Excerpt from

No Scalpel Required

Are plastic surgeons the new dermatologists? Christine Muhlke reports on skin care's latest turf war.

A major benefit of visiting a surgeon rather than a dermatologist - or spa - for treatments that may fall into the "skin care" category is that he or she keeps a trained eye on what to do when wrinkles go beyond Botox. "Some people aren't ready for bigger procedures," says plastic surgeon Frederick N. Lukash, M.D., who has "medical skin-care centers" in Manhattan and Manhasset, New York. "So you need to do smaller things, like skin care, collagen, and fat, that help them along physically and psychologically, and also keep them within your own loop. If they're happy with you, you don't want to lose them."

Mia Stern, a former publicist, is a good example. Stern began seeing Fifth Avenue plastic surgeon John Sherman, M.D., four years ago for Botox and Collagen. At 31, she had crow's feet and forehead and laugh lines that were barely perceptible, and she wanted to keep them that way. Asked why she chose to see a surgeon instead of a skin doctor, Stern says it seemed logical. "Dr. Sherman is trained to shape a face with surgery. When he's injecting Botox into my forehead - anything that is going to change the way my face looks - I feel more comfortable," she says. "And if he thinks you would be better served by something more serious, he'll tell you to stop wasting your money on Botox and to get surgery instead." Indeed, two years ago Stern took her doctor's advice and had eyelid surgery.

Just as plastic surgeons once felt that dermatologists were invading their territory by fighting wrinkles instead of rosacea, dermatologists are on edge about the new crossover. "I personally believe that plastic surgeons are surgeons, and most other things related to skin care are appropriate for a dermatologist," says dermatologist Brad Katchen, M.D., founder of SoHo's SkinCareLab.

"I think a lot of dermatologists resent the fact that plastic surgeons do Botox," says Wendy Lewis, a plastic-surgery consultant and author of America's Cosmetic Doctors and Dentists (Castle Connolly Medical, Ltd.). "Their attitude becomes, 'What do you need to do Botox for when you can make $10,000 from a facelift?'"

"There's definitely a turf war going on, " says Manhattan plastic surgeon Robert Guida, M.D. (who points out that Botox was first used by plastic surgeon Andrew Blitzer, M.D., in the eighties to correct facial spasms).

"But I think it's good for patients; it makes everyone practice at a higher level."

"It's a morass of overlap," sighs Lukash. "Once upon a time, plastic surgeons just did surgery and dermatologists took care of pimples."