Crossing Surgical Borders: Where are We, Where are We Going and Can We Find the Way?

213 There has been intense debate nowadays on what surgical procedures a speciality must do or must not do, particularly among dermatosurgeons, plastic surgeons, oculoplastic and maxillofacial surgeons. Now, dentists and gynaecologists have jumped the fray with each specialist treading on another's toes. Should dermatosurgeons do blepharoplasty or leave it to the oculoplastic surgeon, should plastic surgeons do chemical peels, vitiligo surgery and non‑invasive or minimally invasive lasers or let it be the domain of dermatologists? Should maxillofacial surgeons do hair transplant, should dentists do botulinum toxin injections? Who should do liposuction and who should do non‑invasive body contouring? Should gynaecologists do aesthetic treatment and should dermatosurgeons and plastic surgeons do non‑invasive vaginal tightening or leave it to the gynaecologist? Which speciality is best for facial cancer surgery; the dermatosurgeon, Mohs surgeon, plastic surgeon, maxillofacial surgeon or the cancer surgeon? This blurring of surgical borders is causing confusion and heartburn, especially when it comes to teaching and training. Have we lost the wisdom in our quest for money and knowledge? The main reason for this confusion is the evolution of medicine and surgery. The introduction of minimally invasive procedures has forced everyone to change. Patients want least invasive procedures, with minimal downtime. Technological advances in machines such as lasers, radiofrequency and therapeutic ultrasound make aesthetic rejuvenation simpler. Procedures such as soft tissue fillers for face, lip and nose contouring, botulinum toxin for wrinkle reduction and follicular unit extraction in hair transplant make aesthetic surgery easier and accessible to learn and master, irrespective of basic training. This paradigm shift in aesthetic medicine and surgery has led to blurring of borders. New data released by the American Society of Plastic Surgeons show a shift in the types of procedures patients have chosen, with minimally invasive procedures such as botulinum toxin Type A (up 1% from 2014 and 759% since 2000), soft tissue fillers (up 6% from 2014 and 274% since 2000), chemical peels (up 5% from 2014 and 14% since 2000), laser hair removal (unchanged from 2014, but up 52% since 2000) and microdermabrasion (down 9% from 2014 and 8% since 2000) showing a steep rise, while traditional plastic surgery procedures such as breast augmentation, liposuction, nose reshaping and eyelid surgery showing a gradual decline from 2000. [1] Hawks in associations cry for regulations and restrictions, while the doves want to settle for a middle path. Can associations dictate what another speciality …