15 Years of Training vs. a Weekend Course… Who’s Operating on You?

What’s the real difference between a highly trained plastic surgeon and someone calling themselves a “cosmetic surgeon”? It’s bigger than most people think and it can directly impact your results.

In this episode, we break down key insights from YouTube videos by Hawaii's Dr. Shim Ching of Asia Pacific Aesthetics, a board-certified plastic surgeon known for his focus on precision, artistry, and natural-looking results. We unpack his Four Pillars of Surgical Excellence (training, skill, experience, and artistic ability) and what matters most when choosing a surgeon.

We also talk about into Dr. Ching’s 10-Year Rule which is a simple way to evaluate real surgical experience before making a decision. It's direct and we were really impressed with the simplicity.

If you’re researching plastic surgery, considering eyelid surgery (blepharoplasty), or exploring scarless breast augmentation, this episode will give you a clearer, more practical way to choose the right surgeon.

In this episode, we cover:

• The real difference between a plastic surgeon and a cosmetic surgeon
• Why 15+ years of training matters for safety and results
• The Four Pillars of Surgical Excellence explained
• The 10-Year Rule and how to use it when choosing a surgeon
• Why plastic surgery is a visual specialty where millimeters matter
• How reconstructive training leads to better cosmetic outcomes
• The small technical details that create natural-looking results
• How to evaluate before-and-after photos with a trained eye

If you want safer procedures and results that actually look natural, this episode will change how you choose a plastic surgeon.

Transcript

Erin: 00:00
Welcome to another deep dive. So think about this for a second. If you are uh if you're hiring a structural engineer to build a bridge, right? Right. You check their credentials, you look at their licensing, you make absolutely sure the bridges they've built haven't, you know, s suddenly fallen down.

Trevor: 00:16
Yeah, you do your homework.

Erin: 00:18
Exactly. But when you step into the world of elective medicine and we're talking about handing over the literal blueprints of your body for cosmetic surgery, that comforting safety net just, well, it vanishes.

Trevor: 00:29
It really does. It's shockingly unregulated in some ways.

Erin: 00:32
It is. The landscape of who is actually qualified to alter your physical appearance is, frankly, terrifyingly murky. So today, we're asking the critical question. If you, or maybe someone you know, is ever considering plastic surgery, how do you actually know who to trust with your body?

Trevor: 00:49
And to answer that, we are drawing on a really uh highly detailed series of videos from Dr. Shim Ching.

Erin: 00:57
Right, the Hawaii guy.

Trevor: 00:58
Yeah, he's a board-certified plastic surgeon based in Hawaii, and he's got like a couple of decades of experience under his belt. And he basically breaks down the entire industry into what he calls the four pillars of plastic surgery.

Erin: 01:11
The Four Pillars. I love a good framework.

Trevor: 01:14
It's a great framework because these pillars are essentially the ultimate filter for separating the true masters from well, the dangerous amateurs out there.

Erin: 01:24
Okay, let's unpack this because the very first pillar Dr. Ching talks about, which is training, it starts with this massive disparity in medical licensing that I think most patients, I mean you and me included, are completely unaware of.

Trevor: 01:37
Absolutely. The general public has no idea.

Erin: 01:38
Right. He warns about this thing he calls the weekend course trap.

Trevor: 01:42
Yeah, that's a scary one.

Erin: 01:43
It really is. Like picture this. You walk into a clinic for a highly complex invasive procedure. We're talking a breast augmentation or uh a Brazilian butt lift, a BBL.

Trevor: 01:54
Major surgery.

Erin: 01:55
Major. And the person holding the scalpel is a licensed doctor, sure. But their primary specialty might actually be internal medicine.

Trevor: 02:03
Or they could be an ER doctor.

Erin: 02:05
Exactly, an ER doctor. And their specific training for that complex cosmetic procedure you're paying for. It was like a two or three-day weekend course at a hotel conference center.

Trevor: 02:16
It sounds made up, but it's the legal reality of medical licensing.

Erin: 02:21
Which is insane to me.

Trevor: 02:23
It is. Legally, once a physician gets their medical degree and they pass their boards for a general license, the law gives them broad authority to practice medicine. Trevor Burrus, Jr.

Erin: 02:32
So they can kind of just do whatever. Trevor Burrus, Jr.

Trevor: 02:34
Pretty much. But there is a monumental difference between, you know, diagnosing a systemic illness and surgically altering human anatomy. Right. Like an internist spends their entire career mastering chemical pathways, pharmacology, uh, managing chronic diseases like diabetes or hypertension. Which is super important. It's brilliant. It's a necessary specialty, but it does not involve holding a scalpel. It doesn't involve managing severe tissue trauma or, you know, really understanding the biomechanics of reshaping a human form.

Erin: 03:04
I have to pause on this because it feels like a massive logical leap for a patient to make. Like if someone went to medical school, you assume they study human anatomy.

Trevor: 03:12
Sure, they did.

Erin: 03:12
They aren't just pulling random people off the street to do these surgeries.

Trevor: 03:16
No, definitely not.

Erin: 03:17
But trusting an internist to perform a complex body modification just because they have an MD. It feels a bit like um, well, imagine boarding a massive 747 for a transatlantic flight. Okay. You look into the cockpit and the pilot says, Well, I've been driving a high-speed train for 20 years, and I understand the physics of transportation. Plus, I just spent a weekend on a flight simulator.

Trevor: 03:41
Yeah, getting off that plane immediately.

Erin: 03:43
I am absolutely getting off that plane.

Trevor: 03:45
And that analogy totally holds up when we look at the actual timeline required to become a board-certified plastic surgeon.

Erin: 03:51
Right. What's fascinating here is the sheer amount of time involved.

Trevor: 03:55
Exactly. What's fascinating here is when you measure the hours and the years of dedicated surgical immersion, the idea that a weekend course could substitute for that foundation just i it falls apart completely.

Erin: 04:08
So let's break down that true timeline Dr. Ching outlines. Because it's long.

Trevor: 04:12
It's incredibly long. So you start with four years of university for your undergraduate degree.

Erin: 04:18
Standard.

Trevor: 04:18
Right. Followed by four years of rigorous medical school.

Erin: 04:22
Okay, so that's eight years right there.

Trevor: 04:24
Eight years. And at the end of those eight years, you are officially a doctor. But in the surgical world, you are only at the starting line.

Erin: 04:33
Wow. So those first eight years are essentially just the general foundation.

Trevor: 04:37
Exactly. The real differentiation happens next. To become a dedicated plastic surgeon, that doctor must then complete another five to eight years of specialized surgical residency.

Erin: 04:48
Five to eight years.

Trevor: 04:49
Just in residency.

Erin: 04:50
That's, I mean, we are talking about half a decade or more completely immersed in the operating room.

Trevor: 04:55
Every single day. They are learning tissue management, mastering the uh the really complex blood supply networks of the skin. Right. And they're understanding how the body physically reacts to surgical trauma, all under the strict supervision of veteran surgeons.

Erin: 05:11
And many of them don't even stop there, right?

Trevor: 05:13
No, they don't. Dr. Ching points out that surgeons often pursue an additional one to two years of fellowship training after their residency. Trevor Burrus, Jr.

Erin: 05:21
Just to master a specific niche.

Trevor: 05:23
Yeah, like microsurgery or um craniofacial reconstruction.

Erin: 05:28
So if you add that all up, you are looking at up to 15 years of post-high school highly specialized training.

Trevor: 05:37
Fifteen years.

Erin: 05:38
Think about that timeline for a second. When you see an ad on your Instagram feed for a heavily discounted, you know, weekend special surgery from a non-specialist, you are essentially opting to skip 15 years of that surgeon's homework.

Trevor: 05:51
That's a great way to put it. And skipping that homework means the practitioner lacks the deeply ingrained muscle memory.

Erin: 05:57
Right.

Trevor: 05:58
And the vast catalog of safety protocols that you absolutely need when something inevitably doesn't go according to plan on the operating table.

Erin: 06:05
Trevor Burrus, Jr.

Trevor: 06:07
They do. And the first pillar, training, provides that foundational catalog of medical knowledge. Trevor Burrus, Jr.

Erin: 06:12
But training isn't everything. Trevor Burrus, Jr.

Trevor: 06:13
No, it's not. A certificate on the wall does not hold the scalpel. Training is theoretical. It simply gives you the permission to begin.

Erin: 06:19
Which naturally brings us to how a surgeon translates that knowledge to the table. And that's the second pillar, skill. And Dr. Ching defines skill in a very specific, almost mechanical way. It isn't just knowing like where to make an incision.

Trevor: 06:34
No, it's much deeper than that.

Erin: 06:35
A skilled surgeon needs a natural aptitude with their hands and their eyes, but the critical differentiator he talks about is three-dimensional spatial awareness. Yes. They have to look at a patient's physical structure and literally piece the surgical solution together three-dimensionally in their mind before they even pick up a tool.

Trevor: 06:52
Because it's an incredibly complex engineering problem. You have to remember skin and fat are not inanimate materials like, you know, clay or fabric.

Erin: 07:03
Right. They're alive.

Trevor: 07:04
They are living, moving tissues with elasticity and weight. If you alter the tension on one piece of skin, it pulls on everything around it.

Erin: 07:12
Oh, wow. I never thought about it like that.

Trevor: 07:14
Yeah, it can potentially shift other features or even restrict blood flow. So a surgeon with elite 3D spatial awareness understands the cascading effects of just a single internal adjustment.

Erin: 07:26
And if we connect this to the bigger picture, we have to look at where this specific type of spatial problem solving actually originated. Because this part of the source material completely shifted my perspective.

Trevor: 07:39
It's a really dark but fascinating history.

Erin: 07:41
It really is. Like the common assumption is that plastic surgery was born out of vanity. You know, the Hollywood quest for eternal youth, facelifts, that kind of thing.

Trevor: 07:49
But the roots of this medical specialty are actually deeply tied to trauma and survival.

Erin: 07:54
Yeah. Modern plastic surgery really found its footing in the trenches of World War I.

Trevor: 07:59
Because the scale of facial and bodily trauma from trench warfare, from artillery, it was unprecedented in human history.

Erin: 08:07
Soldiers were surviving explosions that would have killed them in previous wars?

Trevor: 08:11
Right. But they were returning home with completely shattered faces and bodies. And the surgeons of that era had to figure out, often totally from scratch, how to reconstruct a human being.

Erin: 08:22
It wasn't about aesthetics at all.

Trevor: 08:24
No, it was about restoring fundamental human function. They had to invent ways to um to move flaps of skin from a forehead to rebuild a nose.

Erin: 08:34
While keeping the blood vessels attached.

Trevor: 08:35
Exactly, so the tissue wouldn't just die. They were trying to allow a young man to chew food again, to breathe without assistance, or just to walk down the street without being shunned by society.

Erin: 08:46
And Dr. Ching stresses that this reconstructive foundation is an essential part of a modern plastic surgeon's capabilities. Like during his own training, the focus was heavily on these reconstructive procedures.

Trevor: 08:58
And that matters because a great cosmetic surgeon today draws directly upon the incredibly difficult, complex, reconstructive history of their specialty.

Erin: 09:08
Reconstructive surgery basically teaches a profound respect for tissue viability, right?

Trevor: 09:13
Absolutely. If a surgeon knows how to rebuild a jawline that was destroyed by trauma-like, by transferring bone and blood vessels from the patient's leg, they have developed a fundamental understanding of how the human body heals.

Erin: 09:26
So when that same surgeon shifts their focus to an elective cosmetic procedure like a rhinoplasty or a breast lift, they are pulling from this deep well of reconstructive problem solving.

Trevor: 09:37
Which seamlessly integrates into the third pillar: experience.

Erin: 09:40
Experience is where the theoretical and the historical actually meet the practical reality of a patient's long-term outcome. Dr. Ching offers a very straightforward golden rule for patients vetting a doctor's background. You want to see a solid proven track record within a community. And ideally, look for someone with 10 or more years of dedicated practice in this specific field.

Trevor: 10:06
Ten years is a crucial benchmark.

Erin: 10:07
Why ten years specifically?

Trevor: 10:09
Because it accounts for the fourth dimension time.

Erin: 10:11
Okay, right.

Trevor: 10:12
A surgeon with a decade of experience hasn't just performed the surgeries, they have actually had to live with the long-term results of their own work.

Erin: 10:20
Oh, that makes so much sense.

Trevor: 10:21
Right. They have seen how their specific scars mature over three, five, and ten years. They understand how gravity and aging interact with the surgical changes they made.

Erin: 10:30
Because a facelift at year one looks very different at year 10.

Trevor: 10:33
Exactly. And a veteran surgeon has actively refined their techniques based on those years of actual patient outcomes.

Erin: 10:39
But you know, I am struggling to picture the final piece of this puzzle. Well, let's say we find a surgeon who hits all these marks. They have the 15 years of rigorous training, they have the reconstructive background, they possess incredible 3D spatial skills, and they have over a decade of community experience.

Trevor: 10:58
That sounds perfect.

Erin: 10:59
Right. It seems like they should automatically be a top-tier plastic surgeon.

Trevor: 11:03
But Dr. Ching says that is not necessarily the case.

Erin: 11:06
Exactly. Because of the fourth and arguably the most elusive pillar, artistic ability.

Trevor: 11:14
Yes. And this is where plastic surgery diverges entirely from almost every other medical specialty.

Erin: 11:19
What do you mean?

Trevor: 11:20
Well, in internal medicine or general surgery, the ultimate goal is purely functional. A general surgeon can execute a technically flawless, life-saving operation to remove an appendix or repair a hernia.

Erin: 11:32
And once you're sutured up, no one ever sees it.

Trevor: 11:34
Exactly. No one sees that beautiful internal work. Success is measured entirely by the absence of disease and the restoration of health. But plastic surgery, conversely, is an entirely external visual specialty.

Erin: 11:47
Here's where it gets really interesting. It is the difference between hiring a master plumber and a master sculptor. Oh, I like that. Right. If you hire a master plumber to fix the pipes behind your drywall, their only job is to ensure nothing leaks and the water pressure is perfect. You don't care what the pipes look like.

Trevor: 12:04
As long as they function.

Erin: 12:05
Right. But if you hire a master sculptor to build a grand fountain in your courtyard, the internal plumbing still has to work flawlessly, but the external fountain also has to be breathtakingly beautiful.

Trevor: 12:17
The plastic surgeon has to be the plumber and the sculptor simultaneously.

Erin: 12:21
Exactly.

Trevor: 12:21
They're managing the internal blood flow, the nerve pathways, tissue viability that's the plumbing, while also possessing the artistic aptitude to create a natural-looking external result.

Erin: 12:32
And this artistry doesn't manifest as like broad sweeping strokes.

Trevor: 12:37
No, not at all.

Erin: 12:37
Dr. Ching points out that true surgical artistry actually lives in the microscopic details.

Trevor: 12:43
It really does.

Erin: 12:44
A master surgeon relies on a mental list of thousands of tiny refinements acquired over their career. And he gives a brilliant, concrete example to illustrate this difference between average and excellent.

Trevor: 12:56
The staple versus the suture.

Erin: 12:58
Yes. The choice between using a surgical staple versus an internal layered suture. Let's say the surgeon is finishing the procedure and needs to close a long incision.

Trevor: 13:08
They just use a surgical stapler. It's medically safe, it cures the tissue, and it takes literally 10 seconds to close the wound.

Erin: 13:14
Ten seconds.

Trevor: 13:16
But the visual consequence of those ten seconds is significant. Think about the biomechanics of scarring.

Erin: 13:22
Okay.

Trevor: 13:22
When you use a staple, you are just pinching the top layer of skin together.

Erin: 13:26
Right.

Trevor: 13:27
As the body moves, tension pulls at that surface skin. The skin literally fights to pull apart.

Erin: 13:33
Which creates a wider scar.

Trevor: 13:35
Exactly. It creates a wide, highly textured, often very noticeable scar. Sometimes you even get those visible train track marks from the staples themselves.

Erin: 13:44
So what does the surgical artist do instead? Dr. Ching advocates for a much more demanding technique using internal layered sutures. Instead of just clamping the surface, the surgeon sews deep inside the wound. They bring the lower layers of muscle and fat together first, which creates an internal scaffolding to support the incision from the inside out.

Trevor: 14:04
And by placing those deep sutures, the surgeon transfers all the mechanical tension of the body away from the surface.

Erin: 14:11
The internal tissues bear the weight?

Trevor: 14:13
Exactly. The internal tissues bear the weight of the movement. And because the delicate surface skin is no longer fighting to pull apart under all that tension, it can heal gently into a minimal, sometimes almost invisible, fine line.

Erin: 14:27
But executing those layered internal sutures requires vastly more time.

Trevor: 14:31
Oh, so much more time. And patience and technical skill.

Erin: 14:48
And that artistic eye is also deeply tied to the biological reality of symmetry. We all know that human beings are fundamentally asymmetrical. We are. Like if you take a photograph of the right side of your face and mirror it, you look like a completely different person. The left and right sides of our bodies, our bone structures, the placement of our features, they all have natural built-in variations.

Trevor: 15:07
Biological asymmetry is a totally natural human trait. But human psychology is wired to perceive symmetry as the ideal standard of beauty.

Erin: 15:16
Right. Our brains just like it better.

Trevor: 15:18
We do. So following a cosmetic procedure, patients will inevitably hyperfixate on the symmetry of their results.

Erin: 15:25
Staring in the mirror.

Trevor: 15:26
Exactly. And a great surgeon anticipates this. They aren't just mechanically placing identical implants or making mathematically equal cuts on a canvas that is fundamentally uneven to begin with.

Erin: 15:38
They must possess meticulous eye for millimeters. They're basically creating an optical illusion, right?

Trevor: 15:44
Yes, an optical illusion. They are making minute, localized adjustments, like removing a little more tissue on the left or adjusting a vector of tension on the right to create the illusion of perfect symmetry to the naked eye.

Erin: 15:55
And it requires a level of spatial and artistic judgment that you simply cannot download from a weekend seminar. Never. So we've established a robust theoretical framework. We understand the four pillars training, skill, experience, and artistic ability.

Trevor: 16:09
We see how the reconstructive roots inform modern safety, and how minor details like internal sutures elevate the final aesthetic.

Erin: 16:17
So what does this all mean? The next step is translating this framework into a practical toolkit for you, the listener. How do you actually vet a surgeon using these parameters?

Trevor: 16:28
Well, the most direct way to evaluate a surgeon's artistic ability is by looking at their portfolio of before and after photos.

Erin: 16:35
Obviously.

Trevor: 16:36
But there is a massive caveat here that patients often miss.

Erin: 16:39
It is.

Trevor: 16:40
You aren't just looking to see if the photos are objectively good.

Erin: 16:43
Because good is subjective.

Trevor: 16:44
Good is an entirely subjective metric. Dr. Ching emphasizes that artistic sense cannot be quantified mathematically.

Erin: 16:51
Right.

Trevor: 16:52
One surgeon's idea of a beautiful, dramatic contour might be entirely different from your ideal aesthetic.

Erin: 16:58
You are examining the portfolio to see if the surgeon's internal compass of beauty aligns with your own.

Trevor: 17:03
Exactly. If their gallery is filled with highly stylized, exaggerated results and you are seeking a subtle, undetectable refinement, that surgeon is not a match for you.

Erin: 17:13
Regardless of their impressive credentials.

Trevor: 17:15
Exactly.

Erin: 17:16
And as for where to actually build your initial list of candidates, the insider advice points to a mix of offline and online research. Word of mouth remains incredibly powerful.

Trevor: 17:28
Speak to friends or family who have had positive long-term experiences.

Erin: 17:32
Right, long-term. Not just someone who looks good three weeks post-op when they're still swollen.

Trevor: 17:38
Exactly. Dive deep into online review sites and Google reviews. Look specifically at what past patients say about the healing process, and this is crucial how the clinic handled complications.

Erin: 17:49
Because complications happen to everyone.

Trevor: 17:51
They do. How a surgeon handles a complication tells you everything you need to know.

Erin: 17:55
And once you narrow down the field based on their track record and aesthetic alignment, you reach the ultimate test. The most critical part of the entire plastic surgery journey does not happen while you are under anesthesia.

Trevor: 18:06
No, it happens while you are fully awake sitting in the consultation chair.

Erin: 18:09
So what does this all mean when you are sitting across from the doctor? The defining green flag is incredibly simple but so often overlooked. Does the surgeon actually listen to what you want?

Trevor: 18:21
That is huge. Dr. Ching notes that many highly qualified surgeons fail right here. They have the 15 years of training and the technical skill, but they let their ego drive the process.

Erin: 18:32
They impose their own artistic desires onto the patient.

Trevor: 18:35
Is the trap of the expert. A surgeon might look at your face, instantly see a dozen minor asymmetries, and decide exactly what needs to be fixed based on their own portfolio goals.

Erin: 18:45
But a top-tier plastic surgeon operates with empathy. They prioritize your happiness above their own artistic ego.

Trevor: 18:52
A great surgeon needs to clearly understand the specific problem you were trying to solve.

Erin: 18:57
Are you trying to look refreshed for your age? Are you trying to correct a specific physical feature that has caused you anxiety since childhood? Or are you, you know, trying to restore the way your body functioned and looked before an illness or a pregnancy?

Trevor: 19:10
If the surgeon isn't asking those targeted questions and truly digesting your answers, their technical skill is irrelevant.

Erin: 19:17
Because they are preparing to solve the wrong problem.

Trevor: 19:20
Exactly. The consultation must be a mutual interview. You are assessing their ability to safely execute your vision, and they should be assessing whether your vision is medically achievable and psychologically healthy.

Erin: 19:32
A surgeon guarantees absolute perfection, or if they dismiss your specific concerns to upsell you on a completely different, more invasive procedure, you should view that as a massive red flag and walk away. So let's do a quick recap of the insider knowledge we've gained to keep in our back pockets. First, training. We now know to avoid the weekend course trap and demand a board-certified specialist who has survived the brutal 15-year pipeline of dedicated medical and surgical study. Second, skill. We are looking for that elite, three-dimensional spatial awareness that allows a surgeon to engineer a physical solution in their mind, understanding the cascading effects of tissue tension before they make a single cut.

Trevor: 20:31
Third, experience. We want a track record of 10 or more years in the community. We want a surgeon whose practice is deeply rooted in the complex problem solving of reconstructive surgery, a lineage of tissue management that traces its origins all the way back to the battlefields of World War I.

Erin: 20:48
And finally, artistic ability. We understand that plastic surgery is a completely visual external specialty. We want the master sculptor who focuses on the millimeter level details.

Trevor: 20:60
The surgeon who will spend the extra time placing internal layered sutures instead of quick staples to ensure the surface skin heals flawlessly.

Erin: 21:07
Understanding these four pillars completely changes the paradigm of what you are actually paying for when you seek out a specialist. You aren't paying for a commodity, you are paying for an entire career's worth of refined judgment.

Trevor: 21:18
But this raises an important question, though. And it is kind of the philosophical core of everything we have discussed today.

Erin: 21:24
Let's hear it.

Trevor: 21:25
We established that human bodies are inherently biologically asymmetrical.

Erin: 21:30
Right.

Trevor: 21:30
We also established that true artistry in plastic surgery is entirely subjective. There is no single mathematical formula for beauty that applies universally to every patient.

Erin: 21:40
So true.

Trevor: 21:41
So if nature is asymmetrical and beauty is subjective, what is the actual finish line? Is the ultimate goal of modern cosmetic surgery to achieve some kind of objective perfection which might not even exist? Or is it actually about using a scalpel to help a patient achieve a deeply personal? Internal sense of harmony with their own reflection.

Erin: 22:03
Wow. That reframes the entire industry.

Trevor: 22:05
It does.

Erin: 22:06
It shifts the focus away from just fixing flaws and towards aligning the external body with the internal self.

Trevor: 22:12
Exactly.

Erin: 22:12
It makes you realize just how profound that level of trust truly is. You aren't just handing over the blueprints to a bridge. You are trusting someone with the very structure of how you present yourself to the world.

Trevor: 22:23
It's a massive decision.

Erin: 22:24
It is. Thank you so much for joining us on this deep dive. Take this insider knowledge, use it to protect yourself and your loved ones, and as always, keep questioning the world around you. We will see you next time.