As the baby boomer generation ages and the general public strives toward an ageless beauty, an increasing number of “noncore” medical providers are becoming “cosmetic surgeons.” In addition, specialists including dermatologists, plastic surgeons, ophthalmologists, and otolaryngologists, whose primary training includes cosmetic procedures, are expanding their cosmetic practices to meet the increasing public demand for these services and to buffer the economic downturn of third-party reimbursement. The expansion of cosmetic surgery is not limited to private medical clinics. Academic centers have begun creating multidisciplinary cosmetic centers (MCCs) in response to increasing public demand for these services. The organization of multiple medical specialties under one roof is logical since there are multiple components in aging. Epidermal aging and photodamage require the expertise of a dermatologist. Resorption of bone and muscle and displacement of subdermal fat require the expertise of plastic, ophthalmologic surgeons as well as otolaryngologists and oromaxillofacial surgeons. No one specialty can claim to be expert in the vast variety of techniques and procedures required to reverse the aging process. It is therefore perfect timing that an edition of Clinics in Plastic Surgery provides a multidisciplinary approach to this growing field.

A survey of academic physicians from the departments of dermatology, plastic surgery, otolaryngology, and ophthalmology on their attitudes regarding MCCs and toward other specialties providing cosmetic services was recently conducted at Wake Forest University School of Medicine, Winston-Salem, North Carolina. Among survey respondents, the overall opinion on MCCs was positive. Perceived benefits included improved patient care, resource sharing, increased opportunity for multidisciplinary research, improved resident education, and increased cross-referrals. Concerns included fear of competition, jealousy, and ego. Some specialists may feel that their field is self-reliant, that their field can do anything that other subspecialties can without needing to collaborate, and that the other subspecialties will not bring anything to the table. A valid concern would be the difficulty to agree on the scope of practice for each subspecialty in areas where procedures can be performed by multiple disciplines. These attitudes could certainly impede cooperative care, leading to feelings of contempt across disciplines.

Employing a multidisciplinary approach has been successful in various aspects of medicine. Transplant surgery could not have evolved without the cooperation of multiple medical specialties, including immunologists and surgeons. The optimal management of a variety of cancers is aided by cooperation among surgeons, oncologists, and radiologists who meet in tumor boards. The first widespread use of a dermal filler, Zyderm collagen, was developed and tested by both dermatologic and plastic surgeons at Stanford University over 30 years ago. Liposuction was perfected with the advent of tumescent anesthesia by dermatologic surgeons with the surgical expertise of plastic surgeons. Vein surgery was revolutionized with the use of intravascular laser and radiofrequency catheters and tumescent anesthesia developed by dermatologic surgeons combined with ultrasound technology from radiologists and an understanding of the venous system by vascular surgeons. Laser resurfacing and the treatment of vascular and pigmented lesions, developed by dermatologic surgeons along with the surgical expertise of plastic, occuloplastic, otolaryngologist, and oromaxiofacial surgeons, has revolutionized the rejuvenation of photoaged skin as well as congenital birthmarks and traumatic scarring. This is just a short list of advancements in medicine and patient care from multidisciplinary teamwork. Future advancements will continue.

To be sure, one medical specialty alone can improve a patient’s appearance, but how much more fun is it to collaborate and learn from one’s colleagues? Medical technology has become so complex that one would be hard pressed to know it all. It is therefore optimal to integrate the knowledge of other specialties to accelerate advancements in patient care.

The concept of combining a variety of specialties together to enhance patient care has been adopted in academic centers with proven success. The University of Pennsylvania has been successful creating “incentives for a culture of collaboration rather than competition, a culture that stresses the success of the program, the team, and the institution, over that of the more traditional department.” This collection of articles from leaders in Facial Plastic Surgery, Occuloplastic Surgery, Plastic Surgery, and Dermatologic Surgery is an outstanding continuing attempt to engage all specialties toward the advancement of patient care. The editors and authors should all be congratulated for their joint efforts.