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Visit Medical Spa MD's plastic surgery and cosmetic dermatology forums and you'll step into an unlikely brouhaha that's more than just uncommon in cosmetic dermatology and plastic surgery circles, it's unheard of.

Frustrated by what a growing number of cosmetic surgeons see as an wall of silence and infuriating lack of support from cosmetic laser and IPL manufacturers, these doctors have taken their anger public in a kind of free-for-all gang-bang that you don't usually see from cosmetic surgeons. A public riot where 'names are named' and fingers are pointed directly at identified individuals that populate the management teams of prominent cosmetic laser and IPL companies.

At times, entire strings of emails are published detailing conversations and publicly embarrassing top executives and even cosmetic surgeons that act as luminary spokespeople for these companies. It's as though the plastic surgeons have decided to play hard ball.

Of course there's still some self preservation and common sense left. Many of the plastic surgeons comments that are left come from anonymous doctors and the web sites that host these forums generally try to protect the cosmetic surgeons from hidden reprisals.

The web sites hosting these physicians forums have some headaches of their own. Medical Spa MD, the most prominent forum for physicians in cosmetic medicine, has been served with a substantial number of letters and threats from lawyers for daring to make these forum discussions public.

"We've received a number of nasty-grams", says the publisher of Medical Spa MD, "but censoring public discourse between physicians is not what forums are about. The physicians on the site are directly responsible for what they post and commenting that their opinion is that they're not receiving sufficient support from the cosmetic laser companies is just that, their opinion."

The issues are tangled by the types of support answers that the most vocal cosmetic surgeons are demanding, leaving the IPL and laser companies in the uncomfortable position of seeming to be alienating their plastic surgeons as customers, or providing information for treatments that could easily be considered off-label use by the FDA, opening them up to potentially hazardous liability claims from patients and the very cosmetic dermatologists who are demanding the answers.

The problems are not likely to go away. Information that's spread publicly on the web has a long shelf life and it's obvious that technology companies are beginning to take notice. In some cases laser companies have actively joined in the discussion forums and are proactively addressing concerns of doctors as soon as they're posted, leaving a lasting impression of proactive customer support. These tactics seem to be working. IPL and laser manufactures who are active on the forums have a much lower incidence of negative comments.

In the end it's a money game. Many cosmetic dermatologists who are looking for new IPL and laser technology are finding their way to these forums and asking their more experienced peers for advice. IPL and laser manufacturers who aren't playing the game can't expect to win.