To clarify.
All doctors go to medical school to become an MD or DO. This is 4 years on top of your 4 year bachelor’s degree. After that you’re technically a doctor. Generally speaking though, you aren’t going to be able to practice, Most hospitals require board certification in what you specialize in, which requires a 2 or 3 year residency program that specializes you as that type of doc.
So back to school you go. Plastic surgery is a residency program, so more than likely, both plastic surgeons and most good cosmetic surgeons are this specialty(although a cosmetic surgeon could be a general surgeon). After residency programs, you can do sub specialties, like cosmetic surgery is a sub specialty of plastic surgery. So you can do a other fellowship year in that. There are also board certifications for sub specialties, you can be boarded in cosmetic surgery, which has the general path of training I just laid out.
So if you’re going to be official, get a job through a health care organization, the medical staffs there self police you have done the residency and/or fellowships required, as things like board certifications are often required.
Where things get loosey goosey is that when you’re in private practice, you don’t really need more than medical school, and if people want to come to you to get cosmetic surgery in the chair in your office, they can. This means you may not be as qualified for surgery, or cosmetic surgery. So cosmetic surgery can be on the scammy side at the wrong spa type setup.
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