When is a doctor a doctor?

05 December 2022

The residency / residency training

After six years of medical studies and the third state examination, one can apply for the license to practice medicine in Germany. With the license to practice medicine, one receives the full authorization to practice medicine. The specialist training begins for physicians with their work in the hospital.

What is a specialist?

With a completed medical degree and a valid license to practice medicine, physicians can apply for a position as a postgraduate training assistant at a hospital authorized to provide postgraduate training in the specialty. The resident commits to a medical specialty and learns that specialty during his or her first years on the job.

Training to become a specialist

In One Specialty Medical specialties include, for example, internal medicine, general surgery, orthopedics&accident surgery, dermatology, or plastic&aesthetic surgery. Upon successful completion of residency training, the specialist title is earned. Thus, a specialist is a physician who has completed several years of continuing education in exactly one medical specialty.

Doctor training: Why specialist?

A specialist title is required to be able to perform certain activities. It serves as evidence of specialization in a subject area.

Duration of the residency

The prerequisite for the title of specialist in Germany is several years of training. This usually lasts 5 to 6 years. The duration of the training depends on the chosen field.

For example, if you take the plastic surgery residency training, you will go through various stations during the duration of your residency. The 6 years of residency training here are composed as follows:

The period of further training in plastic and aesthetic surgery is 72 months with a person authorized to provide further training at a training center, of which

must be completed 48 months in plastic, reconstructive and aesthetic surgery

Must serve 6 months in the emergency department

Must complete 6 months in critical care (preferably in a burn intensive care unit)

Up to 12 months of continuing education in other areas may be provided to acquire competencies

The training to become a specialist

During the period of further training, the physician is referred to as an assistant physician in the respective specialty or as a physician in further training. The specialist training takes place under the responsibility and direction of the responsible state medical association at a university hospital or an institution of medical care with corresponding authorization for further training. Postgraduate training sites include hospitals and medical practices that are authorized to provide postgraduate training. At the same time, residency is a paid activity.

Physicians must fulfill the points specified in the continuing education catalog on their way to becoming a specialist and have this certified in writing by their supervisor.

The specialist examination and establishment

After completion of the training, a specialist examination must be taken at the state medical association. After passing the exam, you can wear the specialist title (website, business card, practice sign,…).

Without the specialist title, only the treatment of private patients is possible.

Additional designation

In addition to the various specialist training courses, in which a specific specialist title is acquired, there are a number of additional further training courses available.

These additional continuing education courses are special medical qualifications that can be acquired in addition. An additional postgraduate training does not lead to a further specialist title, but to an additional title in addition to the specialist title. These include, for example, further training in acupuncture, geriatrics, intensive care medicine, emergency medicine or sleep medicine.

Admission to the examination in the additional training courses also requires (certain) specialist recognition. Exceptions are medical informatics and emergency medicine.

Your Dr. Yary

Residency in Plastic, Reconstructive and Aesthetic Surgery

October 28, 2022

At a glance: Advanced training (residency) Plastic, Reconstructive and Aesthetic Surgery

Definition: Plastic, Reconstructive and Aesthetic Surgery deals with procedures that are performed for functional or aesthetic reasons, especially on the visible part of the body. Body shapes and visibly disturbed functions are restored or improved. This includes, for example, reconstructions after accidents or tumors, but also aesthetic surgery.

Duration: The residency in plastic and aesthetic surgery lasts 72 months. Of these, 6 months each must be completed in critical care and the emergency department. Up to 12 months can be done in other areas.

Number of specialists: There are 938 specialists in plastic, reconstructive and aesthetic surgery in Germany. Of these, 869 are employed. 311 work as outpatients and 513 as inpatients in a clinic.

What does plastic surgeon actually mean?

The term “plastic” surgery originates from the fine arts: here, “plastic” stands for a sculpture created by modeling a material such as clay. This definition already pretty much outlines what this specialty is all about: Plastic, Reconstructive and Aesthetic Surgery, in a way, models patients’ bodies.

However, it is not enough to equate plastic surgery with pure cosmetic surgery, especially since the term cosmetic surgery is not a protected name. Any doctor I can call himself “”Beauty Doc”, “”Specialized in Beauty”, “”Doctor of Aesthetic Medicine”, “Plastic Surgeon”,…. These terms are not specialist titles but free terms under trademark law that any physician may use. The real specialist title is the specialist in plastic and AESTHETIC SURGERY.

What does science say?

In residency training, the focus is much more on reconstructive procedures, in which lost functions of the body are surgically restored – for example, after injuries, tumor removal or malformations. As in other surgical specialties, residency training in this field consists of the so-called “common trunk” for the first two years. In this basic advanced training, residents first learn the basics of surgery.

A subfield of plastic, reconstructive and aesthetic surgery is burn surgery. This is about treating skin that has been scalded, burned, cauterized, injured by electricity or by lightning. Especially for severe injuries such as deep second-degree and third-degree burns, surgeons in this specialty can help – for example, with skin grafting. In addition to aesthetic treatment, which improves burn marks and scars, it also involves the restoration of movement functions, for example, burns on the hands.

Speaking of hands, hand surgery is an interdisciplinary specialty of plastic surgery and orthopedics and trauma surgery. Plastic surgery is important in this context primarily because of the atraumatic surgical technique that is gentle on the tissue: after all, many fine structures such as tendons, nerves and blood vessels are located close together in the hands. Therefore, microsurgical techniques play a much greater role here than in the area of other body regions.

Your Dr. Yary

HY Hyaluron: Part II

How hyaluronic acid in skin care products differs from the application of filler injections.

September 12, 2022
When you come to our studio, I and the other self-employed doctors at HY STUDIO will discuss with you not only effective therapies that restore skin and facial structure, but also measures to prevent skin aging. Inevitably, we come to talk about hyaluron.

Magic from the test tube

We are on the trail of hyaluronic acid and, in order to fully understand its effectiveness, we must take a narrow look at the structure of the molecule. The longer these molecules are cross-linked, the greater their molecular weight. This is expressed in Daltons (Da). From a weight of 1000 kDa, we speak of high molecular weight hyaluronic acids. This hyaluronic acid is too large to penetrate the skin. It remains on the surface and moisturizes there, at least for a short time. Low-molecular hyaluronic acid with less than 5o kDa penetrates the skin and can develop its effectiveness there. So-called oligohyaluronic acid is even smaller and can therefore reach the deeper layers of the skin. However, this is the crux of the matter, or in our case, a few problems that are not yet clear.

A look at the nitty gritty

The large number of hyaluronic products can really make it difficult to choose. It’s worth taking a look at the guts, or rather, the INCIology. First, just by looking at the INCIs (that’s the table of contents on skin care products), we don’t know what molecular size of hyaluronic acid is used. If Sodium Hyaluronate, Hyaluronic Acid, Hydrolyzed or Sodium Hyaluronate are listed, then you know hyaluronic acid is present in your product. However, it is up to the manufacturer to declare in what quantity and with what molecular size the valuable ingredient has entered the product. And then we are confronted with a second problem. It is true that hyaluronic acid brings us moisture on or even better in the skin. However, there is also evidence that with the wonderful penetration of the skin of the smaller molecules and the good water binding, other foreign substances, such as preservatives, can also get into the skin.

What does science say?

A look at the science now helps to understand the limitation of topically applied hyaluronic acid (topical, by the way, is such a nice dermatologist word to describe something being applied to the skin). To slow skin aging and effectively address it below, we need a basic understanding of what causes our skin to age. To a large extent, external factors have an impact and UV light is a major part of that. Smoking, metabolic changes and ultimately genetics determine the pace of our skin aging. Without going too deeply into the details, everything ultimately results in a loss of collagen and hyaluronic acid. Even though the hyaluronic acid in a well-formulated lotion may ultimately reduce wrinkles by better hydrating the skin, it does not prevent or even reverse the actual structural damage to the body’s own hyaluronic acid. I will describe what actually helps in this case in another article. But this much is already revealed: Retinol and laser therapy are part of it, as well as the thread lift. To dissolve you now, however, why we are nevertheless big fans of hyaluronic acid: With the right filler, such as a skin booster, hyaluronic acid can be carefully injected under the skin, where its water-absorbing effect can gently and aesthetically plump up the skin. With the correct injection technique, this can even promote the body’s own production of collagen. Therefore, I see hyaluronic preparations to be applied to the skin as a kind of cure to reduce feelings of dryness. However, it is not a therapy to actually reverse skin aging.

Your Dr. Sophia

HY Hyaluron: Part I

This goes under the skin

9th August 2022

At HY STUDIO we offer a wide range of minimally invasive beauty treatments. The best known, besides botulinum therapy, is the injection with fillers. You surely know that our fillers, which we use to build up and restore parts of the face, are made of hyaluronic acid. Hyaluronic acid is a real magic substance. It occurs naturally in our body and gives firmness and structure to the tissues.

Prevention, Restoration, Reconstruction

Hyaluronic fillers are a way to restore volume defects, contour the face and hydrate the skin. The charming effect of hyaluronic acid, in addition to building structure, is its water-binding effect. This is, among other things, the reason why we use only advanced filler preparations from Galderma Restylane and only extremely precise techniques during injections. This is how we only can ensure that the so-called filler migration does not occur. This would mean that the treated areas would look swollen and unnatural. Since our patients have a wide variety of needs, fillers also lend themselves well to combination with other methods and techniques, often even in a single treatment. After all, our skin needs time to absorb the filler into the tissue after a treatment. In this case, less is often even more and can lead to the most beautiful results with repeated careful interventions. That is why my colleagues and I take time for a detailed consultation and planning of the treatment, which for this reason may well be planned over several appointments.

The chemistry of effectiveness

Chemically, hyaluronic acid is a string of sugar chains and an important component of our connective tissue. With Restylane products, we use two different technologies to give you the best possible treatment. Gels of the so-called NASHATM (Non-animal stabilized hyaluronic acid) technology have a solid structure and allow precise placement of the gels. I use them for restoring and modulating facial areas, among other things. The gels in the BTTM (Balance Technology) family integrate particularly well into the tissue, allowing soft and smooth distribution. In both product classes, there are again different filler preparations, which are then selected depending on your wishes and needs. Then it is also decided with which technique and into which tissue layer the filler will be injected.

What if ...

Let’s now talk about an important topic that should be part of every good consultation. As a doctor, I may accompany you during your first minimally invasive procedure. That can be quite exciting. It takes trust to let someone get that close to your face. Your trust is important and encourages me and my colleagues to explain the possible risks of filler treatment before every treatment. Although the probability of complications is negligible, fillers are (as the name suggests) filling substances. It therefore requires good anatomical knowledge on the part of the practitioner in order to spare nerves and vessels. Unlike silicone fillers, for example, hyaluronic fillers can be dissolved using a process known as hylase. The body’s own tissue is not permanently damaged during application. Since hylase treatment is reserved for doctors, it is all the more important to have injections performed only in a medical practice. Together with my other self-employed colleagues at HY STUDIO, we can guarantee the best possible safety for you.

Your Dr. Sophia




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