surgeons

The hard work certainly doesn’t end after schooling. For established plastic surgeons, the day-to-day schedule varies greatly but is always demanding.

Dr. Alessi often spends his Monday through Thursday at the office with patients doing everything from cosmetic injectables to consultations to post-op visits. Fridays are typically reserved for surgery. This sort of daily division seems to be the norm, though how the work week is divided depends on the doctor’s preferences. 

For example, Dr. Rosenberg typically schedules his procedures in the morning while afternoons are reserved for pre- and post-op appointments with patients. Usually his RNs and PAs will perform any non-surgical aesthetic treatments, such as an injectable wrinkle reducer or injectable filler. They also help tend to patients as they come out of surgery.

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[Editor’s note: Injectable wrinkle reducers temporarily smooth the look of moderate to severe wrinkles in certain areas of the face, including the forehead, frown lines, and crow’s feet. Injectable filler is a temporary treatment that adds volume to areas of the face such as the lips, cheeks, and laugh lines. Like any medical treatment, both injectable wrinkle reducers and injectable fillers have potential risks and side effects. Talk to a licensed provider to see if they’re right for you. And learn more now by chatting with a trained aesthetic specialist.] 

“There are some days that are all surgery or all clinic, but I like having the variety of the two each day,” he tells us.

Dr. Buford says that he reserves specific days for surgery and cosmetic injectables, which he performs himself, with other days that are comprised of post-op follow ups and new patient consults. And while you’d think that the consults are the easy part, that’s not always true. Especially pre-op, there’s a lot of tempering patient expectations, figuring out what the patient needs and wants, and saying “no” if that’s what the doctor feels is best. This requires an authoritative-while-still-friendly social skill set that is either a natural gift or the result of years of honing.

In addition to all the above, plastic surgeons regularly further their education, and some will even formally bestow their own knowledge upon others.

“I do a fair amount of outside consulting, speaking, and teaching, and so it is not uncommon for me to travel extensively in this capacity,” says Dr. Buford. “I personally enjoy this opportunity to extend my knowledge to others and keep a pulse on...what is going on in [the field].

In that sense, plastic surgeons are constantly doing a balancing act between surgery, pre- and post-consultations, non-surgical procedures, and continuing education. While the schedule is demanding, the work is highly rewarding.

“The field of plastic surgery is very misunderstood,” says Dr. Buford. “While the media would like to portray the field as being comprised of patients who are vain and effectively shallow in their pursuits for [“perfection”], this is simply not the case. Plastic surgeons change lives, and we do so by carefully assessing our patients, their needs, and their goals, and discussing options for helping them achieve these goals.”

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 Dr. Gregory A. Buford is a paid Allergan® consultant