If I only had a dollar for every time I’ve heard this question…! I think this is a very reasonable and understandable query and gets at the heart of what it truly means to be a plastic surgeon. It reminds me of what one of my mentors once told me, which is: “Ziv, don’t go into plastic surgery unless you want to spend your whole career apologizing for your colleagues.” This mentor is a Full Professor of Plastic Surgery at Stanford University and is a full-time researcher. He has published over 1000 scientific articles in some of the top scientific journals (e.g. Nature, JAMA, Science) and is a member of the National Academy of Science. The problem with this question is that it implies that plastic surgeons are only known for performing cosmetic surgery. However, we do so much more.
If you have breast cancer, it is a plastic surgeon who will reconstruct your breast. If you are shot and have a large hole in your leg that requires tissue be moved from your back to cover the hole in your leg, it is a plastic surgeon who will perform that operation. If you have a cleft lip or palate, it is a plastic surgeon who will repair it. If you have a child born with a prematurely fused skull, it is a plastic surgeon who will fix it. If you need a face or arm transplant, it is a plastic surgeon who will lead that surgical team. If you cut a finger or arm off, it is a plastic surgeon who will replant it.
As you might appreciate given the breadth of these cases, we as plastic surgeons operate all over the body, on both young and old patients alike and on many of the bodily tissues such as skin, muscle, fat, bone, and of course, nerves (e.g. in the replantation of an extremity or face transplant). Some of us have dedicated the majority of our practices to peripheral nerve surgery and perform operations on hundreds of nerves each year. That background gives us a unique skill set and degree of experience that is shared by few others.
When it comes to headaches and migraines, they are generally considered to be disorders triggered within the central nervous system and many patients are successfully treated in this way. However, for those who have head pain as a result of mechanical compression of nerves, causing occipital neuralgia or trigeminal branch neuralgia, the treatment needs to occur within the peripheral nervous system. Neurosurgeons predominantly operate on the brain and spinal cord. There are exceptions to be sure, but the majority of neurosurgeons have an expertise in the physiology and surgical treatment of the central nervous system. In contrast, many plastic surgeons have significant experience with peripheral nerves, and thus are much better positioned to work in the peripheral nervous system.
Hope that helps clear up some of the confusion. We clearly need to do a better job as a society, telling the world what exactly it is that plastic surgeons really do.