American Association of Oral and Maxillofacial Surgeons
Guidelines for Credentialing in Facial Cosmetic Surgery

The American Association of Oral and Maxillofacial Surgeons (AAOMS) has adopted the following policy to establish credentialing standards for oral and maxillofacial surgeons who perform facial cosmetic surgery. These credentialing standards should be applied and privileges to perform facial cosmetic surgery should be granted in accord with the institutional credentialing processes currently established for all specialists who perform facial cosmetic procedures. The Association strongly supports the Joint Commission’s criteria and standards for credentialing and privileging, including recognition that granting of privileges must be based on the education, training, experience, current competence and health status of the individual surgeon.

The following credentials are recommended for oral and maxillofacial surgeons performing cosmetic procedures:

   1. Completion of:

        a. Documented residency training¹ OR

        b. Documented fellowship in facial cosmetic surgery² OR

        c. Postresidency training as outlined in Appendix 1 AND

   2. Hospital privileges to perform the procedures OR

   3. Privileges in an ambulatory surgery center accredited/recognized by one of the following:

       a. JC

       b. AAAHC

       c. State Agency

       d. Medicare

       e. State board of dentistry and/or medicine AND

   4. Compliance with state law

¹Documented residency training means a residency training program accredited by the Commission on Dental Accreditation (CODA), the Accreditation Council for Graduate Medical Education (ACGME), or other nationally recognized accreditation agency that establishes credentialing standards for residency training.

²Documented fellowship training means afellowship accredited by the Commission on Dental Accreditation (CODA), the Accreditation Council for Graduate Medical Education (ACGME), or other nationally recognized accreditation agency that establishes credentialing standards for residency training.

In 1997, the American Dental Association (ADA) House of Delegates approved a definition of dentistry which states:

1. Dentistry is defined as the evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body; provided by a dentist, within the scope of his/her education, training and experience, in accordance with the ethics of the profession and applicable law.

In 1990, the ADA House of Delegates also adopted a definition of oral and maxillofacial surgery which states:

1. Oral and maxillofacial surgery is the specialty of dentistry, which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

To assist in the interpretation of “associated structures,” a definition of the term referenced in the ADA Definition of Dentistry is as follows:

1. Associated structures – any structures grouped by some common factor. Structures can be associated with the teeth and jaws by anatomic and/or functional factors (e.g., the teeth and jaws are associated with the major and minor muscles of mastication and all of their attachments; the teeth and jaws are associated with the oropharynx, nasopharynx, and the airway including the trachea). All structures adjacent, attached, or contiguous with the teeth and jaws are associated structures (e.g., the teeth and jaws are associated with the head and neck, including the face and its components, orbital, nasal, aural, etc.)

For additional information, please contact AAOMS Headquarters.

Guidelines for Postresidency Training Facial Cosmetic Credentials and Privileges

If a practicing OMS elects to obtain additional education and clinical experience in the area of esthetic (cosmetic) surgery, it is suggested that the review of the AAOMS credentialing guidelines for maxillofacial cosmetic surgery be followed. The process should include appropriate documentation of experience and may, at the minimum, include the following:

1 Proof of education and training is required in each of the specific procedures requested. This can either be in a letter from the OMS Residency or Fellowship Director, or from appropriate documented experiences with qualified surgeons. It is recommended that such documents contain language relative to the fact that the OMS has completed certain guidelines suitable to allow the director or faculty to use the terms in his/her experience, that said OMS is currently “TRAINED TO COMPETENCE” in specific procedures.

2 Documentation and certificates from all CME, Observational Teaching Programs, etc., should be meticulously maintained. It is suggested that a minimum of 50 hours of CME be documented in the form of didactic-dissection courses dedicated to the subject of esthetic surgery.

3 A detailed surgical log of all experiences should be maintained for any and all cases having esthetic components.

4 It has been suggested that OMS should accumulate a minimum of five (5) experiences as primary surgeon, assisted or supervised by a credentialed surgeon as first assistant for each procedure or similar procedures in which the OMS is requesting privileges. The credentialed first assistant or supervisory surgeon should be expected to provide written confirmation of this fact, and a proctoring-type review of performance in each instance to cover diagnosis, treatment planning, surgical management, and clinical outcome.

Outline of Educational Continuum

LEVEL ONE: Documentation of literature review, videotape review, and appropriate textbook acquisition.

LEVEL TWO: Documentation of completion of CME credits in accredited didactic coursework, to include “dedicated” (i.e. subject specific) courses offered within and out of specialty.

LEVEL THREE: Documentation of completion of accredited didactic-dissection (e.g. surgical skills workshop with hands-on experiences) courses, provided by clinicians who are appropriately credentialed (i.e. hospital privileges for all procedures presented and in a Q/A-PRO setting) and recognized experts in the particular areas of clinical interest.

LEVEL FOUR: Documentation of completion of observational training programs that are formally recognized (by AACS, AAFRS, AAOMS, or ASPRS) or their equivalent, and provided by clinicians who are appropriately credentialed (as above) and recognized experts in the particular areas of clinical interest.

LEVEL FIVE: Documentation of completion of actual surgical experiences on patients, acting in the capacity of assistant surgeon (first assist) or co-surgeon, where the primary surgeon is appropriately credentialed (as above) and preferably in a Q/A-PRO setting.

LEVEL SIX: Documentation of multiple surgical experiences as the primary surgeon, actually first assisted or closely supervised by a surgeon who is appropriately credentialed (as above) and who is recognized to be surgically competent in that area of clinical interest. The “consultant” surgeon(s) would be expected to provide written substantiation of such experiences within levels five and six. It is recommended that procedure specific accreditation be provided such that the “consultant” will verify that the surgeon-in-training has substantial experience, or, preferably that, in the opinion of the consultant, the surgeon has been “trained to competence” in particular area(s).

LEVEL SEVEN: Documentation of actual surgical experience as primary surgeon in an outpatient setting (i.e. surgicenters, clinical surgical suites, or ambulatory “day” surgery facility). It is at this point that the surgical experience and training becomes commensurate with submission of application for hospital privileges.

LEVEL EIGHT: The surgeon has hospital privileges to perform such surgery within a hospital that is accredited by the Joint Commission, and thereby operating in a documented Q/A-PRO setting.

Note: Levels seven and eight exclude residents completing oral and maxillofacial surgery training who can fulfill only levels 1-6 of the guidelines as they cannot legally function as a primary surgeon during residency.