To offset declining insurance reimbursements, more and more surgeons are expanding their practices to include private-pay cosmetic procedures. The result, say certified plastic surgeons, is more and more dissatisfied and sometimes disfigured patients, according to a report in The New York Times. So many doctors are practicing cosmetic medicine outside their specialty and without specialty certification that a trade group composed primarily of doctors who are not board-certified plastic surgeons has formed: the American Academy of Cosmetic Surgery. Dan O'Connor