Plastic Surgery News, December 2021

December 2021

BLUEPRINT FOR RESTRUCTURING ASPS leadership is evaluating a proposal to rebuild the Society’s governance structure from the ground up.

Page 17

Plastic Surgery The Meeting 2021 provides reconnection in Atlanta Page 25

New ASPS, PSF presidents tackle issues facing plastic surgeons Page 7

Reviewing the ASPS Diversity & Inclusion report card Page 9

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WARNINGS REVOLVE™ System must be used within the same surgical procedure. Reuse of this device in the same patient in a subsequent surgical procedure, or for more than one patient, may result in infection and/or transmission of communicable diseases. Do not use the product if sterile packaging is damaged.

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PRECAUTIONS REVOLVE™ System is designed to remove localized deposits of excess fat through small incision and subsequently transfer the tissue back to the patient. Use of this device is limited to those physicians who, by means of formal professional training or sanctioned continuing medical education (including supervised operative experience), have attained proficiency in suction lipoplasty and tissue transfer.

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References: 1. Ansorge H, Garza JR, McCormack MC, et al. Autologous fat processing via the Revolve system: quality and quantity of fat retention evaluated in an animal model. Aesthet Surg J. 2014;34(3):438447. 2. Gabriel A, Maxwell GP, Griffin L, Champaneria MC, Parekh M, Macarios D. A comparison of two fat grafting methods on operating room efficiency and costs. Aesthet Surg J. 2017;37(2):161-168.

REVOLVE™ and its design are trademarks of LifeCell Corporation, an AbbVie company. © 2021 AbbVie. All rights reserved. RVL121411-v3 01/21

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December 2021

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IN THIS ISSUE FEATURES 06 Annual Business Meeting focuses on present and future

Plastic Surgery News

December 2021 Vol. 32 No. 8

Society leadership discusses a strong year for ASPS and The PSF – and big plans for the years ahead.

The mission of the American Society of Plastic Surgeons is to support its members in their efforts to provide the highest quality patient care and maintain professional and ethical standards through education, research and advocacy of socioeconomic and other professional activities.

07 New ASPS, PSF presidents take members’ questions in PSN Presidents Forum

Panelists ask new ASPS, PSF presidents for their take on a wide range of topics facing the specialty.

08 American Hernia Society elects first plastic surgeon as its president

ASPS PRESIDENT

J. Peter Rubin, MD, MBA rubipj@upmc.edu

ASPS past President Jeffrey Janis, MD, assumes leadership of AHS and relishes opportunity for scope expansion.

CHIEF MEDICAL EDITOR

09 D&I report card shines light on Society’s efforts

Summer E. Hanson, MD, PhD shanson.mdphd@gmail.com

In addition to calls for more international representation, 32 percent of respondents say committees aren’t diverse enough.

11 Remembering Bryant Toth, MD, 1950-2021

ADVERTISING EDITOR

Colleagues remember Dr. Toth as a man who worked as an international ambassador for the specialty.

Scot B. Glasberg, MD scotbg@gmail.com

17 COVER: The plan to restructure ASPS governance

EXECUTIVE VICE PRESIDENT

As the Society’s reach expands, some argue the Board of Directors isn’t as representative of membership as it could be.

Mike Stokes mstokes@plasticsurgery.org MANAGING EDITOR

Recipients of the Resident Travel Scholarship share their experiences at Plastic Surgery The Meeting in Atlanta.

Paul Snyder psnyder@plasticsurgery.org

25 Plastic Surgery The Meeting 2021 scores high marks in Atlanta

Michael Costelloe mcostelloe@plasticsurgery.org STAFF VP OF COMMUNICATIONS

20 YPS Perspective: Resident reflections from Atlanta

ASSOCIATE MEDICAL EDITORS

B. Aviva Preminger, MD, MPH premingermd@gmail.com Richard Baynosa, MD richard.baynosa@unlv.edu

SENIOR NEWS EDITOR

PSTM 2021 draws highest number of registrants to date and proves to be a successful hybrid event for members.

Jim Leonardo jleonardo@plasticsurgery.org ASSOCIATE EDITOR

Kendra Y. Mims-Applewhite kmims@plasticsurgery.org CONTRIBUTING EDITORS

Joe Gryskiewicz, MD; Jeff Kozlow, MD; Paige Myers, MD; Neal Reisman, MD, JD; David Schnur, MD; Diana Yoon-Schwartz, MD, PhD CONTRIBUTING WRITERS

Catherine French; Jun Magat; Tyler Neese

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7

COVER DESIGN

Paul Snyder DISPLAY ADVERTISING SALES

Michelle Smith, (646) 674-6537 michelle.smith@wolterskluwer.com, Wolters Kluwer Health CLASSIFIED ADVERTISING

Jeanne Embrey, jembrey@plasticsurgery.org

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COLUMNS 06 Editor’s Message 10 CPT Corner 12 On Legal Grounds 12 An Ethical Matter 14 Legislative Update

16 Practice Management Insight 35 Calendar 38 Classifieds 42 The Last Stitch

Plastic Surgery News (ISSN 1043-4119) is published eight times per year: March, June, September, December single issues – and combined January/February, April/May, July/August and October/November issues – by ASPS. Phone: (847) 228-9900; Fax: (847) 228-9131

POSTMASTER, send address changes to: ASPS Membership Department Plastic Surgery News 444 E. Algonquin Road Arlington Heights, IL 60005 Periodicals postage paid at Arlington Heights, IL, and at additional mailing offices. USPS# 508-890.

The views expressed in articles, editorials, letters and other publications published by PSN are those of the authors and do not necessarily reflect the opinions of ASPS. Acceptance of advertisements for PSN is at the sole discretion of ASPS. ASPS does not guarantee, warrant or endorse any product, program or service advertised.

2021 Subscription Rates: Basic subscription rate: $90; for foreign subscriptions add $90 for first class service. The subscription price for PSN is included in annual membership dues. Letters, questions or comments should be addressed to: Editor, Plastic Surgery News, 444 E. Algonquin Road, Arlington Heights, IL 60005.

plasticsurgery.org Copyright 2021 The American Society of Plastic Surgeons

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EDITOR’S MESSAGE

A call to action as the equity problem evolves and DEI initiatives strengthen

By Summer E. Hanson, MD, PhD PSN Chief Medical Editor

I

t was wonderful to see everyone in person in Atlanta for Plastic Surgery The Meeting 2021.

I know the pandemic isn’t over, but having our largest educational and networking event in person again makes it start to feel like normal again.

Maybe not completely normal, but certainly more normal. To me, this means that I can stop obsessing about vaccine approvals and case counts and focus on more interesting topics such as gender equity, mentorship and balance.

In Atlanta, a group of my colleagues had a conversation about diversity, equity and inclusion (DEI) efforts being a priority of ASPS/PSF and how the Executive Committee, Program Committee and other areas of leadership are making a concerted effort to improve the representation of our member demographics in the virtual and in-person programs. Like clockwork, a particular comment was made: “To be clear, this can’t be at the expense of excellence…”

Friends, comments like this – and the fact that this is even a “concern” in an organization that represents board-certified plastic surgeons – is exactly why we need DEI efforts. Diversity does not come at the cost of excellence. In

fact, the opposite is true. Without diversity or inclusion, organizations have poorer quality of care, higher faculty attrition and lower financial performance.1 I assure you that there are plenty of colleagues who are talented and thoughtful, regardless of gender, race, practice model or identity – just as there are some who are not.

Traditionally, the representation at conferences, courses or in leadership in medicine is not particularly diverse. The oldschool model of patiently waiting for one’s turn to be at the podium has not kept pace with the changing face of our membership or, frankly, medicine. There is a reckoning in academic medicine that is reflective of society as a whole and we should build on the momentum of this recent meeting. Plastic Surgery The Meeting 2021 was a great start to return to in-person education – a year of no “manels,” thoughtful programing by the WPS and DEI groups and the introduction of the PRIDE forum to name just a few examples.

This work is dependent on our collective efforts to maintain diversity on committees, at conferences and throughout leadership.

The call for better representation in plastic surgery is about getting everyone a seat at the table or a spot on the panel – not one underrepresented group at the expense of the other. Although I’m writing this from the perspective of gender, I recognize that I’m privileged in my experience. I’ve certainly faced

questions of my academic ability or capability as a woman (and subsequently as a mother) but I know many have faced far worse bias and discrimination. It’s time for all of us to be an ally and a sponsor to actively promote broader representation among plastic surgeons. We’re all familiar with male-dominated programming in the specialty – and one of the longstanding, independent symposia coming up has a three-day program with zero women faculty. Three days. All men.

Previously, I would roll my eyes when I saw a lineup like this and hope that some of my mentors were asked but unable to attend.

However, at this point in time, I think it’s necessary to call out this lack of representation. I know at least a dozen talented women who could – and should – participate.

The fact is that women comprise more than 50 percent of the population and slightly more than 50 percent of medical school classes. As a surgical specialty, plastic surgery is slightly ahead of the curve compared to orthopedics or urology, where women account for roughly 20 percent of the attending level workforce (range 14-25 percent) and 35 percent of trainees.2 We have been successful in recruiting women medical students to the specialty and demonstrating all that it has to offer. However, another review published just this year found that, in general, women surgeons more often face harassment, lack support and have unequal opportunities compared to their male counterparts.3

I have witnessed the evolution from overt discrimination to implicit bias that many have written about. The equity problem has not gone away – it’s just changed, and the first step is to recognize this. As plastic surgeons, we are inherent problem-solvers. If we are to continue to improve diversity and representation in our specialty, we need more than recognition. We need dialogue and we need continued action. My plan: Mentor the next generation as best I can; call attention to the successful DEI efforts in plastic surgery and those opportunities to do better; sponsor my colleagues for these opportunities in leadership, education and committee work; and be an ally where I can. I challenge those who’ve made it this far to do the same. PSN References

1. Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 111(4): 383-92.

2019.

2. Bucknor A, Kamali P, Phillips N, Mathijssen I, Rakhorst H, Lin SJ, Furnas H. Gender inequality for women in plastic surgery: A systematic scoping review.

Plast Reconstr Surg. 06/2018. 141(6): 1561-77.

3. Lim WH, Wong C, Jain SR, Ng CH, Tai CT, Devi MK, Samarasekera DD, Iyer SG, Chong CS. The unspoken reality of gender bias in surgery: A qualitative systematic review. PLoS ONE. 16(2): e0246420. 2021.

Editor’s note: The views expressed in the “Editor’s Message” column are those of the author and do not necessarily reflect the opinions of ASPS.

Annual Business Meeting covers member concerns, future plans

By Jim Leonardo

A

s Plastic Surgery The Meeting 2021 drew to a close in Atlanta, this year’s ASPS/PSF Annual Business meeting focused on changes for the future on several levels. ASPS members voiced questions about public attendance – and leadership promised comprehensive vetting measures for non-physician attendees for future events.

“We’re looking at cleaning up our bylaws and figuring out how we can engage the right patients in the right way,” ASPS President Joseph Losee, MD, said during the meeting.

“I don’t want just any patient attending our scientific sessions, and I don’t think any doctor wants that. Everybody feels the same way about it – we just have to navigate how that happens.”

The issue percolated on the discussion board at plasticsurgery.org in the weeks leading up to the meeting after it became clear that a patient-advocacy group would have space in the Exhibit Hall in Atlanta. Some ASPS members expressed concern over whether individuals from the group would be able to attend scientific sessions, which have traditionally been a closed space for physicians to share fledgling research and ideas among their colleagues. Some members also noted they’d been targeted and harassed by patients on social media in the past.

During the meeting’s Members Forum, Susan MacLennan, MD, Colchester, Vt., said she knew of some speakers who opted out of presenting at scientific sessions or considered changing their content as a result of concerns that non-medical professionals might attend and possibly disrupt the proceedings.

“My concern is that if we don’t do something more robust to address these issues, it will affect the education of our membership,” she said.

Dr. Losee noted that the FDA and Accreditation Council for Continuing Medical

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Education expects ASPS and other societies to engage patients in order to include and educate them.

“That’s just out there, that’s the environment we’re living in,” he said, adding that the Society recently created the Meeting Attendance and Patient Engagement Task Force to address the matter specifically.

Dr. Losee added that due to attendees’ different roles, it’s impossible to keep all non-medical personnel from going to meetings. Nevertheless, this year, no guests – including members’ spouses – were allowed to attend scientific sessions. In exchange, organizers relied upon “open programming” such as Opening Ceremonies to allow for that attendance, and created one patient-focused seminar.

ASPS President-elect J. Peter Rubin, MD, MBA, said the matter remains a “front-burner” issue for leadership as he assumes his presidential term.

“It’s a process and evolution,” Dr. Rubin said. “We need to develop a vetting process, we definitely need to dialogue with these groups, and understand them and how to set those boundaries.”

Past, present, future After a moment of silence for plastic surgeons who passed since the 2020 annual meeting, Dr. Losee confirmed that this year’s annual meeting, the Society’s first true hybrid event, had the largest number of registrants to date at 3,691 – 2,420 of whom attended in person.

“Despite the pandemic, we had a great, great turnout,” he said.

Plastic Surgery The Meeting 2021 boasted more than 100 live sessions and 50 on-demand presentations, with 75 hours of CME provided, and more than 300 on-demand abstracts available. Of the attendees, 2,790 were medical professionals –1,648 of whom were physicians – as well as 989 residents,

ASPS President Joseph Losee, MD, addresses membership during the Annual Business Meeting in Atlanta.

582 medical students, 153 affiliates or team members and 170 exhibiting companies.

The successful annual meeting put a cap on another strong year for ASPS – media coverage of the Society included more than 12,500 national broadcast, print and online placements that yielded more than $10 million in advertising value. In addition to that, the Society saw 6.1 million direct social media impressions, up 54 percent from 2020; and 155,000 social media engagements, which amounted to more than 15 billion impressions.

Dr. Losee also addressed the Governance Task Force that’s been meeting for a year to discuss the Society’s governing structure (see feature on page 17) in a move he said will make the organization more nimble and membership-driven.

“Many people over the past tried to address governance,” he said. “Our board is very big and unwieldy, and more and more people want a seat at the table. We now manage several societies… we’ve been hesitant to keep expanding and making the board larger.

“We’ll be reaching out for feedback and comments so we can refine the proposal and

keep moving things forward,” Dr. Losee added.

The PSF President Gayle Gordillo, MD, discussed the Foundation’s future focus, and touted the success of the grants distributed last year, including 13 Pilot Research grants, four NEPS grants and a recently launched Diversity & Inclusion Recruitment and Retention grant. Over the past year, more than 106 grant applications requesting $3.3 million were received, with roughly $1.2 million in grants and scholarships funded. Dr. Gordillo praised the registries funded and directed by The PSF, including NBIR and GRAFT, and the Surgeons in Humanitarian Alliance for Reconstruction, Research and Education (SHARE) program to improve surgical care to underserved areas worldwide.

Looking ahead, Dr. Gordillo said great expectations surround MATRIX, a new registry to determine the effectiveness and safety of ADM use in the breast, the construction of which was requested by the FDA. “It speaks very highly of our leadership that the FDA is asking and trusting us to put this initiative forward,” she said.

ASPS Executive Vice President Michael Costelloe, JD, spoke of high expectations surrounding the ASPS “Excelerator” program – a new initiative developed by the ASPS Technology Committee – wherein surgeon-entrepreneurs can “develop products or technologies they can bring to market through the entire process of commercialization, regulatory approval, etc.,” in partnership with the nonprofit MedTech Innovator.

Private practice surgeons and industry partners are expected to be among the program’s many beneficiaries.

Dr. Rubin and Bernard Lee, MD, MBA, MPH, were announced as 2022 ASPS president and The PSF president, respectively; and Gregory Greco, DO, and Howard Levinson, MD, were announced as ASPS and The PSF presidents-elect, respectively. PSN

December 2021

2021 PSN Presidents Forum

New ASPS, PSF presidents tackle questions facing the specialty

By Paul Snyder

D

uring Plastic Surgery The Meeting in Atlanta, incoming ASPS President J. Peter Rubin, MD, MBA, Pittsburgh, and incoming The PSF President Bernard T. Lee, MD, MBA, MPH, Boston, participated in the 31st annual PSN Presidents Forum.

The annual forum provides the Society’s new leaders an opportunity to field a broad range of questions from a diverse group of plastic surgeons. PSN Chief Medical Editor Summer Hanson, MD, PhD, Chicago, served as moderator, and this year’s session covered a wide variety of topics that included patient advocacy, coding for new procedures, scopeof-practice battles and the value of improving diversity throughout the specialty.

The plastic surgeons invited to participate in the forum were Camille Cash, MD, Houston; Risal Djohan, MD, Cleveland; Noopur Gangopadhyay, MD, Chicago; and Thomas McFadden Jr., MD, Greenville, S.C. The following is an edited transcript of the discussion.

This year, only plastic surgeons, other health professionals and paraprofessionals – a category that includes industry representatives – are allowed in the scientific sessions.

We need to have discussions about procedures and scientific data in forums where we have the context to interpret the information that’s coming our way. We do need to understand how to best dialogue with patient groups, but I don’t think that’s going to result in just opening up our scientific sessions. We are exploring the concept of patient-facing sessions and other ways of fostering meaningful twoway dialogue. We’ve met with patient representatives and I believe they understand our perspective and the need to properly contextualize scientific data and emerging research.

They want to learn and be educated about these topics – and we see the value in finding the best environments for that interaction.

was well received across the board. We want to hear what patient-advocates are saying to us. However, having patients walk freely into scientific sessions is not the future of PSTM. Coming from an academic institution, I understand why you wouldn’t want early stage data widely circulated – some of it is not at a publication stage, ready for public circulation and consumption.

Dr. McFadden: If some groups have a certain amount of validity to their complaints, will we give them more credibility and an easier pass into the meeting?

Dr. Rubin: Part of our work is figuring out how to evaluate and vet these groups. When this topic hit my radar, my first thought was: “Patient advocates? That sounds like a good

Dr. Rubin: We have a focus on addressing member engagement and member satisfaction. We exist to serve the needs of our plastic surgeons and help them serve their patients better. ASPS is a support service in promoting competency and professional conduct, in dealing with legislative advocacy and in providing an opportunity for representation and community.

Dr. Cash: A breast implant illness patient-advocacy group was invited to the meeting and given space in the Exhibit Hall. I understand they’re not permitted at the scientific presentations, but I also know that in the past, they’ve had access to scientific panels and were disruptive to the presenters as well as to individual members on their social media platforms – to the point where members feel bullied by these groups. Some presenters dropped out of this meeting as a consequence, which is a real educational loss for the members. How does their presence at the meeting and in our Exhibit Hall benefit our members?

Dr. Rubin: It’s accurate that one patient group, the Breast Implant Safety Alliance, received complimentary space in our Exhibit Hall. This is a complex issue. There’s no more important relationship than what we, as a plastic surgery community, have with all our patients. We really need to better understand the mission of these organized groups and the best ways to work with them.

December 2021

Dr. McFadden: Is there somebody involved in public relations who can either counter or support the viewpoints offered on social media?

Dr. Rubin: Yes, we have an excellent communications team that is constantly watching social media. We’ve even talked about working with rapid-response communication teams, and we are looking into additional resources that we can use. Everyone is wired into social media now, and that’s a huge megaphone for information, misinformation, misguided information, half-truths and out-of-context statements that can be broadcast to the world very quickly.

Dr. Djohan: ASPS has been great in advocating for both safety and quality of patient care. However, cosmetic procedures are commonly performed in sites associated with medical tourism.

Complications and morbidity often occur when patients return home – at considerable distance from where the surgery was performed. How should the Society promote safety and quality for patients in these circumstances?

Dr. Hanson: What would you like to accomplish during your term?

Dr. Lee: From The PSF side, we want to continue to promote the Foundation so that the membership understands what we do.

In a recent survey, we found that most members do not really understand all that The PSF does. The Foundation is responsible for research, philanthropic development, registries, innovation, and international outreach. If our membership doesn’t understand that purpose of The PSF, then how can we raise awareness and philanthropy for all the initiatives that we are trying to accomplish? So my goal is to communicate to our membership what The PSF does for them specifically.

on patient involvement in ASPS scientific sessions met prior to this meeting to begin its work. That group will continue to meet over the next several months to develop recommendations to bring forward.

(Clockwise from top left) The PSF President Bernard T. Lee, MD, MBA, MPH, answers a question; ASPS President J. Peter Rubin, MD, MBA, shares his opinion; quizzers (left to right) Noopur Gangopadhyay, MD, Camille Cash, MD, Risal Djohan, MD, and Thomas McFadden Jr., MD, listen to the presidents; and PSN Chief Medical Editor Summer Hanson, MD, PhD, moderates the forum.

Dr. Cash: I understand the importance of dialoguing, but what about allowing them to attend a scientific meeting and potentially jeopardize some presenters?

Dr. Rubin: We want all of our presenters to feel comfortable presenting data and opinions without fear of retribution. The difference from 10-15 years ago is the megaphone of social media. All of us in this room are bound to a code of ethics in what we advertise, say and how we present ourselves – and how we represent the Society. Others watching presentations may choose to leverage social media to disparage a speaker. We respond very seriously to anyone using tactics such as intimidation, be it through social media, harassment or threats.

We’re not going to allow that and will take appropriate steps to mitigate that risk.

Dr. Lee: Not all patient-advocacy groups have the same purpose. There are some groups that we do have relationships with – we’ve worked with them on breast implant collaboratives in the past. Prior to the COVID-19 pandemic, at the annual meeting in San Diego, we had a patient-advocacy group participate in programming that we designed, and that

thing,” believing it referenced advocates for helping our breast cancer patients get better insurance coverage or better access to plastic surgery care. We recognize that different groups have different missions and we will take that into consideration as we evaluate how ASPS should interact with them.

Dr. Lee: There are key areas where we want patient and public input. In our registry committees, it’s great to have patient input.

For The PSF, we have public members on our board, helping with our strategy and providing patient input, but there is a vetting process. This is different from allowing the public into the scientific sessions and ASPS currently has strict criteria for who can attend our meetings. We will continue to examine this in future years and will refine our policies appropriately.

Dr. Rubin: Another way of participating in the meeting is as an exhibitor, and who is in the Exhibit Hall sends a message to the membership. We appreciate that. The bottom line is that we don’t have an open-door policy – and we don’t plan to have one. We’ll take a very thoughtful and deliberate approach to how we vet these groups. A new task force

Dr. Lee: It goes to the root cause of why patients are traveling internationally to have surgery. Is it truly driven by economics? And where is the misinformation? From a Society standpoint, we’re positioned to tackle misinformation. Our job is to educate the public to do their homework and understand why medical tourism plastic surgery could lead to poor outcomes. In addition, patients should understand why going to a board-certified plastic surgeon member of ASPS is important. We’re doing a lot on our website, developing social media campaigns and patient-facing content about why ASPS members can provide the highest-quality outcomes and the risks of traveling internationally for procedures.

Dr. Cash: What about dialogue with our international affiliates so that they can also educate on this within their communities?

Dr. Lee: Good point. The reality is the people that are doing these low-cost procedures abroad are probably similar to people doing this in our own communities. Whether those people are part of an organized plastic surgery society and interested in registries, safety, data – I’d guess probably not. But we will continue to work with our international affiliates to discuss this important issue.

Dr. Cash: I’m sure our international partners are fighting the same battles against non-board-certified plastic surgeons. Do opportunities exist for strategic alliances to partner-up on this?

Dr. Lee: Yes, we have MOUs with many countries, which is a good first step. The next step is to engage these partners and talk about what we’re seeing, where this is coming from, and how we can protect patients from poor outcomes.

Dr. McFadden: It’s also not strictly international medical tourism. There’s a certain FlorContinued on page 36

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AHS elects first plastic surgeon as president

By Paul Snyder

A

s the first plastic surgeon to be named president of the American Hernia Society (AHS), ASPS past President Jeffrey Janis, MD, says he wants to seize a unique opportunity for collaboration and growth.

“Plastic surgeons often talk about the erosion of our specialty as others come in and learn from or encroach upon us,” he says.

“But we do have counter examples where we have the opportunity to expand our scope – not by doing the same to others, but by innovating and pushing boundaries to bridge and fulfill the gaps that exist. We are poised to pave new roads and break new ground in a Jeffrey Janis, MD multidisciplinary organization that includes both general and plastic surgeons.”

Dr. Janis was named AHS president in September, the culmination of four years as part of that society’s executive committee as well as six years on the AHS Board of Governors. The mission of AHS is to not only advance the science and treatment of hernia, but also to become the worldwide authority on abdominal core health. Given plastic surgeons’ knowledge and expertise with regard to abdominal wall reconstruction, Dr. Janis says the more plastic surgeons that take part in AHS, the more that mission becomes reality.

ASPS serves as the management services organization (MSO) for AHS, which Dr. Janis also says positions the specialty favorably in terms of collaboration.

“With the know-how and vast experience of ASPS when it comes to registries, advocacy, member services, education, working with the FDA and dealing with a variety of regulatory matters, that wealth of organizational knowledge not only is a powerful tool for administrative efforts but, more importantly, for our patients and their safety,” he says. “The influence of ASPS since it became the MSO has been immediate – from administrative details to organizational matters and everything in between.”

Innovation has been a hallmark of plastic surgery throughout the specialty’s history. Dr. Janis cites the work of luminaries and pioneers in the fields of lymphatic surgery, composite tissue allotransplantation, peripheral nerve surgery (innervated breast flaps, targeted muscle reinnervation, regenerative peripheral nerve interfaces, nerve transfers, nerve decompression surgery for headaches, etc.) and others as examples of breakthroughs that boosted plastic surgery through innovation, scope expansion and multidisciplinary approaches to patient problems.

Dr. Janis says AHS has counted several notable plastic surgeons among its ranks over the years, but he wants to see additional board-certified plastic surgeons join in the coming years to foster a long-lasting, symbiotic relationship that will build bridges and foster innovation for patients and the medical community alike.

“I’m very excited for the year ahead, but also for what can happen in the following years,” he says. “It’s an honor to help lead a fantastic, multidisciplinary team through this society – but I’m really looking forward to forging new paths in collaboration, providing value to members, increasing membership and educating both the current and next generations of hernia surgeons.”

For more information on AHS, visit amercasherniasociety.org. PSN

Society closely monitoring harassment sites

A

SPS in November was alerted by several members to efforts that target plastic surgeons by aggregating negative online reviews onto a single platform (“review sites”) followed by unsolicited offers from certain reputation management service companies to remove specific negative reviews on the member’s behalf in exchange for compensation.

Members also report that some content on the review sites appears to be fabricated or misleading – yet these review sites have been unwilling to remove even the false or fabricated content. It is being alleged and reported to the Society that the review sites and certain reputation management companies soliciting affected members appear to be working in coordination.

At press time, ASPS had not been able to verify any common ownership or other business relationship between the review site(s) and the reputation management firm(s), however, the Society is actively investigating the matter.

Society leadership maintains that although there is value in patients sharing their experiences online, any platform involved in charging members to remove negative reviews or sharing fabricated content warrants full investigation.

Given the concerns raised by mem-

bers, ASPS is reminding members to exercise caution when addressing negative online content and engaging with reputation management providers – particularly those you did not contact or to whom you did not provide your contact information.

Although established online reputation management services have existed for more than a decade and can serve a legitimate business need, members are urged to scrutinize the reputation and techniques of any such service that proactively contacts your practice, and specifically identifies the sites from which they can remove negative content about you or your practice.

In addition, ASPS is actively seeking information from any members who may have been targeted by, or fallen victim to, one of these practices, as part of a wider investigation into the prospect of predatory online practices impacting plastic surgeons.

Any members who are aware of such harassment or who have been targeted by these practices should contact ASPS at memserv@plasticsurgery.org with any relevant information.

In furtherance of its commitment to serve and protect its membership, ASPS will provide additional information to inform members on best practices and how to protect themselves as it becomes available. PSN

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December 2021

Tracking progress

D&I Committee Report Card helps committees gauge diversity efforts

By Kendra Y. Mims-Applewhite

I

mproving diversity and inclusion within ASPS and increasing representation within plastic surgery have become increasingly important topics among Society membership.

Recognizing the importance of continuing the conversation and creating ongoing initiatives to advance diversity and inclusion at all levels within the specialty, the ASPS Diversity and Inclusion (D&I) Committee deployed its first D&I Report Card in June to gauge Society committees’ diversity and inclusion efforts.

In 2019, the committee issued the Diversity and Inclusion Self-Assessment survey, which assessed the composition of ASPS committees by age, gender, ethnicity/race and practice type. This year’s report card builds on that by collecting additional demographic data – including questions on sexual orientation, gender identity, disability status and practice setting, thus creating a more in-depth and inclusive survey.

“With the growing understanding that one cannot fix what one does not study, I commend ASPS for supporting a demographic climate survey of our committee membership,” says D&I Committee Chair Paris Butler, MD, MPH. “The information gleaned from the survey was enlightening and will help inform our organization on how best to continue this important dialogue around diversity and inclusion, as well as strategize for future programming and educational efforts.”

The survey revealed that 55 percent of respondents described the composition of their committee as “moderately” diverse (a 15 percent increase from the 2019 self-assessment survey), and 32 percent said their committee should be doing more to increase diversity.

Respondents also noted a lack of international representation on ASPS committees.

The majority of respondents who serve patients in rural or underserved areas (nearly 40 percent) described their committee composition as “not at all” diverse. Non-white respondents described the composition of their committees to be less diverse than white respondents, and nearly half of female respondents reported their committees aren’t doing enough to increase diversity (only one quarter of male respondents felt the same about their committees). Female respondents also expressed a desire to see more women plastic surgeons in higher leadership positions.

When D&I Committee member Purushottam Nagarkar, MD, delved deeper into the data, he discovered differences in the respondents’ perception of diversity within their committees based on their gender, age, race/ethnicity and practice type. Female respondents in academic practice and under age 50 desire more diversity in committees, while male respondents over age 50 and/or in private practice didn’t see the need.

“Recognizing the need for more diversity inversely correlates with one’s perception of existing diversity,” Dr. Nagarkar says. “If you think a committee is already diverse, you don’t feel the need for greater diversity. However, serving on multiple committees helps people realize more diversity is needed.”

Increasing representation Since the Society formed in 1931, only three women have served ASPS president, with Lynn Jeffers, MD, MBA, making history as the first woman of color in 2020. ASPS/PSF Board Vice President of Membership Steven Williams, MD, notes the D&I Report Card’s findings emphasized the need to create more leadership opportunities for women.

“The majority of our committee members feel we need to do more to recognize the value December 2021

Slides by Purushottam Nagarkar, MD, illustrate ASPS members’ views on committee diversity. of women in positions of leadership and create better pathways and support structures to realize that change,” says Dr. Williams, who presented the findings to the ASPS Board of Directors. “Society leadership recognizes membership’s desire for diversity and inclusion. Based on some of the communications of the survey, for instance, we’re looking for tighter partnerships and collaborations with the Women Plastic Surgeons Forum (WPS) to see if we can answer some of the concerns the survey pointed out regarding female inclusion and leadership opportunities.”

Although some survey respondents supported the D&I Committee’s efforts to increase diversity representation (“Diversity brings new perspectives to the table and opportunities for reassessment of current programs,” noted one respondent), others expressed concerns and opposed the idea (“Encourage the underrepresented to excel without discrimination or hurting other people who excel. Stop dividing people. Stop allowing a victim card,” said another). Dr. Williams says more education is needed to help members understand the importance of diversity.

“The EC found the comments interesting and surprising,” Dr. Williams notes. “We encourage people to share how they feel, and the comments demonstrated we definitely have more work to do.”

The right direction The ASPS D&I Committee’s ongoing efforts include recognizing individual and organizational barriers to diversity and inclusion; identifying emerging issues that can affect diversity within the Society; creating new initiatives that promote diversity and inclusion; and promoting the value of having a diverse group of surgeon members included in all the entity’s activities to ensure full and equal representation and participation in ASPS. Since its 2017 inception, the D&I Committee developed a diversity-incident reporting mechanism for members to report bias incidents and concerns; created a resources library on plasticsurgery.org; and distributed

surveys to help guide ASPS diversity and inclusion efforts and clarify the demographic makeup of ASPS/PSF committees.

“The D&I Committee is still relatively

new, but it’s already made some real impact,” Dr. Williams says. “Our overall goal is to expand the D&I Report Card to general membership. One important task going forward is to compare the responses of individuals who actively donate their time, resources and effort to ASPS committees to the general membership and see if their feelings toward diversity are the same or different.

“The committee structure and the internal bodies within ASPS guide programs and resources and point the way toward the future,” he continues. “We started with the committee structure because that’s responsible for a large part of the internal work in the Society, but we want to understand how every member feels about diversity – good or bad.”

Dr. Williams commended the Society’s latest diversity initiative to launch special interest groups – the new ASPS PRIDE Forum, which serves as a central voice to advocate for LGBTQIA+ plastic surgeons and patients, and the Military Plastic Surgery Forum Steering Committee, which serves as a central voice to advocate for military plastic surgeons and their patients’ unique needs – to ensure all groups in the Society are supported and represented. He notes the D&I Committee supports the special interest groups and says he looks forward to building a more diverse and inclusive future.

“ASPS is leading the way in terms of a professional plastic surgery society recognizing the importance of diversity,” Dr. Williams says. “It’s not just about ASPS membership and committee structures embracing diversity and inclusion – it’s also about creating an environment where we can learn how to take better care of an increasingly diverse patient population. We’re headed in the right direction and on our way to a great place.” PSN

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CPT CORNER

Changes and updates for 2022 contain some CPT surprises “CPT Corner” provides general information, available at the time of publication, regarding various coding, billing and claims issues of interest to plastic surgeons. ASPS is not responsible for any action taken in reliance on the information contained in this column.

By Jeff Kozlow, MD, & David Schnur, MD

O

ur objective in this month’s column is to provide updates on challenges that have been faced by our specialty in 2021, as well as updates (and some likely frustrations) on what’s coming in 2022.

Updates from 2021 Changes in the AMA CPT Professional 2021 book related to breast reconstruction were likely one of the biggest changes for our specialty in recent years. Although new language in the CPT book was designed to better help surgeons and coders in this ever-changing space, the application of these changes created challenges for our specialty.

As those who have attend the ASPS Coding course or presentations at PTSM are aware, there was a decision to re-value these codes through survey methodology by the AMA RUC committee – despite ASPS objections. Ultimately, most of the codes in this family required survey for re-valuation and based on the RUC survey results, reasonable recommendations were made by the AMA RUC committee on their valuation. However, CMS opted to deviate from RUC recommendations and subsequently devalued many of these codes. For those interested, the CMS Final Rule for the 2021 Fee Schedule can be found at cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f. Readers should go to pages 84604-09 for detailed information on the valuation of breast reconstruction codes.

A significant decrease in the conversionfactor due to the changes in the outpatient E&M work valuation has resulted in a significant alteration in reimbursement for surgeons participating in Medicare and potentially with private insurers. Unfortunately, the continued decrease in Medicare reimbursement is

likely to continue due to ongoing pressures on CMS. ASPS continues to work independently and as part of the Surgical Care Coalition (surgicalcare.org) to address the ongoing devaluation of surgical care by CMS, which is impacting patient access to our services.

ASPS also advocates for correct coding edits via a longstanding relationship with staff at the National Correct Coding Initiative (NCCI). Through our efforts this year, NCCI removed inappropriate edits that previously limited the reporting of a delayed breast implant (19342) with the autologous flap codes (19364-19369). However, we continue to be made aware of confusion related to appropriate coding for some of our breast reconstruction cases involving implant revisions. Although the new CPT introductory language for 2021 was very clear on the reporting of multiple procedures, the NCCI failed to remove pair-to-pair (PTP) edits between codes, including: • 11970-19370 • 19342-19370 • 19342-19371 • 19380-19342 Letters that ASPS has sent to NCCI detail the negative consequences that these PTP edits are creating for our patients, surgeons, coders and insurers, since the inappropriate edits are in strict contradiction to the language in the CPT book and were well-known as part of the RUC/CMS valuation process. The PSN CPT Corner article from January/February, along with an “AMA CPT Assistant” article from April, supported the language directly written in the CPT book for reporting these procedures. As many insurers base their reimbursement software off the NCCI PTP table, this has also generated problems with inappropriate under-reimbursement for these procedures. ASPS currently has sent an additional letter to NCCI/CMS, requesting a meeting if these inappropriate NCCI edits are not resolved in a timely manner.

We ask that you continue to provide ASPS staff with updates on your concerns and the challenges in reporting your breast reconstruction-related work.

Updates for 2022 AMA CPT Professional 2022 has 405 code changes, 249 new codes, 63 deleted codes and 93 revised codes included in the yearly update. The code description changes that are relevant to plastic surgery procedures are reasonably straightforward this year. However, the subsequent de-valuation by CMS specifically for nasal-fracture reduction is very disappointing (as outlined below).

continued to argue that not only were the previous valuations inappropriate – making comparisons to formal time/intensity survey results inaccurate – but that these new 2022 Final Rule values are so inappropriately low that they do not fit within the fee schedule compared to similar codes. Although it’s unclear if CMS will consider changing their rationale despite the objections raised, we continue to work through these valuation challenges from CMS.

Coding for nasal fractures

Update to Simple Repair guidelines

CPT code 21310 that was previously used to report closed treatment of nasal bone fracture without manipulation has been deleted. New guidelines direct users to report these services with the appropriate E&M code.

CPT codes 21315 (closed treatment of nasal bone fracture; without stabilization) and 21320 (closed treatment of nasal bone fracture; with stabilization) are unchanged in description, but were both transitioned from 10-day global codes to 0-day global codes. This change in global period is an increasing trend of surgical procedure, as the variability of follow-up patterns has been noted.

As both 21310 and 21315 were previously considered “Harvard-valued” codes from the early 1990s and had not been formally surveyed for valuation, the RUC required survey of these codes to provide their recommendations to CMS. Both ASPS and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) participated in this survey, which furnished a high-quality survey result. This led to recommendations from the RUC for what was thought to be a very reasonable work RVU valuation for both codes that fit appropriately in the fee schedule based on reported times and intensity of both procedures. However, despite significant objections to their methodology and rationale by ASPS, AAO-HNS and the AMA, the final rule from CMS resulted in work RVU valuation of 0.93 (21310) and 1.59 (21315). Despite general acceptance that the codes as previously valued were inappropriate for the time/intensity of the work, CMS ruled that because of the removal of the 10-day global period and the associated one post-op visit, the code value must go down. ASPS has

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Revised Integumentary System Repair (Closure) guidelines will become effective on Jan. 1.

Prior to 2022, the guidelines for a simple repair stated that the repair included local anesthesia, and chemical or electrocauterization of wounds not closed. This statement was often misinterpreted to mean that simple repair codes may be reported when sutures are not used, but when electrocauterization is used. However, this statement is incorrect. In order to address the issue, the guidelines have been revised to clarify that chemical cauterization, electrocauterization or wound closure using adhesive strips as the sole repair material is included in the appropriate E&M code. Additionally, the guidelines were revised to clarify that when hemostasis and local or topical anesthesia are performed for the simple repair, they are not reported separately.

New language: Use the codes in this section to designate wound closure utilizing sutures, staples or tissue adhesives (e.g., 2-cyanoacrylate), either singly or in combination with each other, or in combination with adhesive strips. Chemical cauterization, electrocauterization or wound closure utilizing adhesive strips as the sole repair material are included in the appropriate E/M code.

Simple repair is used when the wound is superficial (e.g., involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures), and requires simple one layer closure. Hemostasis and local or topical anesthesia, when performed, are not reported separately.

ICD-10 coding One of the most significant changes for diagnosis coding is the implementation of an official code for breast-implant associated anaplastic large cell lymphoma (BIA-ALCL). Effective for 2022, new diagnostic code C84.7A will be available to report BIA-ALCL. Note that an additional code should be reported to confirm the presence of a breast implant (Z98.82) or personal history of a breast implant, now removed (Z98.86).

Other changes for diagnostic coding include the addition of two codes for irritant contact dermatitis: • L24.A0 – Irritant contact dermatitis due to friction or contact with body fluids, unspecified • L24.A1 – Irritant contact dermatitis due to saliva

Conversion factor With the mandatory budget-neutrality adjustment to account for changes in RVUs (required by law) and expiration of the 3.75 percent temporary CY 2021 payment increase provided by the Consolidated Appropriations Act of 2021, the CY 2022 PFS conversion factor is currently set to be $33.59 – a decrease of $1.30 from the CY 2021 PFS conversion factor of $34.89.

ASPS, along with primary care and surgical specialties, continue to advocate for Congressional relief of these cuts to reimbursement. We will continue to update members as progress is made. PSN December 2021

Bryant Toth, MD, 1950-2021

Tributes pour in for a ‘worldwide ambassador for plastic surgery’

P

lastic surgeons are paying tribute to ASPS member Bryant Toth, MD, San Francisco, who passed away unexpectedly on Oct. 3 at age 71 while in Italy, two days after his son’s marriage in the country.

“Bryant was an extraordinarily good plastic surgeon in the classic way,” says Michael Moses, MD, New Orleans, a close friend of Dr. Toth since their days in residency at Massachusetts General Hospital. “He really did the full spectrum of procedures – but maybe more than that, he was a worldwide ambassador for plastic surgery. He was a visiting professor and taught plastic surgeons in Italy, China, Vietnam and Brazil.”

In addition to running his own private practice, Toth Plastic Surgery, in San Francisco, Dr. Toth was a clinical professor in the University of California-San Francisco (UCSF) Department of Surgery and co-director of the UCSF Benioff Children’s Hospital Craniofacial Department. He was a member of several plastic surgery organizations – both domestic and international – including being a founding member of both the American Society of Craniofacial Surgery and the International Society for Simulation Surgery. His work with ASPS and The PSF included service on several committees, including chairman of the International Symposium Committee.

Dr. Toth graduated magna cum laude from Dartmouth College, where he was named the Rufus Choate Scholar in his senior year.

He received his medical degree from Brown University. In 2015, Dr. Toth told PSN that his early mentors, Jim May, MD, and John Constable, MD, during his residency at Massachusetts General Hospital encouraged him to attempt to “surgically dream” and cemented his decision to become a plastic surgeon.

At the completion of this plastic surgical training, Harvard University awarded Dr. Toth the Kazanjian Fellowship, allowing him to pursue an additional year of cosmetic and craniofacial surgical training in Paris. Dr. Toth said the experience of training with Daniel Marchac, MD, opened his eyes to the global reach of plastic surgery, a defining moment for his future – and life.

“I call it a craniofacial Fellowship, but actually it was a cultural, life-changing Fellowship,” Dr. Toth told PSN. “In addition to the limitless knowledge that I have learned from them, my international friends in our specialty have become some of my closest and dearest.”

In the early years of his practice, Dr. Toth teamed with Dr. Constable and Dr. Moses to form the Indochina Surgical Educational Exchange, enabling the plastic surgeons to travel to Vietnam and Cambodia to operate on facial clefts and repair patients who were left disfigured by the Vietnam War. James Grotting, MD, past chairman of the ASPS Board of Trustees, counted Dr. Toth as a close friend and colleague for nearly four decades. He says Dr. Toth was a one-of-a-kind friend and plastic surgeon whose curiosity and interest in discovery and traveling the globe never waned.

“Although he sought the best all around the world, where he found it was in the hearts of his family and close friends – who were innumerable on all continents,” Dr. Grotting says. “He was incredibly talented, an outstanding communicator, thoughtful and kind. My wife, Ann, and I will miss him forever.”

Scott Bartlett, MD, Philadelphia, trained with Dr. Toth in Massachusetts and says that beyond his love for the specialty, Dr. Toth had a deep affinity for art, history and culture throughout the world – particularly for Italy.

December 2021

“He really was a citizen of the plastic surgical world,” Dr. Bartlett says. “He was always a connoisseur and a gentleman. He truly appreciated getting together with his colleagues and he was always helpful and supportive of all of us.”

Dr. Toth’s colleagues say that of all the places he traveled in the world, he was most fond of Italy – and the country returned that love. Dr. Moses notes that Dr. Toth not only became fluent in Italian but also taught in the country’s major plastic surgery training programs for more than 30 years. Those decades of service were recognized in January 2020, when the President of Italy awarded Dr. Toth the Ufficiale dell’Ordine Della Stella d’Italia (Star of Italy) – the highest civilian honor given by the Italian government – for 35 years

Bryant Toth, MD

of extraordinary contribution to the advancement of medicine in the country.

“Bryant went to more countries to give lectures, teach and perform surgery than any other plastic surgeon I’ve known since Dr. Constable,” Dr. Moses says. “He took Dr. Constable’s lessons of bringing plastic surgery around the world completely to heart. He truly shared plastic surgery on an international level.”

At press time, a celebration of life was being planned for early 2022, with details to be made available at drtothmemorial.com. Dr. Toth’s family requests that those who wish to contribute in his memory consider donating to the UCSF Benioff Children’s Hospital Oakland directly benefiting the Craniofacial Department at givingtogether.ucsf.edu/toth. PSN

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ON LEGAL GROUNDS

More eyes are taking notice of the distracted surgeon – the circulator must stop their work to answer the phone and the repeated inquiries. This distraction is never ending and frustrates the operating team. The repeated calls now dominate the room talk as a distraction.

“On Legal Grounds” provides a general informative overview of the topics addressed. It is provided with the understanding that the author is not engaged in rendering legal advice and the column is not a substitute for obtaining the services of a lawyer or other appropriate professional to independently research and address specific legal or practice problems, issues or situations.

Case Two: The same O.R. manager, decides to critically question the scrub tech and circulator about a case that took place two days prior, chastising the tech and formally adding a complaint to their file. The manager is not interested in the tech’s explanation, leaving the tech in tears. What was a misunderstanding now becomes a real distraction to the entire day’s schedule.

By Neal R. Reisman, MD, JD

A

series of events over the past several months called attention to the problem of a surgeon being distracted in the O.R. This would be a good time to remember that if you’re contemplating, say, multitasking Zoom conferences while operating or taking on additional responsibilities in the O.R., it might violate operating facility, hospital or patient ethics.

There are several situations that interfere with patient care and ethics. The marketing of surgery procedures by filming and posting for social media during surgery can directly interfere with both the surgeon’s duties, as well as those of the O.R. team. There have been several complaints filed in recent years about filming the O.R. team without their consent – and certainly without the patient’s consent. Legal complaints often arise about a negative result if the surgeon was allegedly posting to social media during the procedure – even if it was done with the patient’s permission. Although sometimes an excuse is put forward that an assistant was posting to social media as the surgeon operated, the distraction nevertheless could have led to complications and missed expectations.

Case One: The O.R. manager continues to call the O.R. to inquire how much longer the surgery will take. As scheduling continues – without allowing for turnover time

Case Three: A doctor is performing a “mommy makeover” and wants to post on social media about the case.

He has patient consent. The process of filming and photos include the O.R. team, but they do not want to be part of the posts. There’s an ongoing argument during surgery about not including the staff without permission, in addition to removing content that includes their images. This delay in the procedure leads to additional patient expenses and a frustrated surgical team. The argument reaches levels requiring replacement of the staff during surgery. This level of distraction could have been avoided by having an inclusive, open discussion before the surgery to protect all parties, as well as signed documentation of permissions to record and photograph.

Discussion I’ve experienced the situation where an O.R. manager complains about a surgery tech and/ or nurse just before a procedure. You would hope that a manager would realize his or her actions can become a major negative distraction just before a procedure that carries its own inherent stresses – surgery is tough enough without added stress affecting the O.R. team.

Scheduling and last-minute switching of staff can often initiate increased angst and distract the surgeon, who then might need to catch up in preparing the room to ensure the procedure

runs as smoothly as possible. There should be consideration about the timing and result of “discussions” so as not to intimidate or disrupt the flow and comfort of the O.R. experience, especially for the patient. Distractions can be as minor as the front desk repeatedly calling to ask if you are done yet, or waiting for equipment and sutures that should have been available but are now suddenly on “back order” without notice.

The law carries the doctrine of foreseeability, which is applied to most concerns and liability.

It is foreseeable that if “something” happens, it will lead to potential problems with the standard of care provided. One could ask himself or herself: “If I do or say this, is it foreseeable that the receiving person might be negatively affected? If I insult or criticize the O.R. scrub tech just before a case, will they respond appropriately – or is a negative result possible?

If I hold a Zoom conference during a surgery, is it foreseeable that I could get distracted and have any interference with the delicate surgery I agreed to perform? If I identify the patient in the O.R. and then attempt to make rounds in the facility while the patient is being anesthetized and prepped, is it foreseeable there could be a delay and unnecessarily longer anesthesia?”

There are many such examples, from cellphone ringing/usage to, as I’ve been told, cases where someone on O.R. staff is monitoring eBay to continue to place bids until an auction ends.

The ramifications of such behavior can be devastating to a career and, certainly, to patient care. State medical boards will act, imposing sanctions, suspensions and fines. The legal system is primed to act should any less-than-desirable outcome occur, whether the distraction is directly responsible or not. The foreseeable nature of any distraction exposes significant risk. There have been significant fines and risk to medical license because of such behavior.

Leaving a patient waiting under anesthesia in the O.R. has resulted in the loss of operating privileges. Imagine all the potential disruptions during a lengthy surgery. Perhaps with luck and skill, no problems arise. Should there be a complication, a less-than-desirable outcome or a disgruntled employee, the focus will immediately turn to the distraction.

Even if the distraction does not directly influence the poor outcome, a foreseeable event will be blamed – and that’s very difficult to explain away. A pre-surgery huddle of all parties (surgeon, assistant, scrub tech, circulator and anesthesia) discussing the procedure, expectations and any concerns about care could help avoid such issues. The perceived adversarial interaction between surgeon and anesthesiologist should be avoided. The airline industry sets an example of such pre-flight communications. The obligatory “time out” can also be a time to discuss plans – perhaps before the patient is in the O.R. might be a better time for the discussion.

All members of the team should be alert and comfortable speaking up when any concern is noted. No one is infallible and many eyes are helpful in avoiding errors. As annoying as “foreseeability” is, adopting this mindset will protect the patient and all parties during the stress of a surgical procedure – especially with the higher level of expectations (and distractions) we observe today. PSN

THE HIGHER GROUND

I’m trying to be a good steward of patient records, so why did HHS pounce?

By Joe Gryskiewicz, MD

“The Higher Ground” columnist Joe Gryskiewicz, MD, is a former chair of the ASPS Ethics Committee, a past member of the ASPS Judicial Council, and he has been in practice for more than 30 years. Readers are encouraged to submit queries to him at drjoe@tcplasticsurgery.com.

Names will be withheld, and the views expressed in this column are those of the author and should not be considered legal advice.

Q: HHS recently reprimanded our office because a patient complained after we charged a retrieval fee for her records for a procedure that took place almost 10 years ago.

Although our attorney ultimately settled the matter with HHS successfully – and without penalty – we are left with an ethical dilemma.

I’m currently in the process of adopting yet another EHR system (I’ve been through three without success), and I have 20,000 records dating as far back as 1982 in storage with a record storage company. This company charges me $75 to retrieve a record, yet HHS says I cannot pass this on to the patient.

Instead, HHS says that doctors can only charge a “reasonable, cost-based fee” that includes office labor, supplies – including any CDs or USB drives requested – postage and labor for any summary or explanation of the medical records. Here’s the worst part: “The

12

fee may not include costs associated with verification; documentation; searching for and retrieving the PHI; maintaining systems; recouping capital for data access, storage or infrastructure; or other costs not listed above, even if such costs are authorized by state law.”

How is that fair? I can’t simply neglect my responsibility by giving the patient a copy of their records before I store them because, if they lose them, I am still held responsible. Plus, if I hand over the records to the patient, what happens when they lose them and ask if we have any extra copies lying around?

All that aside, here’s the ethical dilemma weighing on me: My medical board says I only have to keep patient records for seven years, but I have implanted devices that will last much longer. Don’t I have an ethical obligation to help my patients by keeping their records as long as possible, in case questions arise about their device? If I do that, I’ll be paying $75 out of pocket every time they ask for copies. Your thoughts?

A: In the Midwest – especially the northern reaches where I practice – you’ll sometimes hear the name Aldo Leopold, a renowned author and ecologist, who once said that “keeping records enhances the pleasure of the search and the chance of finding order and meaning in these events.” That said, I don’t believe he specified a seven-year cap on that activity – or was ever subject to HHS punish-

ment for his record-keeping, for that matter.

Nevertheless, you hit upon an important topic – and one that many plastic surgeons face as they approach retirement. I assume the arrangement worked out by your attorney with HHS includes not charging patients for retrieval fees going forward, and a refund to the patient at issue who filed the complaint. I’m glad you at least got this straightened out to some degree. The ASPS Code of Ethics does not have particular language relating to how long members should hold on to patient records, but federal and state laws do touch on this subject. Ultimately, this boils down to whether our members prefer to reduce their long-term outof-pocket expenses by destroying records after their state-mandated medical records retention period expires, or whether they feel a higher calling to keep records indefinitely.

The middle-of-the-road approach would be to destroy all records when permitted by state law for your non-device patients, but to keep medical records indefinitely for patients who received such devices.

Although federal law only requires medical records be kept for six years, Minnesota, where I practice, requires they be kept for seven years. We queue-up paper charts on adult patients as they hit the seven-year mark – and shred them the very day we legally can. For patients who received breast implants, however, we scan labels and op notes and hold on to those records indefinitely.

Now that we have an EMR system, we scan all paper charts for returning patients

who have prior paper charts that are less than seven years old. We’re still bursting at the seams – to the point where we rent storage space across the hall for all the paper.

I doubt I’ll shock anyone by suggesting that attorneys have it differently than physicians. Lawyers can (and do) charge for file retrieval. They generally have clients sign an engagement letter which specifies the fees related to file retrieval – and they can lean on that language and fee, should the need to dip into the historical banks arise. For better or worse, we don’t have that kind of luck.

You’ve been scrupulous and conscientious in preserving your records, going above and beyond. Aldo would be proud. Still, no good deed goes unpunished. Had you destroyed your adult patient charts according to the letter of the law, you would have been home free. Here’s another wrinkle: If patients receive aesthetic services that aren’t medically necessary (in other words, the procedures where there’s no insurance reimbursement), HIPAA doesn’t even come into play. So any permissible copying charges will default to what your state law permits for charging. If you plan on hanging onto all those records, there’s another homework assignment – check what your state allows you to charge for those copies.

Whether you’re heading into retirement or not, this is an issue (and regulatory landmine) worth highlighting. Thanks for the question – and I hope this provides a little bit of peace of mind for what to do with nearly 40 years of records. PSN December 2021

Relevance and purpose after retiring

By Enrique Fernandez, MD

Editor’s note: The following is the third of a three-part series on preparing for retirement

by ASPS Life Member Enrique Fernandez, MD. Dr. Fernandez provides more retirement preparation insight online at enriquefernandezmd.com.

T

he personal feeling of relevance is closely intertwined with the actualization of your potential and, more specifically, the fulfillment of your purpose in life.

Feeling relevant could most commonly be thought of as a sense of pride in oneself – perhaps as a result of a lifetime of accomplishments, both personal and professional. This is particularly the case when such accomplishments were achieved in the service of others. The need to feel relevant is an integral element of the human experience, and a desire that knows no boundaries: age, sex, race, language, geography, occupation or vocation. It is widely experienced and yet it is ultimately quite personal.

Companions on the journey My career as a plastic surgeon unexpectedly came to an end as a result of colon cancer and other medical problems.

Thankfully, years later, I’m now cured, healthy and well. At the time of my diagnosis, however, I reflected upon my character, my purpose in life and the years I’d spent in the profession of plastic surgery that provided me with a unique opportunity to be of service to so many and improve their condition. Truth be told, I still reflect on these things.

When my career ended, I recognized that my purpose in life – to improve the human condition – had not. Nor did my desire to continue to feel relevant. I had to find another way to define that purpose.

I reflected on my experiences as a leader and mentor, and I recognized that I could exercise these skills in a manner that fulfilled my purpose. Doing so would

continue to provide a means to fulfill a personal need that would endure well beyond the end of my career that illness imposed upon me.

As my consulting/coaching career evolved in the years following my retirement, I saw firsthand that the need to feel relevant is a very common desire. Sometimes, it may not be clearly understood or elegantly expressed, but it’s an ever-present pursuit. Frankly, it’s inherent to our nature.

Persistent needs There are two sources of personal and professional relevance. The primary source arises from within yourself. The secondary source is expressed to you by others. The sooner you understand this concept, the better you can establish a solid balance between the two. Although the pursuit of relevance is a lifelong chase – remember how you craved attention and validation as a child – my personal experience found that this particular need becomes more acute as we begin to anticipate the transition to the end of a career.

There’s undoubtedly a sense of accomplishment that comes with retirement, not to mention joy and anticipation for what the future holds. There also are many feelings of uncertainty.

These diverse feelings are distinctive, but intertwined, and truly irrespective of job description, title, profession or vocation. As you approach retirement, you’ve known for years about your character, your purpose and how you chose to express it, even if the awareness of those factors lies somewhat dormant sometimes as we actually go about the day-to-day business of our lives.

During times of triumph, tragedy and transition, reflect on your principles with deliberate purpose. Be true to yourself and apply it to the present circumstances. The end of a career isn’t the end of your relevance. Knowing this is essential to your ongoing success, and it will serve you well to achieve renewal and fulfillment in the next great phase of your life. PSN

Monmouth society keeps the streak alive

Meet the 2022 Nominating Committee In October, the ASPS/PSF Board of Directors finalized the election of the 2022 Nominating Committee. The committee’s roster for 2022 is as follows: Joseph Losee, MD Co-Chair, ASPS Immediate-Past President University of Pittsburgh School of Medicine Pittsburgh Gayle Gordillo, MD Co-Chair, The PSF Immediate-Past President Indiana University School of Medicine Indianapolis Abigail Chaffin, MD Southwest Regional Representative Tulane University Division of Plastic Surgery New Orleans Katerina Gallus, MD West Regional Representative Restore SD Plastic Surgery San Diego Denise Gottfried The PSF Public Member TekTeam Medical Industry Consultants Palo Alto, Calif.

Summer Hanson, MD, PhD The PSF Representative University of Chicago Medicine and Biological Sciences Chicago C. Scott Hultman, MD, MBA ASPS Carryover Member Johns Hopkins Burn Center Baltimore Carl Manstein, MD Northeast Regional Representative Private Practice Meadowbrook, Pa. Amy Moore, MD ASPS Representative The Ohio State University Wexner Medical Center Department of Plastic and Reconstructive Surgery Columbus, Ohio Galen Perdikis, MD The PSF Representative Vanderbilt University Medical Center Department of Plastic Surgery Nashville Samuel Poore, MD, PhD ASPS Representative University of Wisconsin School of Medicine and Public Health Division of Plastic Surgery Madison, Wis. Gary Rogers, MD, MBA, MPH Midwest Regional Representative George Washington School of Medicine Children’s National Medical Center Washington, D.C.

The Monmouth Society of Plastic Surgeons celebrated 17 years of in-person educational activities this year. “We never really knew if we were going to survive the COVID-19 pandemic, or whether we were going to be able to ever get together in person again,” notes Stephen Chidyllo, MD, DDS. “Our last meeting before the New Jersey shutdown was the first week of March 2020, in Freehold, N.J. A week later, our offices were closed, our medical supplies mandated by the state to be confiscated and all elective surgery stopped. We finally were able to enjoy each other’s camaraderie again on June 2, when we held our first in-person meeting since then in Red Bank, N.J.” The Monmouth Society of Plastic Surgeons registered as a local-regional society of ASPS in 2016. Membership is open to all plastic surgeons in the New Jersey and surrounding regions. “We are looking forward to many more years of local, in-person plastic surgical educational activities,” Dr. Chidyllo says. PSN

December 2021

Seth Thaller, MD Southeast Regional Representative University of Miami Miller School of Medicine Miami

Prospective candidates who are interested in applying for a position under the Nominating Committee’s purview should know that the Candidate Conduct Policy strictly prohibits candidates from contacting any member of the Nominating Committee throughout the nominating process and that questions or concerns about the process should be directed to Nominating Committee co-chairs or Peggy Pissarreck, the Nominating Committee staff liaison, at ppissarreck@plasticsurgery.org. PSN

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LEGISLATIVE UPDATE

No Surprises Act presents latest challenge in physician reimbursement

By Tyler Neese

I

n the waning hours of 2020, Congress hastily passed the No Surprises Act – legislation designed to address surprise medical billing at the federal level – as part of its year-end package. Providing appropriate guardrails on out-of-network (OON) billing has been a longtime advocacy focus for ASPS, and this far-reaching bill passed despite significant opposition from the Society.

As ASPS continues its efforts to protect patients from unanticipated out-of-network bills, two provisions of the No Surprises Act will be of particular concern for the specialty: the independent dispute resolution (IDR) process; and the price-estimate requirements placed on providers when scheduling care or upon request from uninsured and self-pay patients.

Background Following years of negotiation, the No Surprises Act was signed into law as part of the Consolidated Appropriations Act. Enacted on Dec. 27, 2020, the consolidated appropriations bill outlined various rulemaking deadlines throughout 2021 and 2022. Most provisions of the Act take effect on Jan. 1, including the federal IDR process and protections for the uninsured.

Throughout the rulemaking process, various agencies are charged with issuing regula-

tions and guidance, including the HHS, and the departments of the Treasury and Labor.

To date, these agencies have issued four major rules or guidance documents, including an Interim Final Rule with Comment (“IFC Part I”); FAQs delaying enforcement of certain provisions; a Proposed Rule including HHS en-

Advocacy in the states A quick look at some of the work ASPS did in September and October to advocate on behalf of the specialty at the state level.

forcement (carrying financial penalties) of the No Surprises Act requirement; and an Interim Final Rule with comment (“IFC Part II”). IFC Part II takes steps to implement several provisions of the No Surprises Act – primarily the federal IDR process for disputes over items and services eligible to select federal IDR. Together, these rules and guidance documents are designed to lay the groundwork for the law to take full effect in 2022.

Process and policy Although ASPS has been vocal regarding its concerns with specific provisions of the No Surprises Act, perhaps most concerning is

regulators’ blatant disregard for Congressional intent in the Interim Final Rule (IFR), which clearly amounts to a price-setting effort and a giveaway to insurance carriers.

In their rulemaking process, federal agencies ignored Congressional intent and set the insurance-dictated, median in-network rate as the de facto benchmark for guiding payment determinations in out-of-network billing disputes. This provision threatens to not only drive down physician reimbursements in disputes that go through IDR, but also to undermine physicians’ bargaining power in all contract negotiations by creating an incentive for insurance companies to keep providers out-of-network in order to access the “cheap” rates that IDR will provide for insurance companies.

In providing a rationale for implementing the IDR provisions, the regulators pointed to the behaviors of a few provider practices and essentially deemed them illegitimate market responses. However, the insurance plans’ proposals were considered legitimate and largely adopted in rule. The government, it seems, believes that virtually anything insurers do to bargain with providers is legitimate, while anything that providers do to bargain with insurance carriers is illegitimate.

Recently, Ali Khawar, assistant secretary of the DOL’s Employee Benefits Security Administration, aggressively defended the agency’s position in a webinar sponsored by the Council for Affordable Health Coverage: “Obviously we did take an approach in the interim final rule that wasn’t an accident,” he said during the webinar. “We’ve been thinking about this issue a lot, and it was a deliberate decision.”

By way of this action, regulators such as Khawar clearly signaled that insurers – not physicians – should dictate the terms of care and reimbursement, creating further inequities

Thank you, PlastyPAC contributors

P

lastyPAC, the bipartisan political action committee of ASPS, works to educate and influence Congress on issues that directly affect plastic surgery. As the largest voice for reconstructive and cosmetic surgery, PlastyPAC is grateful for the support of the following people whose contributions during September and October help play a key part in the specialty’s success on Capitol Hill.

Alabama James Grotting, MDI California Lynn Jeffers, MD, MBAI Debra Johnson, MDI Gordon Lee, MDu Thomas Satterwhite, MDu Steven Williams, MD Michael Wong, MDu

• ASPS was alerted in July to a shocking video on social media of a liposuction procedure being performed by two NPs in Indiana. It illustrated a clear disregard for patient safety and scope of practice, as well as a lack of appropriate qualifications of the collaborating physician. After alerting the relevant parties in Indiana, ASPS determined there would be value in initiating a national campaign to educate legislators on the harmful effects of broad NP scope expansion, and to ask for tighter controls surrounding their scope of practice. The Society began the campaign by contacting leadership at all state plastic surgery societies and state medical associations to invite them to cosign the Society’s outreach. Now in the final phase of the campaign, ASPS is contacting the state legislatures. So far, the Society has contacted state policymakers in Georgia, Kansas, Louisiana and Nevada.

• ASPS joined the Michigan scope-of-practice coalition, Michigan for Advancing Collaborative Care Teams (MiACCT), which focuses on growing, strengthening and preserving the healthcare teams patients rely on for care.

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Connecticut Andrew Chen, MDn District of Columbia Catherine Hannan, MDu Florida Anthony Dardano, DOu David Halpern, MDI Bruce Mast, MD Ernesto Ruas, MDu Sarvam TerKonda, MD Georgia David Hill, MDu James Krupp, MDn Nirav Patel, MD, JDs Charles Schafer, DOn Mark Walsh, MDu Illinois Anmol Chattha, MDn

Sara Dickie, MD Daniel Krochmal, MDI Loren Schechter, MDI Kansas W. Thomas Lawrence, MD Kentucky Debra Bourne, MDs Milind Kachare, MDn David Kirn, MDu Massachusetts Theodore Calianos, MDu Deborah Ekstrom, MDu Janice Lalikos, MDu Bernard Lee, MD, MBA, MPHI Basil Michaels, MD Missouri Justin Sacks, MD, MBAu New Jersey Sean Bidic, MDI Steven Kozusko, MDn Casey Sheck, MDn New York Steve Fallek, MDu Franziska Huettner, MD, PhDu

Alan Matarasso, MDI Ash Patel, MBChB Aviva Preminger, MD Malcolm Roth, MDI Adam Schaffner, MDs Thomas Sterry, MDu Peter Taub, MD L Kevin Tehrani, MD North Carolina Lynn Damitz, MDI Eric Halvorson, MDu Rosiane Roeder, MDu Ohio Steven Bernard, MD Katherine Grunzweig, MD R. Michael Johnson, MDI Bryan Michelow, MD Pennsylvania Leo Farrell, MDu Gabriela Garcia Nores, MDn Jeffrey Gusenoff, MDs Keli Kolegraff, MD, PhDH Rhode Island Loree Kalliainen, MDu Victor King, MDn

South Carolina Laura Figura, MDu Tennessee L Galen Perdikis, MD Texas Steven Albright, MDs Kristen Aliano Messina, MD Alfonso Barrera, MD C. Bob Basu, MD, MBA, MPHI Eileen Curry, MDs Patrick Hsu, MDI Jack Hua, MDn Emily Kirby, MDs Janak Parikh, MDn Aldona Spiegel, MDI Charles Verheyden, MD, PhD Virginia Henry Wilson, MD Washington Cristiane Ueno, MDu Wisconsin Michael Bentz, MDs Christopher Hussussian, MDu

Presidential Circle: $5,000 (max) L Congressional Circle: $3,500+ H Premier Circle: $2,000+ Chairman’s Club: $1,000+ u Patron: $500+ s Young Plastic Surgeons: $200+ n Residents: $25+ J

I

December 2021

and exacerbating the financial burden many assume in order to receive necessary care.

Uninsured and self-pay patients An additional concern in rulemaking related to the No Surprises Act centers on the requirements to provide good-faith estimates to uninsured and self-pay patients. Specifically, the IFR implements two major provisions: requirements for providers and facilities to provide a good-faith estimate to uninsured (or self-pay) individuals when an item or service is scheduled or upon request by the uninsured (or self-pay) individual; and the Patient-Provider Dispute Resolution (PPDR) process when billed charges to the uninsured (or self-pay) individual exceed the good-faith estimate for an item or service by more than $400.

It should be noted that these provisions apply to all providers and facilities – unlike the No Surprises Act balance-billing protections, cost-sharing protection and federal IDR provisions, which apply in defined sets of circumstances. These provisions require all healthcare professionals to provide goodfaith estimates to any of their patients who are uninsured or self-pay when scheduling a procedure or upon request by an uninsured patient. It’s unclear whether this reflects Congressional intent, but this requirement would also apply to cosmetic surgical procedures. It’s also important to note that the rules lay-out that a “self-pay” patient can be an insured patient who states a lack of intent to submit a claim to their insurance plan.

ASPS remains concerned about the agency’s lack of clarity on the process when these obligations are created “upon request” by a patient with whom the physician has no prior relationship; the tight timelines around the provision of information to patients; and the administrative burden of collecting the

good-faith estimates from other providers and facilities that will be involved in the care (and having to do so in such a short timeframe).

State implementation The federal No Surprises Act will trigger a patchwork of balance-billing scenarios across the country. Some states will follow federal law, others will maintain their current state balance-billing policies and some states will operate under a hybrid set of federal and state laws. The legislation, however, is generally designed to defer to state law and regulation on balance-billing and out-of-network payments from plans to providers.

The No Surprises Act allows a “Specified State Law” to govern, defined as “a state law that provides a method for determining the total amount payable… to the extent the state

law applies.” The departments tasked with issuing regulations and guidance around the law ruled that Employee Retirement Income Security Act (ERISA) plans that “opted-in” to state regulation (where allowed) can be governed by state law, to the extent it applies. Still, regulators stipulated that the state law must apply to the plan, issuer, coverage involved (including where a state has allowed a plan to “opt-in”); apply to the nonparticipating provider or nonparticipating emergency facility; and apply to the item or service involved.

ASPS advocacy ASPS has been actively working with federal agencies throughout the rulemaking process to help make the policy more palatable to physicians.

The Society outlined key concerns with

the bill in a Dec. 14, 2020, letter to Speaker of the House Nancy Pelosi; Senate Majority Leader Mitch McConnell; House Minority Leader Kevin McCarthy; and Senate Minority Leader Charles Schumer. The letter warned lawmakers that the package before them was “largely skewed in favor of payers over physicians, particularly those in small and rural practices.” Although ASPS acknowledged concessions that had been made in order to reach a deal on the package, the Society urged Congress to make key revisions in order to ensure the legislation was truly fair and balanced – specifically, provisions to ensure fair and timely physician reimbursement and adjustments to the IDR process to prevent it from being heavily skewed in favor of payers.

These efforts represent a continuation of the Society’s leadership in advocating for policy protecting patients from unanticipated out-ofnetwork bills, which dates back to 2018.

During the final months of the rulemaking process, the Society will continue to work with lawmakers and regulators in an effort to prevent harmful provisions of the No Surprises Act from being implemented into law. ASPS is also working with key lawmakers on Capitol Hill who are influential in balance-billing discussions, such as Ways and Means Committee leadership – Reps. Richard Neal (D-Mass.), Kevin Brady (R-Texas), Tom Suozzi (D-N.Y.) and Brad Wenstrup (R-Ohio) – to request technical changes to the law to improve the IDR process and ensure the median-in-network rate is not used as the de facto benchmark. PSN Editor’s Note: In the Oct./Nov. issue of PSN, the Legislative Update column contained an example suggesting a hand surgeon might prioritize an aesthetic result over restoring function. The Editorial Board knows prioritizing the preservation and restoration of function is a fundamental discipline of the specialty and PSN regrets the oversight.

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WHITLEY HOTEL - ATLANTA, GA | INFO & REGISTRATION WWW.SESPRS.ORG December 2021

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PRACTICE MANAGEMENT INSIGHT

Surgeon-to-surgeon marriage: The female surgeon’s perspective

By Diana Yoon-Schwartz, MD, PhD (with Ashley Amalfi, MD; Sugene Kim, MD; and Sheila Nazarian, MD)

A

s I celebrate my 20th wedding anniversary the same year that ASPS celebrates its 90th anniversary, I find myself thinking about the duality of a surgeon-to-surgeon marriage: successes, failures and impact on practice. Four female plastic surgical colleagues, each married to other surgeons from varied disciplines (cardiothoracic, urology, neurosurgery and a fellow plastic surgeon), shared their thoughts about what it takes to be successful both in practice and as a parent spouse.

Interestingly, an academic general surgery study published in JAMA revealed that 28 percent of female surgeons were married to another surgeon, with an additional 14 percent married to nonsurgical physicians. Overall, 90 percent of female surgeons lived in a dual-career household. In contrast, male surgeons are far less likely to marry another physician – much less a surgeon (only 15 percent) – and only slightly more than 50 percent of male surgeons were in dual-career households. According to a 2018 study in PRS, women plastic surgeons in general (64-65 percent) have a lower marriage rate than their male counterparts (87 percent); and female plastic surgeons are more likely to be divorced (14-20 percent) than male counterparts (8 percent). Statistically speaking, at least, female plastic surgeons face more challenges in obtaining and maintaining a married life.

As female plastic surgeons, we admit that we need a supportive spouse to “make it work.” It is essential to have a partner who understands our different roles but also is able and willing to share in the complex tasks that help balance career and family life.

What are some practical thoughts on balancing the married, dual-surgeon tightrope act?

• We all need help at home. Be willing to beg, borrow and pay for someone to assist in taking care of your children and your home. Live-in nannies might be necessary.

Housekeepers or house assistants can be vital. Laundry services do not have to be limited to your practice. Send out clothes if laundry is burdensome. Be willing to hire a chef on occasion to prepare good, healthy meals. Dog walkers may be necessary – not just when you’re on vacation. Pay for as much help as you need and maybe a little more, just to make sure. Be willing to ask family or friends for help – especially when it comes to caring for your children.

Be ready to graciously reward them with gifts or other luxuries because the return on your investment will be worth it.

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All of us agree that our husbands help divide and conquer our various household duties. Ashley Amalfi, MD, notes that in her household, the last one out of bed makes it. That’s the same in my house – and since my husband is better at it, if he gets out of bed first, he perfectly makes his side then “tucks me in,” so I have very little to complete. All our spouses are willing and able to share household responsibilities. When my husband left for a job in New York as I was finishing my chief year at UCLA with two toddlers, he said:

• Coordinate operative block days, weekend/emergency on-call schedules and conferences/meetings. When my children were young, my husband and I made sure that those dates were different.

As the children got older and became independent, we tried to have the same working days so that we could enjoy more time off together. In fact, now that we are almost empty-nesters, we even try to attend each other’s meetings and have additional shared time alone.

• It’s also important to know when to keep things separate. Sugene Kim, MD, and her husband,

al surgery residency programs and met at the Washington, D.C. V.A. Hospital. Dr. Nazarian was introduced to her husband through a mutual friend.

Regardless of the circumstances of how we met, however, we each have suggestions on how to keep a marriage between two incredibly busy medical professionals healthy: • No matter how busy you are, find time for each other. Dr. Kim says she reserves Friday nights for family dinner with the kids; but Saturday nights are date nights with Bob. I remember the difficulty of trying to balance a busy operative schedule with three kids under the age of 5 – sometimes I’d have to proactively schedule time to be with my husband.

Your patients, your practice and your children are all very important – but don’t forget your life partner who makes all the aforementioned possible.

• Make sure to take family trips and vacations to connect. As any parent knows, children grow up quickly. They are not really pleasant to travel with until they are about 5 years old – and by the time they’re 15, they aren’t always eager to go on family trips as school, sports and their social lives consume more of their time. Take advantage of those 10 years to make some amazing family memories.

• Explore, discover and share adventures. Try to learn new things together (e.g., golf, cooking, a new language). Engage in shared activities/ sports (e.g., skiing, tennis, running, ballroom dance, massage, pottery).

Emphasizing the importance of family time with (clockwise from top left) ASPS members Ashley Amalfi, MD; Sugene Kim, MD, and C. Bob Basu, MD, MBA, MPH; Sheila Nazarian, MD; and Diana Yoon-Schwartz, MD, PhD. “If you have any problems when I’m not here, throw money at the problem and help it go away.”

• Outsource anything that doesn’t bring you joy. Even, as Dr. Amalfi notes, for something as simple as “returning Amazon orders.”

• Communication is key. Make sure everyone knows your schedule of important events. Before shared calendars were readily available on our mobile devices, my home had a large bulletin board (full disclosure: we still do) with all important contacts, appointments, events, games and vacations. In fact, I share my personal schedule – including dates of school breaks and important family events – with my office. This allows my practice staff to help me avoid scheduling conflicts.

ASPS/PSF Board Vice President of Finance and Treasurer C. Bob Basu, MD, MBA, MPH, both have private plastic surgery practices in Houston. However, as Dr. Kim points out, “Bob and I have separate and distinct private practices as we have different personalities and perspectives on running our practices.

Running a private practice allows each of us to express our own individual style and creativity.”

It’s about time With the exception of Sheila Nazarian, MD, the female surgeons who offered their pearls of wisdom to this piece met their spouse at work. I met mine in medical school during his cardiac Fellowship; Dr. Amalfi met hers during surgical intern orientation; and Dr. Kim and Dr. Basu were at neighboring gener-

• Don’t forget to go the extra mile.

Remember every once in a while to do special/extraordinary things for each other. Take care of their “to do list,” schedule a massage, cook their favorite meal, prepare a warm, fragrant bath. In other words, find a way to communicate how special your spouse is to you.

Considering the elements of communication and coordination, many of the essentials of maintaining a cohesive staff and practice are the same skills that are needed at home.

During difficult practice challenges, we rely on our staff and during difficult moments outside the office, we rely heavily on those we love most. Life is full of joys and challenges – and having a willing and able partner is a blessing not to be taken for granted. As we prepare to celebrate the holidays and a new year ahead, remember to take time to thank your “home staff” for all their efforts. PSN Dr. Yoon-Schwartz is chair of the Practice Management Committee and is in private practice in Huntington, N.Y.

December 2021

Drawing up plans for the future Past attempts to restructure the ASPS Board of Directors haven’t been successful, but as the Society’s size and influence grows – at local, national and global levels – more people want their voices heard. Now there’s an effort to restructure governance and make it increasingly efficient and representative for membership.

By Paul Snyder

December 2021

T

he PSF past President Nicholas Vedder, MD, can still recall the excitement he felt while attending his first ASPS/PSF Board of Directors (BOD) meeting 12 years ago.

“I remember sitting there and thinking that I would be involved in the future direction of the Society,” he says. “And I sat there and listened the whole time. I don’t think we voted on anything other than to approve the minutes. It was eye-opening to me – and discouraging. It really wasn’t until I got elected to a position on the Executive Committee (EC) when I was Board Vice President of Academic Affairs that I realized that everything really happens at the EC level.”

That fact, Dr. Vedder says, highlights a structural problem with ASPS. Although there are representatives from some membership groups, a few subspecialty societies and the public on the 29-member BOD, it typically meets just twice a year. Those meetings, Dr. Vedder says, mostly consist of rubber-stamping decisions already made by the EC – a smaller body composed of the ASPS/PSF presidential line and board vice presidents – which often meets monthly to tackle issues facing the specialty and Society.

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“It’s really a top-down organization right now,” Dr. Vedder says. “Yes, there is representation on the BOD, but that’s not really the true, forward-thinking, governing power of the Society. The EC feeds down to the BOD, which seems upside down.”

In his own time on the board and the EC, ASPS immediate-past President Joseph Losee, MD, had a lot of time to think about that fact as well. That’s why he spent much of his presidential term working on a plan to change the topdown structure to a bottom-up one that would not only be more representative of membership, but make the BOD a more nimble entity that could meet with more frequency and play a more defined role in navigating the Society’s future. It also addresses the ever-increasing requests to add members from subspecialty societies, member sections, managed societies and others for greater representation at the board level.

Dr. Losee acknowledges the tough history that has been tied to this kind of proposal.

“It’s not as if governance restructure is a new idea,” Dr. Losee says. “We’ve tried this. Many presidents have tried this many different ways. In the past, maybe the task force charged with governance restructuring was for it and the EC wasn’t, or the EC was for it and the BOD wasn’t, or the BOD was but the Trustees weren’t.

At the moment, it appears as if – in general – the task force, the EC, the BOD and the Trustees have all been engaged, contributed and are approving of the concept.”

All parties, however, want ASPS members to understand the potential change – and get involved with planning. The first “town hall” on the governance change is expected to be held in December, and Dr. Losee says there will be continued membership engagement efforts throughout the year to generate more buy-in and involvement with the proposal. Ultimately, Dr. Losee says, the goal is to facilitate the

generation of new ideas from within the membership and stakeholder groups and provide a direct line to a more-nimble governing body that can take action on those ideas.

On paper, achieving that goal is slightly more involved.

The concept At Dr. Losee’s direction, the ASPS Board/EC Composition Task Force first convened in the fall of 2020 to identify opportunities for greater engagement on the part of the membership and significant stakeholders (e.g., state and regional plastic surgery societies, plastic surgery subspecialty societies and member special

Right now, the Board of Directors isn’t as effective as it could be. Yes, we need more representation, but we can’t just keep piling people onto a board that isn’t really making key decisions. I’d argue that would only dilute attention to any topic and not enhance participation. This proposal gives membership different kinds of voices.

– ASPS immediate-past President Joseph Losee, MD

interest groups). The resulting task force recommendations led to the current plan for structural revisions to the ASPS/ PSF BOD – and development of a new body of constituencies called the Council of Representatives (COR) to provide representation to the aforementioned significant stakeholders. The COR would have three subcouncils: the Subcouncil of Member Sections, the Subcouncil of State/Regional Societies and the Subcouncil of Specialty Societies.

The specific details of how this reorganization will ultimately look are yet to be determined – the member feedback that the Society seeks in the coming months could also modify the plan. Under the structure presented to the current EC and BOD in October, the EC would be dissolved and the restructured ASPS/PSF Board of Directors would be streamlined

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to include the six members of the presidential line (ASPS president, The PSF president, ASPS president-elect, The PSF president-elect, ASPS immediate-past president, The PSF immediate-past president); the seven board vice presidents (academic affairs, development, education, finance, health policy and advocacy, membership and research); and the chairs of the three COR subcouncils. This structure would revamp the ASPS BOD, cutting it from 29 members to 16 members.

Two board vice presidents would also be assigned to each COR subcouncil as a liaison, in essence giving these groups a stronger voice on the BOD. The PSF BOD would consist of the same members

• Framing • Patient Positioning • Patient Preparation

as the ASPS BOD – and there may be up to three public members (right now, there is one).

The proposed structure would have the COR essentially represent ASPS membership from the perspective of the Society’s major stakeholders. The subcouncils would have the authority to adopt resolutions and recommendations for consideration, response, action or disposition by the ASPS BOD. Dr. Losee says one of the main reasons for moving forward with governance restructuring is because of the requests for greater representation on the Board of Directors. However, he adds that it’s not practical to expand a board that already has 29 members and, perhaps more significantly, that doesn’t function as a true board should.

“We should get real about creating a

new BOD that’s different from the current EC,” he says. “Right now, the BOD isn’t as effective as it could be. Yes, we need more representation, but we can’t just keep piling people onto a BOD that isn’t really making key decisions. I’d argue that would only dilute attention to any topic and not enhance participation. This proposal gives membership different kinds of voices – members can do work on committees, and now with the new proposed structure, subcouncil chairs, made up of the broad membership, would gain a voting seat. In essence, the subcouncils would help populate the agenda of the board.”

Once a resolution or recommendation of the subcouncils has been put before the BOD, the board would have the responsibility and obligation to take action – be it a motion to accept or reject, remand the matter back for further clarification or request an advisory opinion from the Trustees.

Building momentum The scope of this change is not lost on Dr. Vedder, who not only said he’d waited 12 years for this kind of reorganization to occur, but also called the proposal the “most significant structural change” he’s seen in nearly 30 years as an ASPS member.

In October, the ASPS/PSF BOD voted to move the idea forward to increase member understanding of the proposed new structure. Early estimates of the restructure do confirm that there would be a cost associated with overhauling Society governance, although it was noted that with certain older ASPS programs sunsetting and other possibly expendable items (e.g., cocktail receptions) on the estimate, that figure is fluid and likely will drop.

Dr. Losee says that with effort, the cost does not have to be significant. Dr. Vedder agrees, and says the return on investment for the Society would be profound.

“This is about increasing membership engagement, which is probably the most important thing that any organization can do,” he says.

ASPS/PSF Board Vice President of Membership Steven Williams, MD, says if ASPS is going to continue on the track its established over the past few years of increasing its services to members, getting more organizational buy-in from state and regional societies – not to mention increasing international partnerships – governance changes have to follow that.

“The structure needs to grow,” he says. “Dr. Losee recognizes that we need to make sure we’re building a more representative body where ideas can come from grassroots sources in a more efficient manner. Ultimately, that should tie the governing structure more closely to the needs and desires of membership. When it comes to arguments that members make where they feel like they’re not heard or that ASPS doesn’t represent them, this is an answer to that. This is the first step in making a lot of that better.”

As membership input is gained and plans are brought into clearer detail, Dr. Losee says he will prioritize keeping the plan on track. Acknowledging that previous attempts at governance restructuring also lost steam as various issues arose and December 2021

ASPS/PSF Proposed Organizational Chart ASPS Board of Directors

PSF Board of Directors

Membership: Presidential Line, Board Vice Presidents, Subcouncil Chairs

Membership: Presidential Line, Board Vice Presidents, Subcouncil Chairs, up to three (3) Public Members

ASPS Committees

PSF Committees

Council of Representatives Authority: The Council of Representatives shall have the authority to adopt resolutions for consideration, and response, action or disposition by the ASPS Board of Directors.

Trustees

Advisory Requests

Leadership: Chair, Vice Chair and Secretary of each Subcouncil

Appellate and Advisory Body

Membership: All Delegates from each Subcouncil ory

is Adv

ts

ues

Req

Subcouncils State and Regional Societies

Subspecialty Societies

Charge: To facilitate communication of and collaboration on the issues affecting the Society’s membership at the state and regional level through recommendations and resolutions to the Board of Directors.

Leadership: Chair, Vice Chair, Secretary elected

by Subcouncil Delegates Membership: Each approved state and regional society shall be entitled to appoint one (1) Delegate per two hundred fifty (250) Active and Life Active Members within its voting membership, up to three (3) Delegates in total.

Charge: To represent the subspecialty practices within the membership of the Society and facilitate the generation and presentation of recommendations and resolutions to the Board of Directors reflective of the unique interests, priorities and concerns of the subspecialties.

Charge: To represent the membership of the Society and facilitate the generation and presentation of recommendations and resolutions to the Board of Directors reflective of the interests, priorities and strategic initiatives of the membership.

Leadership: Chair, Vice Chair, Secretary elected

by Subcouncil Delegates

Leadership: Chair, Vice Chair, Secretary elected

by Subcouncil Delegates Membership: Each approved Member Special Interest Group (“SIG”) shall be entitled to appoint one (1) Delegate per fifty (50) members, up to five (5) Delegates in total.

Membership: Each approved subspecialty society shall be entitled to appoint one (1) Delegate per two hundred fifty (250) Active and Life Active Members within its voting membership, up to three (3) Delegates in total.

Delegates must be Active Members.

Stakeholders Represented: State and Regional Societies comprised of at least ninety percent (90%) Active and Life Active Members of the Society.

Board Vice President Liaisons: Advocacy and Development

Judicial Council

Member Sections

Delegates must be Active Members.

Stakeholders Represented: Subspecialty Societies comprised of at least ninety (90%) Active and Life Active Members of the Society, or otherwise be contractually affiliated with the Society.

Board Vice President Liaisons: Education and Academic Affairs

Membership Denials

Ethics Committee

Delegates do not have to be Active Members, except those elected to Leadership.

Stakeholders Represented: Membership Special Interest Group to be formally created, including converting existing forums into SIGs (e.g. WPS, YPS, PRIDE Forum).

Board Vice President Liaisons: Membership and Research

In addition to dissolving the Executive Committee, the governance restructuring plan (above) put forward by the ASPS Board/EC Composition Task Force would result in a reduced number of seats on the ASPS/PSF Board of Directors – but with a stronger voice for state and regional societies, subspecialty societies and ASPS member sections thanks to the creation of subcouncils.

drew attention away from those efforts, Dr. Losee says he wants a detailed proposal to make its way to the Bylaws Committee for a vote by general membership in 2022.

That means a year of work, however, and plans at this point remain flexible.

During the Annual Business Meeting in Atlanta, Dr. Losee said he’d already heard from members who offered thoughts and ideas on structural changes that he liked in concept – and that he remains open to more such input from members. In the coming months, the task force will continue to pin down the financial analysis and build engagement from members, stakeholders and staff.

“We’re starting now with general membership, state and regional societies and subspecialty societies to present the model, seek feedback, gain approval,” Dr. Losee says. “Ideally, we present it to the ASPS/PSF Board of Directors during the Spring Meeting, and from there it could go to the Bylaws Committee to pin down December 2021

the details ahead of a membership vote later in the year.”

That means that in the months ahead, Society leadership will be eager to hear from members so that the final structure reflects as much input as possible. Dr. Williams encourages everyone to participate in the upcoming town halls.

“Membership expects a real return on investment from their associations with this organization,” he says. “It’s good to be able to demonstrate that return on investment. Without a more streamlined mechanism of getting those membership concerns and ideas to leadership, that can’t happen. I think this is a critical opportunity – it’s just a question of: Do they have the time to help us out with it?

“We’re all very busy,” Dr. Williams adds. “We all have incredibly hectic lives.

But you know, 15-30 minutes of paying attention to this could be really great, because it means that an organization that has grown in resources and representation can serve you better.” PSN

Get involved The first virtual town halls on the proposed ASPS/PSF governance restructure – which will focus on state and regional society involvement, as well as subspecialties – will be held in December via Zoom teleconference calls on the following dates: Governance Structure Town Hall: State and Regional Society Focus

Tuesday, Dec. 14 8:30 pm to 9:15 pm EST

Governance Structure Town Hall: Subspecialty Society Focus

Thursday, Dec. 16 8:30 pm to 9:15 pm EST

Further town halls for general ASPS membership will follow in 2022.

For Zoom links to the events and other queries related to the proposed governance restructure, email governance@plasticsurgery.org. PSN

19

YOUNG P L A S T I C

S U R G E O N S

PERSPECTIVE WRITTEN BY AND FOR YOUNG PLASTIC SURGEONS

Travel scholarship winners reflect on their time in Atlanta

S YPS P e r s p e c t i v e

ome of the plastic surgery residents who won travel scholarships to Plastic Surgery The Meeting 2021 in Atlanta shared their experiences and takeaways from this year’s meeting with PSN. I want to thank the ASPS, The PSF and ASMS for putting on a wonderful national meeting and providing both optimism for the future of our specialty and a return to normalcy with in-person meetings. I would also like to thank KLS Martin for sponsoring the Resident Travel Scholar Award that allowed me and other residents to attend the meeting, present our research and interact with the governing body.

In Atlanta, I was paired with a mentor and invited to attend meetings of the ASPS Residents Council, Young Plastic Surgeons (YPS) Steering Committee and Legislative Advocacy Committee. I have been involved in plastic surgery research since I was a medical student, but these sessions provided my first exposure to the leadership and ASPS legislative efforts.

Brett Phillips, MD, MBA, Duke University’s plastic surgery residency program director, was my assigned mentor. He was open and welcoming – and I was grateful to connect and discuss clinical practice patterns, research interests and committee developments at multiple points throughout the meeting.

The Residents Council meeting led by Lisa Gfrerer, MD, PhD, was inspiring. The group discussed several issues and generated real solutions to the problems experienced by the residents of programs that closed over the past year. The efforts to streamline and elucidate the process of finding a new residency position highlight the support that residents and ASPS members have for our colleagues, particularly during difficult times. That sense of community continued through the YPS Steering Committee, as the future leaders of our field collaborated on ways to stay up-to-date in a changing world and economy. I was truly impressed by the members of the Legislative Advocacy Committee, who made a significant effort to volunteer in state and national lobbies and government bodies to protect the safety of our patients by limiting out-of-scope practice of non-plastic surgeons. It was encouraging to see such a strong, determined group of people carry such enthusiasm to ensure the highest patient safety as well as the stability of our careers as plastic and reconstructive surgeons.

I was able to present my research with Raymond Tse, MD, Seattle, on unilateral cleft lip nasal deformity and the changes expected following primary repair and foundation-based rhinoplasty. This steered me toward several amazing sessions on the ASMS Track, learning from national experts on congenital, post-traumatic and post-oncologic craniofacial reconstruction. I was humbled and honored to meet the recipient of the 2021 Noordhoff Humanitarian Award, William Magee, MD, and Kathy Magee of Operation Smile, who built a system to provide care for thousands of children with cleft lip and palate around the world.

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(Left to right) ASPS/PSF Vice President of Membership Steven Williams, MD; Benjamin Massenburg, MD; Christina Rudolph, MD; Hannah Langdell, MD; Elizabeth Moroni, MD, MHA; Sarah Hart, MD; Harry Siotos, MD; Robertino Basso, MD; and Paul Cantin of KLS Martin during a reception for this year’s travel scholarship winners at Plastic Surgery The Meeting 2021 in Atlanta.

The meeting reinvigorated my love for plastic surgery, craniofacial surgery and global surgery, and I look forward to collaborating with you all again next year at Plastic Surgery The Meeting in Boston.

– Benjamin Massenburg, MD University of Washington Plastic Surgery The Meeting 2021 was a great event with many interesting presentations, forums and discussions that stimulated my motivation to conduct further research and pursue innovation in plastic surgery.

The organizing committee did an amazing job of bringing people together both from the different corners of the nation and internationally – as speakers and attendees – despite the pandemic. I specifically enjoyed participating in the discussion for the plane change in breast reconstruction. Subpec to prepec change is in high demand at the moment and learning tips from faculty at various centers of excellence was very valuable.

It was a great honor for me to be chosen as a Resident Travel Scholar; receiving the award from ASPS/PSF Board Vice President of Membership Steven Williams, MD, will be a lasting, lifetime memory.

– Harry Siotos, MD Rush University Medical Center There was a palpable sense of community interwoven throughout Plastic Surgery The Meeting. It could be due to the fact that this was the first major in-person meeting since the onset of the COVID-19 pandemic, but I think it also had to do with the genuine excitement that ASPS members have in coming together to share their knowledge and experience with their colleagues and friends. I was privileged to be a part of the meeting and look forward to getting more involved in our Society. In fact, this year’s meeting marked the

beginning of my service terms on the Leadership Development Committee, Legislative Advocacy Committee, Clinical Research Subcommittee, Researcher Education Subcommittee and the Residents Council.

Looking around the room at committee meetings was a great reminder that ASPS is a living entity made up of vibrant and engaged surgeons who are passionate about our specialty and generous with their time.

It was a nice reminder that all of the benefits that I avail myself of as a resident member of ASPS are the direct result of someone else’s hard work and dedication – something I want to pay back through continued committee involvement and service.

The greatest joy of PSTM for me was reconnecting with mentors and colleagues from other institutions to exchange knowledge and experiences. It was incredibly rewarding to see my counterparts at other institutions that I met on the interview trail coming into their own as residents and figuring out where their career will take them. In that vein, the educational sessions also helped me to solidify my dedication to a career as a reconstructive microsurgeon.

I am truly lucky to be counted among the incredible and diverse group that makes up plastic surgery, and even more lucky to have been given the opportunity to attend PSTM as a Resident Travel Scholar. The meeting reinvigorated my drive to pursue my professional goals and underscored the importance of mentorship on goal development and attainment. I am very grateful to the ASPS/ PSF for investing in my education and development, and I am committed to paying it forward in the near future.

– Elizabeth Moroni, MD, MHA University of Pittsburgh Being selected as an international scholar to Plastic Surgery The Meeting and be among residents and future colleagues from all over

the world opened possibilities to me in terms of participation and improving my knowledge and educational skills that can help me back in Argentina. I’m thankful to have finally met colleagues and dedicated residents from the United States and abroad, and I will forever be appreciative of how helpful and kind they were with me when I inquired about a topic or simply introduced myself. As a recipient of the travel scholarship, ASPS paired me with Dr. Gfrerer to serve as my mentor throughout the meeting. I met her at the Residents Reception on the first day and she helped make sure I got the most out of my experience during the meeting.

I was also excited to be involved in committee and board meetings, which helped me better understand the constant work the Society does for all of its members year after year.

Although I never doubted how meticulous the organization is or the sizable efforts they make on behalf of membership, it’s still remarkable to see from the inside how hard they work.

Residents are the keystone of plastic surgery’s future, so it was impressive to see their level of involvement in ASPS and The PSF to improve the organization and provide their points of view on the structure and function of the Society. From what I saw, active members are actively engaging residents, listening to them and doing their best to steer educational changes that need to be made.

I really enjoyed making new friends and having fun with them in the social events of the meeting. Even though it’s important to meet colleagues in a formal way, it’s hard to replicate the feeling of comfort when you can network and socialize in a more relaxed, friendly and informal manner. Sharing experiences with other plastic surgeons made me appreciate them more and want to be in contact for future social and academic meetings.

This was my first experience engaging with ASPS and I hope it’s the beginning of a long relationship. The cooperation between countries fosters a great opportunity to share information and experience – and it will surely improve the standards of the organization from all over the world.

– Robertino Basso, MD Hospital Italiano of Bueno Aires I’m incredibly thankful for the opportunity to attend Plastic Surgery The Meeting 2021 as a travel scholar, particularly for the chance to be involved in committee meetings. During my time in Atlanta, I attended meetings of the Residents Council, the YPS Steering Committee, Women Plastic Surgeons Steering Committee and Legislative Advocacy Committee. These experiences provided firsthand insight into how residents, private practice and academic plastic surgeons around the country collaborate to enact change to support our specialty, patients and education at local, regional and national levels. The committee meetings taught me that it’s never too early to enact change through collaboration and empowering others.

December 2021

As a result of receiving the scholarship this year, I began to learn how to become an empathetic, compassionate, socially aware, empowered plastic surgeon and leader who can provide inclusive, whole-person care and functional quality-of-life improvements, while also empowering others to lead. I learned how to become an advocate for my patients, colleagues and future plastic surgeons. The lesson I take from my time in Atlanta is that leadership is born from collaboration and supporting others at all levels. I’m looking forward to attending next year. I would like to thank KLS Martin and my chief, Ash Patel, MBChB, for making this scholarship possible.

– Christina Rudolph, MD Albany Medical Center The ASPS Resident Travel Scholarship provided a range of opportunities to experience the many enriching facets of Plastic Surgery The Meeting 2021. I was impressed by the diversity of the educational programming at the meeting – and my favorite sessions included learning about the management of mangled upper-extremities, tips on microsurgery efficiency and the challenges facing plastic surgeons in underserved communities. These talks exemplified to me the importance of attending national meetings. My institution performs a high volume of microsurgery, but the speakers presented new frameworks for how to consistently perform breast microsurgery in a more efficient manner by employing a two-team approach, relying on preoperative imaging – and meticulously tracking the time per surgical step.

As a resident at Duke University, I never had exposure to practice models in underserved communities. The speakers who discussed this subject broadened my knowledge of the hurdles involved in starting a solo prac-

tice, the impact that a single plastic surgeon can have in a rural community and the steps being taken to recruit and retain surgeons in rural America. Another highlight that aims to promote innovation within ASPS was “The Tank” competition where two finalists presented their devices and technology to an expert panel of judges.

The ability to participate in the WPS Steering Committee meeting was special, because it gave me a sense of community and belonging amongst this highly accomplished and motivated group of female plastic surgeons. It was interesting to learn about the history of the committee and how much it has grown since its inception. Similarly, the YPS Steering Committee brought together the future leaders of the Society and addressed ways to educate and promote medical student and resident engagement. Being able to sit-in at the Legislative Advocacy Committee meeting was exciting in terms of being able to see how the priority agenda for the coming year is set, as well as brainstorming ways to address scope-of-practice issues.

Most importantly, the scholarship allowed me to meet in-person with friends and colleagues. The relationships that are built at meetings are invaluable, and it was such a wonderful occasion to reunite and rekindle that sense of community. Overall, the Resident Travel Scholarship provided an inside look at the Society’s committees and structure, serving as motivation to stay involved and, hopefully, one day be a leader within ASPS. – Hannah Langdell, MD Duke University As a lucky recipient of the travel scholarship, I was fortunate to attend Plastic Surgery The Meeting 2021 in its entirety. One of the most essential experiences for me was attend-

ing the numerous events sponsored by the WPS Forum, as it facilitated the opportunity to build new relationships, explore the facets that make a successful female plastic surgeon and reflect on my ultimate career goals.

At the WPS Steering Committee meeting, I was introduced to the female leaders of the organization who work together not only to chart a course for female membership going forward, but also to synergistically tackle challenges. At the WPS luncheon, we all had the pleasure of witnessing a powerful and inspiring keynote address about being female surgeons and leaders. It was inspiring for me to be able to meet so many women in all phases of their career. I shared lunch with two inspiring third-year medical students who reminded me of the excitement of our field and the pride we have in our specialty. I reconnected with a mentor practicing outside of my residency program whom I had met at a previous networking event and received real-time career advice and encouragement.

Finally, I had the chance to meet residents from all over the country, and we bonded over our shared residency experiences. At the WPS networking social hour, I bumped into a colleague who I had not seen in a decade, when she was a general surgery resident and I was a third-year medical student. I also met many women who willingly passed out their phone numbers and graciously offered to provide guidance, support and advice whenever needed. The Resident Travel Scholarship for PSTM allowed me the chance to not only experience all this, but also to catch a glimpse of all of the exciting things that lie ahead for me as a female plastic surgeon.

– Sarah Hart, MD Univeristy of Michigan YPS

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December 2021

21

YPS P e r s p e c t i v e

Perhaps most significantly, I learned that being involved in the plastic surgery community begins at the residency level. ASPS is a tight-knit community that encourages a supportive, collaborative environment that fosters growth and inspires others to focus on inclusive, whole-person, integrated care.

The experience has inspired me to apply next year to the Residents Council and educate my fellow residents on ways to get involved.

In turn, through my continued involvement in ASPS as a resident and, later, as a future attending, I hope to learn how to continue to break down barriers by enacting change and advocating for my colleagues and future patients.

In Atlanta, I continued to foster relationships that I developed as a medical student.

I felt fortunate to share this experience with a fellow resident who I had met on the interview trail. I was able to reconnect with my former chief resident, Aditi Kanth, MD, who’s now a pediatric craniofacial surgeon in New Jersey. It was inspiring to see her present research regarding academic female plastic surgeons, collaborating and learning from fellow female craniofacial surgeons and being a WPS Steering Committee member.

Attending the various pediatric and craniofacial seminars and meeting (and learning from) various leaders in the field solidified my goal to became a pediatric plastic surgeon.

My experiences supported what I learned from my mentors – that ASPS has a strong focus on humanism in plastic surgery and provides a multidisciplinary avenue for plastic surgeons to be involved in ethics, research, health policy, advocacy and wellness. As physicians, we have strong moral responsibilities to improve our patients’ quality of life through research, health policy, advocacy and access, while also having moral obligations to be advocates for our colleagues.

INDICATIONS ALLODERM SELECT™ Regenerative Tissue Matrix (ALLODERM SELECT™ RTM refers to both ALLODERM SELECT™ RTM and ALLODERM SELECT RESTORE™ RTM products) is intended to be used for repair or replacement of damaged or inadequate integumental tissue or for other homologous uses of human integument. This product is intended for single patient one-time use only. ALLODERM SELECT™ RTM is not indicated for use as a dural substitute or intended for use in veterinary applications.

IMPORTANT SAFETY INFORMATION CONTRAINDICATIONS ALLODERM SELECT™ RTM should not be used in patients with a known sensitivity to any of the antibiotics listed on the package and/or Polysorbate 20.

WARNINGS Processing of the tissue, laboratory testing, and careful donor screening minimize the risk of the donor tissue transmitting disease to the recipient patient. As with any processed donor tissue, ALLODERM SELECT™ RTM is not guaranteed to be free of all pathogens. No long-term studies have been conducted to evaluate the carcinogenic or mutagenic potential or reproductive impact of the clinical application of ALLODERM SELECT™ RTM.

DO NOT re-sterilize ALLODERM SELECT™ RTM. DO NOT reuse once the tissue graft has been removed from the packaging and/or is in contact with a patient. Discard all open and unused portions of the product in accordance with standard medical practice and institutional protocols for disposal of human tissue. Once a package or container seal has been compromised, the tissue shall be either transplanted, if appropriate, or otherwise discarded. DO NOT use if the foil pouch is opened or damaged.

DO NOT use if the seal is broken or compromised. DO NOT use if the temperature monitoring device does not display “OK.” DO NOT use after the expiration date noted on the label. Transfer ALLODERM SELECT™ RTM from the foil pouch aseptically. DO NOT place the foil pouch in the sterile field.

PRECAUTIONS Poor general medical condition or any pathology that would limit the blood supply and compromise healing should be considered when selecting patients for implanting ALLODERM SELECT™ RTM as such conditions may compromise successful clinical outcome. Whenever clinical circumstances require implantation in a site that is contaminated or infected, appropriate local and/or systemic anti-infective measures should be taken.

ALLODERM™ and its design are trademarks of LifeCell Corporation, an AbbVie company. © 2021 AbbVie. All rights reserved. ALS148048 07/21

22

December 2021

Experience.

It’s what AlloDerm RTM is made of. ™

With 2.5 million implantations and over 25 years on the market, know that your patients will receive the safety and quality you expect from AlloDerm™ RTM—the industry leader.1-4 Thank you for continuing to choose AlloDerm™ RTM.

ALLODERM SELECT™ RTM has a distinct basement membrane (upper) and dermal surface (lower). When applied as an implant, it is recommended that the dermal side be placed against the most vascular tissue. Soak the tissue for a minimum of 2 minutes using a sterile basin and room temperature sterile saline or room temperature sterile lactated Ringer’s solution to cover the tissue.

If any hair is visible, remove using aseptic technique before implantation.

ALLODERM SELECT™ RTM should be hydrated and moist when the package is opened. DO NOT use if this product is dry. Use of this product is limited to specific health professionals (e.g., physicians, dentists, and/or podiatrists). Certain considerations should be made to reduce the risk of adverse events when performing surgical procedures using a tissue graft. Please see the Instructions for Use (IFU) for more information on patient/product selection and surgical procedures involving tissue implantation before using ALLODERM SELECT™ RTM.

ALLODERM SELECT™ RTM is available by prescription only.

For more information, please see the Instructions for Use (IFU) for ALLODERM SELECT™ RTM available at www.allergan.com/AlloDermIFU or call 1.800.678.1605.

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ADVERSE EVENTS The most commonly reported adverse events associated with the implant of a tissue graft include, but are not limited to the following: wound or systemic infection; seroma; dehiscence; hypersensitive, allergic or other immune response; and sloughing or failure of the graft.

References: 1. Data on file, Allergan. 2018; Number of AlloDerm™ RTM Units Sold. 2. Wainwright DJ. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns.

Burns. 1995;21(4):243-248. 3. Data on file, Allergan Aesthetics; May 2021; Plastic Surgery Aesthetic Monthly Tracker. 4. Data on file, Allergan Aesthetics; Search Performed on PubMed in June 2021.

December 2021

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PSRC/PSF Research Grant

Reprogramming tissue to develop lymphedema treatment on the live animals. Fortunately, we’ve been able to stay on track.

By Jim Leonardo

Editor’s note: The following is part of an ongoing series highlighting The PSF Research Grant Award winners, and research they’re conducting to improve patient safety and develop new technologies for plastic surgeons. These features examine research funding awarded prior to the current year, as projects to which grants were awarded this year may not yet have results ready to discuss.

THE RESEARCHER

FOCUS ON PLASTIC SURGERY RESEARCH

Al Hassanein, MD, MMSc Title: Assistant Professor, Division of Plastic Surgery, Indiana University School of Medicine Award: PSRC/PSF Research Grant Project: Inducible Lymphovenous Shunts Using Tissue Nanotransfection Technology PSN: How can tissue nanotransfection technology can impact or treat lymphedema?

Dr. Hassanein: Lymphedema is a challenging problem characterized by chronic limb swelling. It commonly occurs after breast cancer treatment and affects 30 percent of patients who undergo lymph node dissection and radiation during their treatment. Although there are surgical techniques that can improve lymphedema, there’s currently no cure. We’re trying a novel approach for lymphedema to attempt to induce lymphovenous shunts similar to a microsurgical lymphovenous bypass currently used to treat lymphedema. We’re using a tissue nanotransfection technology (TNT) to focally deliver genetic cargo in the murine tail model of lymphedema. TNT was developed by Chandan Sen, PhD – my mentor at Indiana University – as a non-viral, platform technology for point-of-care tissue reprogramming. We’re adapting this for a lymphedema treatment application.

PSN: How far along are you in your research?

Dr. Hassanein: We’re making good progress despite the challenges triggered by the

(Clockwise from top) Dr. Hassanein with The PSF immediate-past President Gayle Gordillo, MD (second from left), her daughter, Kristen, and Greg Borschel, MD (second from right), during the American Association of Plastic Surgeons meeting in May; flanked by Alex Wong, MD (left), and Brian Gastman, MD, as they moderate a scientific session during the 2019 Plastic Surgery Research Council meeting in Baltimore; and in Indianapolis with his sons Miles (left) and Beckett, and his wife, Kourtney.

COVID-19 pandemic. We’ve set up the mice tail model in the lab, created ideal ways to visualize the mouse tail lymphatic changes – including a live-animal intravital microscopy – and have optimized TNT delivery in the model.

We learned a great deal about how much was taken for granted prior to COVID-19. Fortunately, we have an extremely dedicated team, so despite these challenges we safely navigated the project forward.

PSN: What do you see as the practical applicability of TNT delivery?

Dr. Hassanein: Lymphovenous anastomosis is a microsurgical technique performed in patients with lymphedema and involves bypassing the dysfunctional lymphatic system directly into the venous system at multiple locations on the limb to decompress the lymphatic system. Physiology, the lymphatic system ultimately brings the lymph back into the venous system, so a lymphovenous bypass gets the lymph there earlier. However, it’s

time consuming and technically challenging – the lymphatic vessels are extremely small and require “supermicrosurgery” techniques.

High magnification microscopes, specialized instruments and indocyanine green-imaging systems are needed for the procedure, which takes hours in the O.R. Our goal is focally delivering therapeutic genetic cargo to affected lymphedema areas using TNT to induce multiple lymphovenous shunts that would function like microsurgical lymphovenous bypasses. TNT avoids the need for viral vectors for gene delivery and makes treatment to focal, non-global areas feasible. This makes it more potentially clinically applicable.

PSN: Has anything unexpected surfaced?

Dr. Hassanein: The biggest, unexpected issues were mostly related to the pandemic. Science always throws curveballs. There were certainly other non-COVID-related challenges, such as optimizing TNT delivery in the model and practically performing intravital microscopy

SAVE THE DATE Feb. 25 - 26, 2022 A Virtual Event The ASPS Plastic Surgery Coding Workshop provides attendees with the most up-to-date coding information and specialty specific instruction. This comprehensive two-day learning program is a live, online interactive meeting.

Blended instruction with live and on-demand modules allows the newest coding professionals and those with more experience to learn accurate coding and implementation strategies from experts in the field while minimizing risks, costs of travel and time commitment.

This is the only ASPS Coding Workshop in 2022 and it will not be recorded. Don’t miss out! Make plans to join us virtually on Feb. 25-26!

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PSN: Who are your key collaborators on this project?

Dr. Hassanein: Dr. Sen, our vice chair (Research) in the Department of Surgery at Indiana University and director of the Indiana Center for Regenerative Medicine, has been a great mentor on this project. His TNT has numerous applications for tissue reprogramming and gene delivery. It has been exciting to be able to apply the technology to treat lymphedema, a difficult problem that affects so many people. Mithun Sinha, PhD, who’s also faculty in our plastic surgery division, has been a very close collaborator and has helped drive this project.

The PSF immediate-past President Gayle Gordillo, MD, our plastic surgery division chief at Indiana University, has been extremely supportive of the project and has facilitated it.

I spent two years in the lab of Arin Greene, MD, during my general residency and trained with him during my plastic surgery residency at Harvard University. He first introduced me to lymphedema and has continued to mentor me throughout my training and career. We also have a post-doc Ganesh Mohan, PhD, who has been instrumental.

PSN: What did you want to be when you were growing up?

Dr. Hassanein: I wanted to be a basketball player. I loved basketball growing up and played all the time. I was waiting for a big growth spurt, but I topped out at 5’10”. I played basketball in high school in the suburbs of Chicago. When I arrived at college at the University of Illinois, I played pickup ball in the gym and my dreams of trying to one day walk on that Big Ten team were crushed.

Fortunately, I’m tall enough for medicine.

PSN: What has been your favorite science project – with the exception of The PSF research?

Dr. Hassanein: I really enjoyed my time as a research Fellow with Dr. Greene. We used a rabbit model for cranioplasty and showed how well particulate bone grafts worked to ossify cranial defects. Particulate bone graft is used worldwide now and has helped a lot of patients.

PSN: How do you spend your time away from work?

Dr. Hassanein: My wife, Kourtney, and I have twin 6-year-old boys and trying to keep up with them takes up most of my time at home. Outside of work, my time is spent watching them play baseball, basketball and soccer. We live very close to a trail in the Indianapolis area called the Monon and spend a lot of time there riding our bikes.

PSN: What sounds are most commonly heard in your O.R? Dr. Hassanein: I like all kinds of music.

Overall, my favorite music is 1990s alternative rock, blues and jazz. However, I mostly listen to Top 40s in the O.R., since the music is up-tempo and universally tolerated by almost everyone in the O.R. However, I get made fun of a lot for that by the residents and lose cool points.

For more information about the many research studies funded by The PSF or to support our current and future research initiatives, please go to ThePSF.org. PSN December 2021

Back in action

By PSN staff

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or the first time since September 2019 and the onset of the COVID-19 pandemic in March 2020, ASPS returned to an in-person meeting in October – and thanks to a hybrid format that encouraged and facilitated virtual engagement for those who couldn’t attend in person, Plastic Surgery The Meeting 2021 in Atlanta proved to be another record-breaking event for the Society.

“It was great to be back in-person again,” says ASPS immediate-past President Joseph Losee, MD. “It was a successful and positive experience from every angle and I’m completely happy with the way it turned out.”

Plastic Surgery The Meeting 2021, sponsored by Allergan Aesthetics, an AbbVie company; Mentor Worldwide LLC; 3M Health Care; MTF Biologics; Stryker; and Galderma boasted the largest number of registrants to date at 3,691 – 2,420 of whom attended in person, and 1,271 tuning in virtually. With more than 100 live sessions, 50 on-demand presentations and 75 hours of CME provided – not to mention more than 300 on-demand abstracts available – the educational component of the Society’s annual meeting more than lived up to the high standards set in years past.

“With the hybrid and on-demand format, it was possible to see almost every educational session,” says ASPS/PSF Vice President of Education Scott Hollenbeck, MD, who added that December 2021

the in-person ingredient is an invaluable part of the annual meeting’s magic. “I had almost forgotten how meaningful it is to see friends and colleagues in person and exchange stories about career and life experiences. These interactions, which often occur in the hallways and at the social events, are of great value and create a sense of community within our specialty. It was really nice to have that back again.”

Patients of Courage This year’s Opening Ceremonies, sponsored

by CareCredit, poked a bit of fun at the Zoom meetings so many members became accustomed to over the past 20 months. The extended video skit featured connectivity issues, kids and spouses vying for attention in the background, exaggerated outdoor noise, Dr. Hollenbeck having to insist that he is “not a cat,” and other Society leaders playing up the various technical glitches that defined the past year and a half. After lamenting that he was sick of virtual meetings, and that he wished “we could meet in person,” Dr. Losee emerged on stage in a shirt, tie and sport jacket – along with torn-up board shorts and flip flops.

“What are you wearing?” The PSF immediate-past President Gayle Gordillo, MD, asked him. “This isn’t a Zoom call.”

The lighthearted beginning to Opening Ceremonies drew strong laughs from the attendees, but as usual, the Patients of Courage: Triumph Over Adversity Awards program proved to be a highlight. Since 2003, ASPS has honored more than 50 reconstructive plastic surgery patients through the program, which commemorates the bravery and charitable actions of three courageous patients whose lives have been changed or saved through reconstructive surgery.

Jada Monet Idokogi was diagnosed with juvenile polymyositis at age 14, which resulted in her suffering from severe calcinosis cutis that affected her abdomen, back, arms and thighs. She underwent extensive excision of all areas of calcinosis through an extensive process that required more than 10 surgical procedures. Jada earned a Bachelor of Science in mathematics at the University of Maryland while undergoing experimental, high-dose cyclophosphamide chemotherapy as an inpatient. During her recovery, Jada moved to Houston to pursue her graduate degree, earning a PhD in biostatistics in 2020. Throughout her treatment, Jada remained positive in the face of numerous challenges posed by both the disease and multiple surgical procedures. Now 29, Jada is an inspiring example of perseverance through both her academic achievements and defying the poor survival

odds she initially received from her doctors.

Jen Rozenbaum was diagnosed with breast cancer in 2017 at age 41. Her treatment included bilateral mastectomies, staged expander-implant reconstruction and chemotherapy.

Following her diagnosis, Jen dedicated herself to providing information and emotional support to women both newly diagnosed and those undergoing cancer treatment. As a professional portrait and boudoir photographer, she turned to photography during her chemotherapy treatments as a tool for healing emotionally and began photographing women who had undergone breast cancer surgery.

Now with more than 30,000 Instagram followers, Jen shares images of women after mastectomy and reconstruction to normalize breast cancer bodies and provide an accurate portrayal of recovery. She launched her podcast “Shamelessly Feminine” in 2018 while recovering from breast reconstruction, then published a book in 2020 to share her breast cancer journey. Her photography remains a pivotal platform to help heal and empower those touched by breast cancer.

“When Ron Israeli, MD, mentioned nominating me, I was so humbled,” Jen tells PSN. “Taking photos and making videos throughout my journey gave my disease purpose. It allowed me to stay positive and believe that I’m helping others.”

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Marc Buoniconti, son of the late NFL Hall of Fame linebacker Nick Buoniconti, suffered a severe spinal cord injury in 1985 while making a tackle for the Division I Citadel Bulldogs college football team. The injury left the young athlete paralyzed, rendering him a quadriplegic. However, Marc used the injury as a point of inspiration, and his family and Barth Green, MD, co-founded The Miami Project to Cure Paralysis, which has produced some of the nation’s most notable medical research and multiple breakthroughs in the management and treatment of spinal cord injury. As he struggled to wean himself from a ventilator after his injury, Marc committed his energy to raising funds for The Miami Project. He eventually returned full-time to the University of Miami, making the Dean’s List and graduating in 1993 with a degree in psychology.

Now 54, Marc serves as president for The Miami Project. He undertook a vigorous campaign, championing the message that paralysis “does not have to be forever.” Marc, who underwent reconstructive surgery in 2020 for his first pressure ulcer, says his mission is to help people walk again and get everyone out of wheelchairs. To reach that goal, his family formed The Buoniconti Fund, which has raised more than $500 million in support of The Miami Project’s research programs.

“Marc truly believes that paralysis is not forever, and that through research a cure will be discovered,” says ASPS member Devinder Singh, MD. “Plastic surgeons are commonly called into action for complex wounds, and that’s precisely what was keeping Marc in the hospital for four months,” he adds. “When I was consulted for a large perineal/ischial ulcer, I recommended a muscle flap transfer, which was very successful and helped him heal. Having Marc get out of the hospital was great, but letting him return to his important mission was even better.”

Each of the patients were recognized by their nominating surgeons: Jason R. Bailey, MD, who treated Jada; Dr. Israeli, who treated Jen Rozenbaum; and Michael Plastini MD, who along with Dr. Singh treated Marc Buoniconti.

New inductees to Maliniac Circle The 2021 inductees into the Maliniac Circle, a philanthropic designation reserved for plastic surgeons who give back to the specialty through $100,000 deferred-gift commit-

ments or contributions of $50,000 or more via cash or appreciated securities, were also recognized during Opening Ceremonies. The newest Maliniac Circle members are: • John Gatti, MD, and Margaret Gatti, Esq. • Gayle Gordillo, MD • Dan Hatef, MD, and Lynsi Hatef • John Osborn, MD, and Katie Osborn, MD • Geoffrey Sisk, MD, and Lauren Sisk

ASPS President’s Panel The ASPS President’s Panel, “Our Role in the Future of Breast Surgery: Do We Have One?” was sparked by a recent meeting of a state plastic surgery society that had an ACS endorsement.

“They were going to engage in a successful model of single-surgeon oncoplastic surgery and train general surgeons how to do mastectomy and other breast surgeries,” Dr. Losee noted during the panel. “The American Society of Breast Surgeons (ASBS) accredits oncoplastic surgeons, general surgeons, (after) five mastopexies – general surgeons are being credentialed in hospitals to do breast augmentation, implant reconstruction, mastectomies and reductions.”

In response, Dr. Losee helped assemble a group that included ASPS and its sister societies to send the ACS a white paper on the issue. The PSF past President Linda Phillips, MD, an ACS Board of Regents member and UTMB-Galveston Division of Plastic Surgery chief, told the group that she’s been active in bringing the issue to the ACS board.

“I’m taking on specialty engagement and I’ll get together with other specialties,” she said. “There’s practice creep in other areas, and we can build upon this synergy to make sure we’re protecting the safety of our patients.”

ASPS past President Jeffrey Janis, MD, another member of the panel, remarked that there was proposed panel at an ACS meeting two years ago that was to be called, “No Plastic Surgeon, No Problem.”

“The fact the title got so far down the line is a great reason why we’re here now,” he said, adding that the title was ultimately changed.

When asked by Dr. Losee whether ASPS members should be on these teaching panels, Dr. Janis said plastic surgeons shouldn’t isolate themselves – but they need to ram home the importance of board certification.

“It’s in our DNA to collaborate with others,” Dr. Janis said. “We’re the last true general surgeons, and we help other specialties achieve

Close the Loop 5K raises more than $82,000

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ore than 200 participants took part – either in person or virtually – in the 2021 Close the Loop 5K, which was held during Plastic Surgery The Meeting in Atlanta. The participants raised more than $82,000 in supporting The PSF’s breast reconstruction awareness efforts.

A complete list of top finishers is available at p2p.onecause.com/bra5k – and virtual participants can still enter their time to see how you stack up against the competition.

The PSF remains committed to reaching its targeted fundraising goal of $100,000 for this year’s efforts, and donations will continue to be accepted through Dec. 31. Proceeds support uninsured or underinsured women who choose to have breast reconstruction following a lumpectomy or mastectomy due to breast cancer.

• A donation of $250 will support transportation to/from medical appointments, medical garments worn during recovery and lymphedema treatment.

• A donation of $500 will support medication, supplies and clinic fees.

• A donation of $1,000 will support lost wages and child care during reconstruction and recovery.

The Breast Reconstruction Awareness Campaign is sponsored by ASPS and The PSF, and financially supported through corporations, institutions, private practices and individuals. This year’s sponsors of the Close the Loop 5K were Allergan Aesthetics, an AbbVie Company (Platinum), Stryker (Gold), along with Integra Foundation, MicroAire, Mentor and MTF Biologics (Silver). More information on The PSF’s Breast Reconstruction Awareness Campaign is available at thepsf.org/programs/breast-reconstruction-awareness-campaign. PSN

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better outcomes because we’re part of the care team. But we’re also not in the business of training our replacements, so where does one line end and the other begin? For many courses, you don’t know who’s in the audience and what their intent is when you give them the skills that they’re asking for – then they leave the ‘weekend course’ and go do what you’ve trained them for. We need to emphasize the skill set of a properly board-certified and trained plastic surgeon and their value to the multidisciplinary team.”

The panel also tackled the question of plastic surgeons missing out on being part of breast care because of a stronger interest in aesthetic procedures or work that provides better compensation. Dr. Janis cited recent data that suggested that while many zip codes throughout the United States don’t have plastic surgeons – leading breast surgeons to handle more procedures – there are cases where zip codes rich with plastic surgeons are also losing out.

“In one area, the division chief there lamented that even though plastic surgeons are right around the corner, many weren’t interested in doing this work,” he said.

So how can plastic surgeons who want to perform breast surgery redirect patient flow?

“We have to stand up locally,” Dr. Phillips said. The person in charge of an ACS course that questioned the need for plastic surgeons joined her institution’s faculty, and when she pursued privileges there, the request was rejected, leaving Dr. Phillips and another plastic surgeon in charge of all those cases – including call. “That means we’re always there, we’re making sure there’s coverage, so there’s not a single instance when we’re not there.”

The PSF past President Michael Neumeister, MD, chair of the Department of Surgery and the plastic surgery RRC at SIU Springfield, said that a build from division to department has many benefits for plastic surgery programs – budgeting not the least of them – but short of that, academic plastic surgeons should try to get a seat at the table however possible.

“This is going to be a slow process,” he acknowledged. “You need to show up at the multidisciplinary discussions about the patients. You need to be there talking about the cancer and treatment with radiology, and medical oncology and such, and show that you’re part of that team.”

Lisa Wu, MD, professor of surgery at the Hospital of the University of Pennsylvania,

as well as vice chair of clinical operations and microsurgery Fellowship director, was asked whether expanding scope of practice to become “the complete breast surgeon” made sense in this environment.

“Ultimately, what’s best for patients?” she asked, noting that she forged her own breast surgery training module over approximately 10 years. “In 2017, I did a non-accredited breast surgery oncologic Fellowship at my own institution with the idea of becoming a person who did it all. Can a plastic surgeon be a breast surgical oncologist? Yes: You can train in general surgery, do a plastic surgery Fellowship and join a hospital system that allows you to do oncologic breast surgery without a breast Fellowship. You can do an integrated plastic surgery Fellowship and a breast Fellowship, and practice surgical breast oncology.

“More important, should a plastic surgeon do it?” she added. “I truly believe this is the best thing for the patient – you have the benefit of thinking and seeing through breast oncologic eyes as well as aesthetic eyes.”

Dr. Janis said there’s little time to waste on deciding whether to forge a new path.

“We’re already seeing that we’re losing the mastopexies, reductions and augmentations through the symmetrizing procedures,” he said. “We’re not at the table. This is scope creep and we’re at a crossroads now: Are we going to put our flag in the ground and stake our claim, to say that we’re qualified to do this and more – or are we going to stick our head in the sand (and lament our losses)?”

The PSF President’s Panel The PSF President’s Panel, “What Has The PSF Done For Me?” celebrated the Foundation’s reach and depth as experienced by the four panelists invited by Dr. Gordillo, who embraced the dual role of moderator and respondent. She was joined by The PSF past President Paul Cederna, MD, University of Michigan professor of biomedical engineering and plastic surgery section chief; The PSF past President Andrea Pusic, MD, MHS, Brigham and Women’s Hospital plastic and reconstructive surgery chief and Patient-Reported Outcomes, Value and Experience Center director; and Indiana University Department of Surgery Assistant Professor Mithun Sinha, PhD. Dr. Gordillo referenced the movie “It’s a Wonderful Life” and the “what if?” scenario of George Bailey having never existed to illustrate the effectiveness of The PSF grants. As a young December 2021

faculty member, Dr. Gordillo wanted to cure hemangiomas and needed funding to conduct research, but she had no “track record” upon which to impress funding decision-makers.

“I got my first grant from The PSF, and that was hugely important,” she said. “It’s a badge of credibility; it says you can compete for funding nationally. That grant, which I got in the middle of my post-op Fellowship, helped me get my NIH grant. (Even a small grant) gives you credibility – that your specialty society thought you have potential.”

Dr. Gordillo used that and other small grants to gather enough preliminary data to receive a National Institutes of Health grant of $30,000 – and the subsequent research that resulted wouldn’t have been possible without the Foundation’s support.

Dr. Cederna noted that ASPS members are tasked, among other things, with giving back what’s lost through trauma or other conditions.

“We strive to do the impossible,” he said. “The PSF knows about firsts; it’s been investing in young scientists’ new ideas and novel concepts for years. Pilot grants are given every day, and they are for new ideas and innovations. That larger extramural funding is critical for the success of these larger project – and it can’t happen without that pilot data that The PSF helps provide.”

As a researcher who’s taken on several different roles and tasks as a plastic surgeon, Dr. Cederna’s current research mainly involves working with amputees to provide them with useful and viable artificial limbs via regenerative nerve peripheral interfaces – an important focus, as 180,000 people face new amputations each year, he said.

Dr. Pusic, who created the BREAST-Q, co-developed the Q-PROM and has been hugely influential in the development of several other patient-reported outcomes measures, told the audience that treating patients’ conditions is a major part of plastic surgery, but that they often need more.

“Early-on, everything we did was with the goal of saving lives; a lot has changed, particularly in plastic surgery,” she noted. “We’ve changed how we think about outcomes. If the goal is quality of life, only patients can tell us that.”

Dr. Pusic said she was one year into practice when she wanted to study differences in breast reduction techniques, as perceived by patients.

“There were no measures available,” she December 2021

recalled. “We wrote a The PSF grant for a PRO study, and they funded it. That was the beginning of a much longer story and a bigger journey.”

Although the outcomes measure story “is still being written,” the fact of the matter is that the plotline stems from The PSF and a paradigm shift in the way researchers think about and measure outcomes in plastic surgery.

Lecture highlights Plastic Surgery The Meeting included several lecture highlights, notably an in-depth dive on healthcare and the future of plastic surgery in the post-COVID world by Robert Pearl, MD, a Stanford University professor, bestselling author and former CEO of The Permanente Medical Group. William Magee Jr., DDS, MD, also delivered a lecture on love and leadership. Dr. Magee, who founded Operation Smile in 1982 with his wife, Kathleen, during the annual meeting became the first recipient of the newly created Noordhoff Award for his continued efforts in humanitarian work.

Foad Nahai, MD, Atlanta, discussed the many hats he’s worn over his years in the specialty – but none so important as that as mentor, he said during the Trustees Talk, “Where Would I Be Without My Mentors?” Dr. Nahai, past Maurice J. Jurkiewicz chair and professor of surgery at Emory University; editor-in-chief of Aesthetic Surgery Journal; and past president of the American Association for Accreditation of Ambulatory Surgical Facilities, American Society For Aesthetic Plastic Surgery and International Society of Plastic Surgeons; said he doubted that many plastic surgeons exist “who during our training and career haven’t benefited from the guidance of one or more mentors.”

Dr. Nahai said the mentoring he received spans three continents and began with his parents, Marcelle and Rouhoullah Nahai.

University of Bristol (England) Department of Medicine Chair Alan Earnest Alfred Read, MD, had the greatest influence on Dr. Nahai’s career, and he added that without Dr. Read, “I probably wouldn’t be on this podium today.” Dr. Read had encouraged Dr. Nahai’s relocation from Bristol to Baltimore, among other assistance, and though Baltimore didn’t work out to his satisfaction, Dr. Nahai kept working and eventually landed in Atlanta.

“I ended up at Grady Memorial Hospital,” where on the first day he met John Bostwick, MD, and future PSF President Stephen

Mathes, MD. “That day I decided: ‘This is going to be home; I’m going to be a plastic surgeon.’ ” Today he continues to practice in Atlanta with his son, Farzad.

Over the course of that career, Dr. Nahai has trained 100 residents at Emory University and 45 at other institutions.

“When one teaches, two learns,” he said.

“Where would I be without my mentors? I certainly wouldn’t be where I am today.”

Arun Gosain, MD, past president of ASMS and The PSF, delivered this year’s Kazanjian Lecture, “Caring for Children With Facial Anomalies – Inspiring the Next Generation to Follow in our Footsteps.” Presented biannually in honor of Varaztad Kazanjian, MD, an oral surgeon who rose to prominence during World War I and is widely considered the father of craniofacial plastic surgery, Kazanjian Lecture speakers are chosen by ASMS leadership for their enduring and/or innovative contributions to the craniomaxillofacial subspecialty of plastic surgery.

“What factors can be cultivated that will cultivate and retain interest in craniofacial pediatric plastic surgery among young people?” he asked, before assessing surgeon and patient needs and factors such as economic gain and service to humanity. Identifying a lack of interest in craniofacial surgery, Dr. Gosain asked what could be done to reverse that.

“At an individual level, start with mentorship,” he said, followed by building diversity in trainees as well as clinical innovation. From an institutional standpoint, plastic surgeons can highlight that pediatric craniofacial surgery is critical to the hospital’s mission, and nationally/internationally, a better focus could be brought to advocacy and the improvement of global health opportunities. “We need to maintain the continuity between the training period with our own mentors and with the mentees who’ve sought us out, and develop reciprocal mentorship relationships as those careers evolve.”

The 2021 Maliniac Lecture was delivered

by Bryan Mendelson, Melbourne, Australia, a past president of International Society of Aesthetic Plastic Surgery who’s certified by both the American Board of Surgery and American Board of Plastic Surgery, and renowned for his advancements in surgical anatomy of the face.

Dr. Mendelson’s address was relayed via video.

The ASPS Maliniac Lecture, named for the Warsaw-born founder of ASPS, Jacques Maliniac, MD, is delivered each year by a plastic surgeon based outside the United States and

who’s contributed significantly to the specialty.

Dr. Mendelson said his lecture, “Identity, Anatomy and Self-Esteem” was based in part on Dr. Maliniac’s influences, which were gathered by training in pre-war Paris and Berlin. The 1931 book by Jacques Joseph, MD, Rhinoplasty and Facial Plastic Surgery, influenced Dr. Maliniac, in particular that “a person whose looks caused social or economic disadvantage was as severely afflicted as a person who suffered from a debilitating disease.”

Dr. Mendelson highlighted small blepharoplasty procedures and the changes that resulted, emphasizing how small changes can have a disproportionate and positive benefit.

“A small change in facial proportion changes our perception, not just of someone’s looks but of the person’s personality,” he said.

Dr. Mendelson also recounted the story of a young man who lost considerable weight and wanted facial aesthetic procedures but arrived at clinic stooped over and wearing a hoodie. He almost didn’t operate on the man because of the way he appeared – the man had lost 100 kg on diet and exercise alone – and as a child with Tourette syndrome, he was mercilessly tormented. Dr. Mendelson said he performed the surgery, after which the patient and his parents were profoundly thankful and emotional.

“But I thought, ‘My God, to think that I wasn’t going to operate on him because I judged him like everybody else does: by the way he presented,’ ” Dr. Mendelson recalled. “Today, he’s a social worker in the United Kingdom.

Any one of you here could’ve done that; we’re in a very privileged position… it’s what you do for your patients that determines their quality of life – and nothing can replace that.

“I hope this session that Dr. Maliniac so kindly provided for all of us will open up your minds and appreciation for the opportunities the specialty of plastic surgery offers us,” he added.

Looking ahead to 2022 During the Closing Ceremonies, Plastic Surgery The Meeting bid adieu to Dr. Losee and Dr. Gordillo, making way for the formal introductions of 2022 ASPS President J. Peter Rubin, MD, MBA, and 2022 The PSF President Bernard T. Lee, MD, MBA, MPH. The new presidents are eager to assume the leadership roles and continue steering the organization to new heights in the year ahead.

Next year’s annual meeting will take place in Boston. PSN

Mount Sinai reclaims the Residents Bowl crown

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return to in-person programming at Plastic Surgery The Meeting 2021 paved the way for a return of the Residents Bowl trophy to Mount Sinai, as the New York team claimed its second title by defeating the University of Michigan. They secured their first trophy in 2019 during the last in-person meeting in San Diego.

“This year, we were really just hoping to make it past the first round,” says Jared Gopman, MD, who captained this year’s squad (which also included Paymon Sanati-Mehrizy, MD, Yasmina Zoghbi, MD, and Stefani Fontana, MD, PhD). “We just kept winning and winning.”

Dr. Gopman, the team’s lone link to the 2019 title, notes the experience in Atlanta was notably different compared to two years ago, when he was the youngest on the squad.

“A lot more pressure on me this year to take it home – but, thankfully, we were able to pull together as a team and everyone contributed,” he says. “We couldn’t have done this without the full team effort.”

This year’s Residents Bowl was the first time that organizers implemented a hybrid format, allowing some teams that were not physically in Atlanta to compete. Scoring followed a similar pattern to last year’s virtual event, with points accumulated for correct answers – even if the team wasn’t the first to buzz for the answer. There were some early upsets in this year’s competition, including last year’s champions, the University of Pittsburgh, getting bounced in the first round by Stony Brook University/Nassau University Medical Center.

ASPS/PSF Board Vice President of Research Peter Taub, MD, who’s Mount Sinai’s residency program director, says this year’s team started out as a “sleeper,” but he watched them gain confidence as the tournament progressed.

“With each victory, they realized a win was not out of the question and got stronger,” he says. “A big congratulations should be given to the strong Michigan team that advanced to the finals.”

Dr. Gopman says in his time at the program, he never saw Dr. Taub as excited as when the final match ended.

“It’s a good way to make your program director happy,” Dr. Gopman says.

This year’s premier sponsor for the competition was Allergan Aesthetics, an Abbvie Company. Mount Sinai will look to defend its title – and attempt to capture its third championship in four years – next year in Boston. PSN

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2021 ASPS president’s address

A career – and specialty – sustained by unity, pride and family The following is an edited version of the Opening Ceremonies address of 2021 ASPS President Joseph Losee, MD.

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s this year winds down, I find myself reflecting not only on our accomplishments, but also on larger themes that can sustain us in the years to come – particularly three important messages of unity, pride and family.

First, unity. If ever a president had a singular mission – a hope to accomplish – mine has been to foster greater unity within our specialty. ASPS must work across subspecialty divides and collaborate on the bigger issues, serving as the hub of the plastic surgery wheel.

Unity is critical because we face an existential crisis. Today, throughout Europe, gynecologists and general surgeons, in some countries, own reconstructive breast surgery.

We can find today, within our own borders, places where a successful model of single-surgeon oncoplastic surgery has already taken root in the United States. Today, general surgeons are being accredited by the American Society of Breast Surgery and credentialed by ASPS President Joseph Losee, MD hospitals to do breast reductions, mastopexies and reconstruction. they pivoted. Through education, they It’s naive to go on simply believing that expanded their own scope of practice and “just being better” will win in the long run. acquired the skills to save themselves from a When our colleagues in vascular surgery greatly diminished future. and neurosurgery faced a similar specialWe need to be proactive; pivot; and adapt. ty-changing threat posed by interventional We need to evolve our own scope of practice radiology and minimally invasive surgery, and become the complete breast surgeons.

Standing by and lamenting the fact that more non-plastic surgeons are performing reconstructive plastic surgery isn’t an effective solution. Hope is not a viable strategy.

The second message is one of pride. This month is Gay Pride Month in Atlanta, and as the first openly gay president of ASPS, I’m

proud to be in Atlanta with you, as members of a Society that has not only embraced diversity and inclusion, but also has put it at the forefront of how we move forward as an organization.

This year we launched the ASPS PRIDE Forum, and I’m proud to say that ASPS is purposefully supporting our LGBTQ+ plastic surgeons and patients as well. I want to specifically thank Allergan Aesthetics for partnering with ASPS on this initiative.

The third and final message is one of family. My husband, Franklyn, who is with us tonight, is an academic pediatric anesthesiologist. He has always driven home the message to our son, Hudson, who is 12 and also here with us, that love and relationships are the most important parts of life.

I believe that our relationships in medicine inoculate us against burnout. I’ve always said I don’t believe in work/life balance. I believe in work/life integration and how this supports wellbeing. The relationships with my work and home families are intertwined, and looking around this room is proof of that.

My wellbeing is sustained by my professional and personal family – and Franklyn and Hudson, you are the cornerstones of my wellness, the very best parts of me.

Finally, to you all, my work family, from the bottom of my heart, I thank you for the privilege of being your president this year. To our ever-working and devoted ASPS staff, I can’t thank you enough for making everything this year possible. PSN

2021 ASMS president’s address

Finding resolve when you’re confronted with the unexpected The following is an edited version of the Opening Ceremonies address of 2021 ASMS President Delora Mount, MD.

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ood evening and thanks for being here. I really mean it. Thanks for showing up – in person. Isn’t it great to physically be with your colleagues again?

In preparation for my address, I’ve pledged to not use the word “COVID” any further. We’ve heard this enough and its negative and devastating impact on the world.

What I would like to speak about is resilience and opportunity arising like a phoenix over the past two years. The term is “resolve” – resilience and action.

First, I would like to note the roles plastic surgeons have played in resolve and action.

This key characteristic unique to our specialty was seen in members such as ASMS immediate-past President Peter Taub, MD, who did shifts in the ICU at his hospital during the initial wave of the pandemic crisis in New York, to the step-up inclusion of plastic surgeons in the local ICU/ward coverage models. Plastic surgery residents performed life-saving and innovative coverage, and despite our specialty’s often narrowly identified expectations and critical care capabilities, we collectively stepped up.

Second, I would like to focus on the incredible innovations in pivoting plastic surgery education to virtual platforms, which allowed us to somewhat mitigate the heartbreaking cancellations of our ASMS in-person educational courses. These courses, which probably most of you attended at one point in your residency, teach the spectrum of basic to advanced craniomaxillofacial surgical techniques with hands-on focus.

Obviously, we had to put a hard-stop on

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ASMS President Delora Mount, MD these in-person courses, but with thoughtful and innovative pivots to virtual-education platforms, resident education in craniomaxillofacial surgery has continued – maybe even thrived with this opportunity.

The resolve we never realized existed to handle major changes in curriculum and create new ways of educational delivery demonstrates again how plastic surgeons were up for this challenge. I’d like to particularly congratulate Gaby Doumit, MD, our education chair, and every single member of the ASMS Education Committee for their talents, hard work and continuation of the mission of our organization.

Third, I would like to highlight this year’s ASMS achievement in publishing our own journal, FACE. Although the idea of this journal had been debated, planned, abandoned, researched and debated again,

it was ultimately resurrected just as the lockdown arrived. The journal, a collaboration between ASMS and the American Society of Craniofacial Surgeons, pivoted rapidly to select editors, associate and section editors, and content structure. I’m proud to say we published our inaugural issue during the peak of the pandemic, in summer of 2020.

I would like to particularly recognize John Van Aalst, MD, the editor-in-chief, and our various section editors. The fourth issue currently is in publication and the journal has already proven wildly successful in readership, click-throughs and content validity. At this trajectory, it’s in line for indexing soon.

Lastly, I would like to thank the ASMS Board and our gracious president-elect, Jack Yu, MD, for allowing me to serve an extra year as president. ASMS decided to forego the yearly succession protocol, as many of

the highlights of a presidential year – course attendance, visiting professorships and meetings – were tabled. Little did I know that I would also face a significant health crisis during this time, testing my own personal resolve. In fact, at this very moment last year – the actual date of the virtual meeting address – I was undergoing extensive spinal fusion surgery, and the unfortunate complications that arose from the procedure. This required me to dig deep, garner support from my community of plastic surgeons, both locally at the University of Wisconsin and around the world, and, ultimately, heal and thrive after a potentially career- and mobility-ending procedure.

I would especially thank my family; my son, Alex, and mom, Deloris, who moved in with me for several months to care for me, for your support. I would also like to thank my covering colleague, Catey Garland, MD, who kept our craniofacial practice afloat in my absence. To my community of ASMS members and staff who called, emailed and encouraged me from afar, I extend my deepest gratitude. I am thankful for recovery, I have a renewed purpose and resolve to return to craniofacial practice, and I’m thankful for the resilience I didn’t even know I had. Now I have the opportunity to share my story, in hopes that shining a light on the ergonomics of surgery and its effects on the surgeon can help another surgeon avoid this particular pathway.

I thank you all for the opportunity to serve as the ASMS president. It has been a pleasure serving as leader of such a talented, resilient and innovative group of plastic surgeons. May our collective plastic surgery innovation and resolve continue to make the world a better place. PSN December 2021

2021 The PSF president’s address

A journey traveled with friends, mentors – and unending inspiration The following is an edited version of the Opening Ceremonies address of 2021 The PSF President Gayle Gordillo, MD.

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s I stand here before you at the pinnacle of my career, I can tell you that I certainly didn’t get here on my own.

I want to acknowledge the people in plastic surgery who were instrumental in helping me along my journey to this point.

It started when I was an undergraduate at Stanford University. My biology lab partner, Dayna Arnstein, MD, had worked with Malcolm Lesavoy, MD, in Los Angeles as a high school student and earned a research position in the plastic surgery division at Stanford. I kept bugging her to get me job in the division because I really wanted to operate. That was 1982, when I met Michael Kulick, MD, a plastic surgery resident at the time. My job was to help him determine whether Motrin could decrease scar-tissue formation around breast implants that I put in rabbits or around flexor tendon repairs that I did in monkeys. Through that experience, I was hooked on science and plastic surgery. I met Bob Chase, MD, who would give me my grades for my research work – and the experience definitely helped me get into medical school. I also met Rod Hentz, MD, who happened to be the senior examiner with me the first time I was a guest examiner for the oral boards. Ironically, at one of the oral board exams about four years ago, I was the senior examiner and my guest examiner was Joe Rosen, MD, who I met as an undergraduate when he was a resident in the same class as Dr. Kulick.

After graduating from Stanford, I worked for two years at a non-profit hearing organization called Project Hear. My job was to develop a biosynthetic tympanic membrane prosthesis using bovine collagen (Zyderm from Collagen Corp). The surgical practice affiliated with Project Hear consisted of two ENT surgeons and a plastic surgeon by the name of Burt Brent, MD. I had the unbelievable privilege of going to the O.R. to watch him operate in person. When I was

The PSF President Gayle Gordillo, MD getting ready to leave for medical school, he was kind enough to write a letter to Ron Berggren, MD, the chief of the plastic surgery division at Ohio State University, to ask for his help in finding me a research project.

Since Dr. Berggren was stepping down, he gave the letter to Robert Ruberg, MD. I arrived in Columbus, Ohio, for medical school in 1986 – and knew I wanted to be a plastic surgeon. I met Dr. Ruberg shortly before starting medical school. He found a research position for me that summer and has been my mentor ever since. No one impacted my journey more than him. He guided me through medical school, residency and my career as a faculty member at Ohio State. He has been a role model as he also held many leadership positions within organized plastic surgery – and he’s always willing to use the privilege of his leadership to sponsor my professional development. He is a gentleman and a scholar – and although I’m a secular person, I like to say that Bob has been a blessing in my life.

Combining plastic surgery with science is my true passion and I hope my science will be my most lasting contribution to our specialty.

Two scientists I met at OSU were instrumental in my development: The first was Charley Orosz, MD, a transplant immunologist, with whom I did a three-year research Fellowship prior to starting my plastic surgery residency.

Charley was an incredibly thoughtful, creative mentor and teacher who helped me get my first NIH grant. The other is Chandan Sen, PhD. I joined the OSU faculty in 1999 and he joined in 2000 – and we have been research partners ever since. Over the ensuing years, Chandan and I, along with his wife, Sashwati Roy, PhD, MSc, MPhil, BSC, developed – through shared vision, mutual respect and complementary skill sets – a large research program in wound healing and regenerative medicine. Although the work is hard and there have been many challenges along the way, the science has been exhilarating.

The relationship I’ve with Chandan and Sashwati is incredibly special and based on a strong commitment to the overall research team. So much so that when I decided to leave Ohio State to take the position as chief of plastic surgery at Indiana University, the whole research team came with me. It’s truly one of the proudest accomplishments of my

life and the current $28 million funding portfolio speaks to the strength and success of the team and our shared vision.

When I put my professional journey into a broader context, I realize that none of this would have been possible – nor as richly rewarding – without the unconditional love and support of my parents, siblings and two children, Derek and Kristen, who are here with me tonight. Derek and Kristen, being your mom has been the most important job in my life – well beyond whatever I’ve done in plastic surgery. Thank you for tolerating my crazy efforts to balance my professional and personal life.

I’m going to tell you a story about plastic surgery that relates to you. When I was a senior resident attending this meeting, you were 2 and 3 years old. I went to the Women’s Plastic Surgeons luncheon and randomly asked many of the older women surgeons in the room if they had children and if those children were well-adjusted and successful. I never would have done any of this if those women hadn’t reassured me that I could contribute to plastic surgery and still raise my children into the thoughtful, wonderful people that you have become.

I feel a kinship and a debt of gratitude to those women and others who showed me that it’s possible to be a mother and a leader in plastic surgery. Women such as our previous presidents of The PSF, Mary McGrath, MD; Carolyn Kerrigan, MD, MHCDS; Linda Phillips, MD; and Andrea Pusic, MD, MHS; as well as other national leaders such as Susan Mackinnon, MD; Sheri Slezak, MD; and Anne Taylor, MD, MPH, who was also my classmate in medical school. All of you have been an inspiration to me. I would like to thank all the plastic surgery faculty, residents and staff that I have worked with at both Ohio State and Indiana University.

Finally, a shout out to William Kuzon, MD, and Warren Garner, MD, who provided mentorship over the course of my career. It has been an incredible journey and I’m excited to see what new adventures lie in the next phase of my career. PSN

Awards presented during Plastic Surgery The Meeting 2021

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he following ASPS/PSF awards were presented by ASPS President Joseph Losee, MD, The PSF President Gayle Gordillo, MD, and ASPS Trustee Nicholas Vedder, MD, during the Board of Directors dinner during Plastic Surgery The Meeting 2021 in Atlanta.

ASPS 2021 President’s Award: Lynn Jeffers, MD, MBA Dr. Losee: “Dr. Jeffers served as a White House presidential scholar and went into college, medical school, plastic surgery and earned an MBA – all at the University of Michigan.

When you review her CV, it’s a course in leadership.

And because leadership is service, the CV contains pages and pages of service to ASPS for more than 20 years. The Excel spreadsheet that documents her ASPS service has 236 distinct lines that detail her service and leadership to more than 46 different committees and task forces – including our Society’s highest office.”

ASPS 2021 Honorary Citation: Joseph Serletti, MD Dr. Losee: “Dr. Serletti’s name has become synonymous with free-tissue transfer, and his contributions to microsurgery have made free-tissue transfer an incredibly reproducible, predictable and routine operation. He’s recorded this experience in over 240 manuscripts, 26 book chapters and co-edited a textbook… He possesses the talent of identifying and mentoring future leaders in plastic surgery – over 30 years ago, he saw potential in a brand new, second-year medical student who was simply lucky enough to wind up in his O.R. Since that day, he has been my greatest advocate, mentor, advisor, coach and best friend.”

December 2021

ASPS 2021 Honorary Citation: W.P. Andrew Lee, MD Dr. Losee: “Dr. Lee’s contributions to the advancement of the specialty include being a founding father of a new field within plastic surgery: vascularized composite allotransplantation. He established several multidisciplinary programs for VCA, performed the first bilateral hand transplant, the first transhumeral transplant and the first total penis-scrotal transplant. He’s had numerous federal research grants, authored over 230 publications and 40 textbook chapters and co-edited a textbook. He’s been a friend and a mentor who I work to make proud – and try to be more like – every day.”

The PSF 2021 Lifetime Service Award: Robert Ruberg, MD Dr. Gordillo: “Another giant of plastic surgery, Joseph Murray, MD, once said: ‘Service to society is the rent we pay for living on this planet.’ If that’s the case, then I’m sure Dr. Ruberg has a big, big house. He has served in the specialty at the highest levels, but at the core, he’s a teacher. He’s beloved by the many residents he’s trained at Ohio State over the course of his distinguished career. I met Bob in 1986, just before I started medical school, and he’s been a role model and a mentor ever since.”

The PSF 2021 Distinguished Career Researcher Award: Andrea Pusic, MD, MHS Dr. Gordillo: “The impact of Dr. Pusic’s work is writ large across the field of plastic surgery. She’s been a thought leader in the registry space for plastic surgery, developing collaborative relationships with the FDA, breast implant manufacturers and other international plastic surgery organizations with the goal of mining the data within those registries. She’s now about to put a patient-reported outcomes tool within the National Breast Implant Registry to help all plastic surgeons better understand the patient experience of breast implants. Although her career is far from over, she’s already made a lasting impact on the specialty.”

ASPS 2021 Special Achievement Award: Luis Vasconez, MD Dr. Vedder: “Dr. Vasconez is known to all as a pioneer in reconstructive surgery. He has published well over 200 peer-reviewed articles and written four books. He has trained more than 70 plastic surgeons throughout the country, including many of the specialty’s leaders. He has been a mentor – either directly or indirectly – to countless more. He is truly a living legend. What plastic surgeon on earth does not know the famous ‘Law of Vasconez:’ ‘The only part of the flap that dies is the part that you need.’ Above all, he’s one of the kindest, humblest and warmest human beings you will ever encounter.” PSN

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Top resident abstracts honored at annual meeting

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n impressive number of scientific papers were submitted for consideration by resident authors from 19 different countries for the 2021 Plastic Surgery The Meeting Resident Abstract sessions. A total of more than 270 resident abstract presentations were accepted, of which the top 40 resident authors were invited to present their research during the live abstract sessions held in Atlanta on Friday, Oct. 29. Highly favorable reviews were received from those who attended the in-person sessions and from the moderators who facilitated the sessions.

The Scientific Program Committee was also pleased to provide the opportunity to accepted resident authors to submit their 5-minute pre-recorded presentation for inclusion in the On-Demand offerings as part of the Plastic Surgery The Meeting’s virtual platform. On-Demand presentations will be available for viewing until Nov. 30.

Moderators were volunteer members representing ACAPS, ASPS and YPS:

Aesthetic, Breast Reconstruction, Research Session

Aesthetic, Breast Reconstruction, Research Session: Amanda Silva MD; Jessica Suber, MD

Defining Our Terms: Are Post-Operative Complications Adequately Defined in the Rhinoplasty Literature?

Nicholas Oleck, MD Duke University Medical Center

Hand Session: Joshua Adkinson, MD; Alexander Spiess, MD Maxillofacial Session: Sanjay Naran, MD Recon/Burn/Microsurgery, Research Session: Sami Khan, MD; John Stranix, MD The following were honored as the outstanding resident presentations:

Hand Session The Effect of Flexor Digitorum Profundus Repair Position Relative to Camper’s Chiasm on Tendon Loads and Work of Flexion Eric Mitchell, MD Western University - Canada

Maxillofacial Session Maxillomandibular Development after Mandibular Distraction Osteogenesis in Isolated Pierre Robin Sequence Patients Kimiko Agari, MD University of Southern California / Children’s Hospital of Los Angeles

Reconstruction/Burn/ Microsurgery, Research Session Evaluating the Efficacy of Micro-Fragmented Adipose Tissue and Intra-Articular Corticosteroid Injections for Symptomatic Knee Osteoarthritis: A Randomized, Placebo Controlled Study. Preliminary Results Joshua Harrison, MD University of New Mexico

Outstanding paper and poster presentations of Plastic Surgery The Meeting 2021

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he following paper and poster presentations received honors during Plastic Surgery The Meeting 2021 in Atlanta.

Aesthetic

Session 1 (Tie) Developing the Aesthetic Postoperative Complication Score for Detecting Major Morbidity in Facial Aesthetic Surgery Jose Cataneo, MD Non-Surgical Correction of Congenital Ear Anomalies: A Critical Assessment of Caretaker Burdens and Aesthetic Outcomes Jacob Dinis, BS Session 2 Outcomes for Cosmetic and Reconstructive Surgeries of the Periorbital Complex from the “Tracking Operations and Outcomes for Plastic Surgeons” Database Jose Cataneo, MD Session 3 The Safety of Lipofilling in Calves Katarina Andjelkov, MD, PhD Session 4 Venous Tributaries of the Lip: Implications for Lip Filler Injections Amanda Moorefield, BA Session 5 The Role of Tranexamic Acid (TXA) in Plastic and Reconstructive Surgery: A National Perspective Stav Brown, MD Session 6 Hybrid Nasal Filler: Combining Different Structural Fillers Agarose Gel and HA for Non-Surgical Rhinoplasty Omer Buhsem, MD

Breast

Session 4 Utilizing a Federated EMR Network to Aid Pre-Operative Decision Making: Risk Stratification of 90-Day Surgical Site Outcomes by BMI for Autologous Breast Reconstruction Susan Taghioff, BS Session 5 Fat Graft Only Breast Reconstruction with and without Buried Dermato-Cutaneous Flaps: A Minimally Invasive Approach Boris Goldman, MD Session 6 Contralateral Prophylactic Mastectomy Practice and Insurance Policy Coverage in the US Michael Ha, MA, MB Session 7 Improving Gender Affirmation Surgery: Application of Negative Pressure Wound Therapy for Chest Masculinization with Free Nipple Grafts Areeg Abu El Hawa, BS Session 8 A National Review of Insurance Coverage of Noncancerous Breast Reconstruction Marissa Klein, BS Session 9 Oncoplastic Breast-Conserving Surgery Versus Lumpectomy: An Analysis of Surgical Complications and Oncological Outcomes in 633 Breast Cancer Patients Sadek Mowakket, MD(c), BHSc Session 10 Effects of Neoadjuvant Chemotherapy on Autologous and Implant-Based Breast Reconstruction: A Systematic Review and Meta-Analysis of the Literature Shayoni Nag, BA

Craniomaxillofacial

Session 1 Radiation Therapy and Breast Reconstruction: A Retrospective Analysis of Reoperation Rates Jiaxi Chen, MD

Session 1 Interfacility Transfer Guidelines for Isolated Craniomaxillofacial Trauma: A National, Multi-Disciplinary Expert Consensus Matthew Pontell, MD

Session 2 Acellular Dermal Matrix Modulation of the Peri-Prosthetic Breast Microenvironment during Breast Reconstruction Ruth Tevlin, MD

Session 2 Assessment of Intraoperative Transfusion and Blood Loss in Craniosynostosis Repair Patrick Chin, BS

Session 3 Mitigating the Risk of Breast Cancer? Analysis of Incidentally Found Proliferative Lesions in Oncoplastic Breast Reduction and Breast Reductions for Macromastia Kerry Morrison, MD

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Session 3 Proportions of Long-Term Explantations and Complications of Autologous Heterotopic Bone Graft Versus Alloplastic Cranioplasties: A Systematic Review and Meta-Analysis Michelle Oberoi, BS, BA

Session 4 Evolution of Perioperative Pathways in Cranial Vault Remodeling Meghan Brown, MD Session 5 Incidence of Orthognathic Surgery in Patients with Repaired Cleft Lip and Palate Laya Jacob, BS Session 6 Cross-Linguistic Speech Evaluation in Patients with Cleft Palate Jenna Stoehr, BA Session 7 Expanding Smartphone Follow-up after Patient Discharge from International Facial Reconstruction Collaborations in Ethiopia Daniel Bradley, BmedSci (Hons), BMBS, MRCS, BDS (Hons) Session 8 Secondary Reconstruction in Free Flap Failures in Head and Neck Cancers: A Critical Analyses to Surgical Decision-Making Samarth Gupta, MBBS, MS, MCh Session 9 A Single Institutional Review of Periauricular Vestiges and Renal Anomalies: The Role of Screening Renal Ultrasonography Carlotta Barbon, MD Session 10 The Role of 3D Scanning Technique in Accurate Evaluation of the Skin Surface Area of the Skin Deficiency and the Skin Acquired in Tissue Expander Reconstruction Patients Zequan Li, MD Session 11 Analysis of Referral Patterns for Patients with Craniofacial Skeletal Trauma and Concurrent Traumatic Brain Injury Christina Beck, MD

Hand

Session 1 Comparison of Relative Value Units and Operative Time in Hand Surgery Christopher Conlon, MD Session 2 Improving Nerve Coaptation Outcomes in Targeted Muscle Reinnervation: A Novel Bioengineered Device Erica Lee, MS Session 3 Psychosocial and Functional Impact of Finger Replantation Yannick Hoftiezer, MD

Migraine

Session 1 Microcomputed Analysis of Nerve Angioarchitecture after Combined

Stem Cell Delivery and Surgical Angiogenesis to Nerve Allograft Tiam Saffari, MD Session 2 How the Local Environment Induces Differential Gene Expression in Regenerating Nerves after Neurotmesis Kasey Wood, BS

Practice Management/ Surgical Pearls

Session 6 Perioperative Experiences of Transgender Adults Seeking Gender-Affirming Surgery: A Qualitative Interview Study Alan Makhoul, BA Session 7 Preopertive Anterolateral Thigh Flap Perforator Imaging: A Systematic Review and Meta-Analysis Reece Moore, BS

In-Vivo Elasticity of Human Skin Darren Abbas, MD Predicting Burn Surgical Candidacy Using Deep Learning on Photographic Images Samantha Huang, BS Session 8 Disparities in Telemedicine Literacy and Access in the United States Catherine Wu, BS

Session 1 The Opportunity Cost of Resident Involvement in Craniofacial Surgery: An Analysis of Relative Value Units Sumun Khetpal, MD

Session 8 An Analysis of 400 Sternal Wound Reconstructions at a Single Institution: Bacterial Pathogens Vary with Time Kevin Kuonqui, BA

Session 9 Electroceutical Technology Against Wound Microbial Biofilm Infection Nandini Ghosh, PhD

Session 2 Stick the Landing Page: Evaluating Diversity Promotion on Integrated Plastic Surgery Residency Program Websites and Instagram Accounts Waverley He, BA

Session 9 (Tie) Assessment of Financial Conflicts of Interest Related to the Use of Dermal Substitutes in Burn Management Jacob Radparvar, BS

Aesthetic Are Grafts Effective in Increasing Nasal Tip Projection? Comparing Columellar Strut Versus Septal Extension Grafts Taruni Kumar, BS

Session 3 Board Certification in Cosmetic Surgery: An Examination of Online Advertising Practices Shirley Chen, BS

Dog Bytes: Data on Canine-Inflicted Pediatric Injuries Christopher Kalmar, MD, MBA

Breast (Tie) The Impact of Autologous Versus Implant Based Breast Reconstruction on Body Mass Index in Breast Cancer Patients Eva Roy, BS

Session 4 Factors Affecting Female Plastic Surgeons’ Decision to Pursue and Maintain an Academic Career: A Qualitative Analysis Aditi Kanth, MD

Reconstructive

Session 1 Can Mentorship Shatter the Glass Ceiling in Academic Microsurgery?

A National Survey of Microsurgery Fellowship Trained Women in Academic Plastic Surgery Salma Abdou, MD Session 2 Severity of Fracture Pattern Is Associated with Reconstructive Outcome in Acute Traumatic Lower Extremity Free Flap Reconstruction Tyler Merceron, MD Session 3 Postoperative Outcomes after Penile Inversion Vaginoplasty: Prevention and Management of Rectal Injury Shane Morrison, MD, MS Session 4 Improved Physical Function and Pain Scores after Lower Extremity Osseointegrated Implant Placement: A Closer Look at Complications and Patient-Reported Outcomes Wooram Jung, MSc Session 5 Cryopreserved Allogeneic Adipose Improves Neo-Dermal and Epidermal Thickness After Burns Shawn Loder, MD

Research & Technology Session 1 Improving Fat Graft Retention with Micro/Nanobubbles In-Vivo Daniel Zaki, MS

Session 2 Poly-4-Hydroxybutyrate 3D-Printed Scaffold: A Novel Biocompatible, Biodegradable and Biologically-Derived Scaffold for Maintenance of Projection and Volume in Nipple Reconstruction Xue Dong, MD, PhD Session 3 Prediction Nipple-Areolar Complex Necrosis in Nipple Sparing Mastectomy with a Machine Learning Model Sterling Braun, MD Session 4 3D Printed Positioning Guide: A New Design in Virtual Surgical Planning of Craniosynostosis Surgical Correction Katelyn Lewis, BS Session 5 A Solution to Poorly Tolerated Lower Limb Amputations: Osseointegrated Prostheses Prove Cost Effective in the United States Grant Black, BA Session 6 Feasibility of Face ID Truedepth Cameras for Functional Monitoring of Facial Movements in Craniofacial Surgery Daniel Boczar, MD Session 7 (Tie) Standardizing Dimensionless Cutometer Parameters to Determine

Best Posters of PSTM

Host Biofilm Interaction in Breast Implant Illness Imran Khan, PhD Craniomaxillofacial Cleft Rhinoplasty: A Novel Flap for Correcting Alar Base Malposition Niki Patel, MS, BS Hand Upper Extremity Firearm Injuries in Pediatric Patients: An Analysis of Demographic Factors, Management, and Outcomes D. Spencer Nichols, BS Practice Management Composition of Governing Boards within Top-Grossing Hospitals: A Cross-Sectional Study Rami Paul Dibbs, BA Reconstructive (Tie) Delineating the Risk Factors of Venous Congestion: An Analysis of 455 DIEP Flaps with Radiographic Correlation Hao Huang, BS Immediate Lymphatic Reconstruction Drastically Lowers Lymphedema Incidence in Axillary and Inguinal Lymphadenectomy: A Systematic Review Taruni Kumar, BS Research & Technology 13-Cis Retinoic Acid Activates Regenerative Behavior of Primary Human Lymphatic Endothelial Cells Jerry Hsu, BS

December 2021

A record-setting Senior Residents Conference

A record-setting 141 senior residents and 26 faculty members participated in the 2021 Senior Residents Conference, hosted in Atlanta and planned by SRC Co-Chairs Paris Butler, MD, MPH; Sara Dickie, MD; and John Stranix, MD. More than 200 residents representing 19 countries submitted their research to the live and on-demand Resident Abstract sessions. The top-rated abstracts were presented in person at Plastic Surgery The Meeting 2021.

December 2021

PSTM: A YPS Perspective

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always look forward to reconnecting with colleagues and mentors from different parts of my career and training, as well as making new connections at Plastic Surgery The Meeting. It is a great venue to learn from the masters in almost every field of plastic surgery and learn new techniques and pearls that allow me to improve my practice.

This year, I was offered the opportunity to give back and contribute to the meeting – not only in the form of presentations, panels and committee work, but also in being able to provide mentorship to residents and students. It was an enlightening coalescence of how far I’ve come and how much further I need to go. As a YPS Steering Committee member, I felt honored to be a part of the movement to instill progressive change and diverse evolution to the plastic surgery community. At our YPS meeting, we were excited to expand on several opportunities for mentorship and diversity, including resident travel scholarships, PROPEL (a mentorship program pairing plastic surgeons at different stages of their careers), ROADMAP (a program to provide advice and resources for medical students interested in plastic surgery regardless of background), our first virtual medical student day and LIMITLESS, an initiative for women plastic surgeons composed of a leadership summit, podcast series and mentorship program.

It was also encouraging to see the passion and sincerity of our YPS and Women Plastic Surgeons Forum members at the luncheons and cocktail receptions, all of whom are dedicated to empowering each other and the next generation. Plastic Surgery The Meeting is truly a meeting of the minds, and it is inspiring to see that year after year, more and more of these “minds” are of different backgrounds, ethnicities, genders and perspectives.

– Cathy Tang, MD YPS Steering Committee Member YPS

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December 2021

December 2021

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ASPS welcomes newest members to its ranks The following surgeons joined ASPS on the October 2021 ballot for Active and lnternational membership. ASPS has a formal membership process which requires an application, letter of sponsorship, board certification, adherence to ethical standards and more. The Society extends a warm welcome to its new members.

FOR ACTIVE MEMBERSHIP Alabama

Prasanth Patcha, MD

Alberta, Canada Alan Harrop, MD

California

Gehaan D’Souza, MD Naina Tanya Judge, MD Hyuma Leland, MD Hubert Shih, MD Cathy Tang, MD, MS

Florida Paul Durand, MD

Georgia

Oladian Afolabi-Brown, MD Eugenia Page, MD

Illinois

Chad Purnell, MD Victor Stams, MD

Iowa Patrick Hawkes, MD

Kentucky Katherine Durnen, MD

Michigan

Trevor O’Brien, MD

Nevada

Joshua Goldman, MD

New Hampshire David Lee, MD

North Carolina Yemi Ogunleye, MD, MS

Ohio

Pennsylvania Avery Capone, MD

Quebec, Canada

Joshua Vorstenbosch, MD, PhD

Tennessee

Brinkley Sandvall, MD

Virginia

Tzujane Chen, MD James Economides, MD Munique Maia, MD Julia Stevenson, MD

Washington

Joseph Meyerson, MD

Wisconsin

Texas

Ember Ewings, MD

Pakistan

Switzerland

Kunj Desai, MD Courtney El-Zokm, MD

Ryan Schmucker, MD

FOR ACTIVE MILITARY MEMBERSHIP Arizona

Leland Webb, MD

Virginia

Erick Martell, MD

FOR INTERNATIONAL MEMBERSHIP

Argentina

Gonzalo Rueda Cangaro, MD Eugenio Chouhy, MD Fernando Crocco, MD Celeste Di Pietro, MD Carlos Jorrat, MD

Australia

Michael Kernohan, MRCS, MSc Eldon Mah, MD Jia Miin Yip, MBBS, PhD

Belgium Christophe De Roover, MD

Brazil

Croatia

Zlatko Vlajcic, MD, PhD

Nicos Mantas, MD Christian Popa, MD

Tito Cipollini, MD Eugenio Gandolfi, MD Elena Giardini, MD Michele Maruccia, MD Edoardo Raposio, MD, PhD Luigi Di Rosa, MD

Dominican Republic

Japan

Cyprus

Kemil Issa, MD

Germany

Ercan Cakmak, MD Dominik Von Lukowicz, MD Fabian Wolfrum, MD

Tiago Bodanese, MD Gustavo Gimenes, MD Mauricio De Maio, MD Renata Mariotto, MD Otavio Taugen, MD

Honduras

Chile

Jayanta Bain, MD Ved Prakash Cheruvu, MCh Ashish Davalbhakta, MS, MCh Rustom Ginwalla, MD Parag Sahasrabudhe, MBBS,

MS, MCh Aashish Sasidharan, MCh Amitabh Singh, MD, MCh

Valeria Arancibia, MD Veronica Pena Martinez, MD Eduardo Morales, MD Diana Sierra de Prince, MD Marco Rios, MD Carolina Salisbury, MD

China Chunyong Han, MD

Colombia

Laura Cala, MD Miguel Cardona, MD Milena Quintero Casadiego, MD

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Italy

Bety Patricia Ordonez Rubio, MD

India

Indonesia

Hartono Kartawijaya, MD

Israel

Noam Hai, MD Avry Raveh, MD

Masae Ishida, MD Kunitoshi Ninomiya, MD Osamu Nishizeki, MD Tadashi Nomura, MD Shunsuke Sakakibara, MD

Malaysia

Koh Khai Luen, MBBS, MS

Mexico

Iksolder Mosquera Aldana, MD Iliana Diaz Anguiano, MD Ubaldo Carpinteyro Espín, MD Antonio Ramos Garcia, MD Heriberto Garza De la Llave, MD Monica Haro Martinez, MD Gabriel Hernandez Nuno, MD

Netherlands

Gustavo Felix Koeijers, MD Franziska Lichtenegger, MD Marc Mureau, MD, PhD Dietmar Ulrich, MD, PhD

Norway

Hans Marius Solli-Nilsen, MD

Afzaal Bashir, MD, MS Bilal Khan, MD Tahir Shafi Khan, MD

Peru

Enrique Chau Ramos, MD

Philippines

Lourdes Josephine Angliongto Ramos, MD

Qatar

Graeme Glass, MBChB, PhD

Romania

Adrian Costenco, MD

Russia

Svetlana Gagarina

Vyacheslavovna, MD

Saudi Arabia Faisal Obeid, MD

South Korea Eon Rok Do, MD Ju Young Go, MD, PhD Hong Jin Kim, MD Kwang Sik Kook, MD Jeong Yeop Ryu, MD, PhD

Thomas Fischer, MD Dirk Schaefer, MD

Taiwan

Jian-Jr Lee, MD Jeng-Yee Lin, MD Yu-Te Lin, MD Yi-Chia Wu, MD

Thailand

Piya Rungruxsiri, MD

Turkey

Dicle Aksoyler, MD Sarper Yilmaz, MD

United Arab Emirates Anshu Mishra, MD

United Kingdom

Maria Del Carmen Miranda

Garces, MD, PhD Leong Hiew, MD Simon Mackey, FRCS T.K. Sankar, MD Vivek Sivarajan, MD, MBChB

Venezuela

Anna Maria de Abaffy

Steffens, MD

Spain

Jose Cordoba Campos, MD Juan Carlos Hijano Mir, MD

December 2021

CALENDAR For additional ASPS/PSF meeting information, visit the Meetings & Education page at www.plasticsurgery.org/meetings; e-mail registration@plasticsurgery.org; or call (800) 766-4955 / (847) 228-9900.

Dates, locations and program information are subject to change without notice.

DECEMB ER 9-12

Florida Plastic Surgery Forum Palm Beach, Fla. Contact: (435) 602-1326 Web: fsps.org

J AN UARY 2022 13-16

Facial and Rhinoplasty Symposium

4-6

2022 Spring Meeting Online Contact: (800) 766-4955 Web: plasticsurgery.org Directly provided by ASPS

10-11

Dallas Cosmetic Surgery and Medicine Meeting

Dallas Contact: (877) 809-7525 Web: dallasrhinoplastyandcosmeticmeeting.com Endorsed by ASPS

Las Vegas/Online Contact: (562) 799-2356 Web: meetings.theaestheticsociety.org

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AP RI L 2022

2nd Annual SESPRS and ISAPS Periorbital and Facial Symposium

9-12

Atlanta Contact: (435) 901-2544 Web: sesprs.org

San Diego Contact: (978) 927-8330 Web: meeting.aaps1921.org

28-30

13-June 8

37th Annual Atlanta Breast Surgery Symposium

ASPS In-Service Exam For Surgeons Online Contact: (800) 766-4955 Web: plasticsurgery.org/exams Directly provided by ASPS

CALENDAR

Atlanta Contact: (435) 901-2544 Web: sesprs.org

AAPS 2022 Centennial Meeting

20-24

FEB R UAR Y 2022 10-12

56th Annual Baker Gordon Educational Symposium Miami Contact: (305) 854-8828 Web: bakergordonsymposium.com Endorsed by ASPS

13-16

The Aesthetic Meeting 2022 San Diego Contact: (562) 799-2356 Web: surgery.org

20

The Rhinoplasty Society Annual Meeting 2022

San Diego Contact: (904) 786-1377 Web: rhinoplastysociety.org/meetings2022

WPS Retreat 2022

Tuczon, Ariz.

Contact: (800) 766-4955 Web: plasticsurgery.org Directly provided by ASPS

Mountain West Society of Plastic Surgeons Annual Meeting

There’s a group for everyone at ASPS; get involved today!

Snowbird, Utah Contact: (847) 228-3346 Web: mwsps.org Jointly provided by ASPS

25-26

Plastic Surgery Coding Workshop Online Contact: (800) 766-4955 Web: plasticsurgery.org Directly provided by ASPS

MAR CH 202 2 LEARN MORE: PlasticSurgery.org/For-Medical-Professionals/Community

December 2021

3-4

Ohio Valley Society of Plastic Surgeons 65th Annual Meeting

24-27

Did you know these special interest groups exist?

JUNE 2022

3

ASPS In-Service Exam For Residents Online Contact: (800) 766-4955 Web: plasticsurgery.org Directly provided by ASPS

Louisville Contact: (216) 375-5025 Web: ovsps.org

10-12

New England Society of Plastic and Reconstructive Surgeons Inc. 62nd Annual Meeting New Castle, N.H. Contact: (603) 880-4385 Web: neplasticsurgery.org

Please note that due to the ongoing COVID-19 pandemic, some scheduled meetings could yet be rescheduled, canceled or moved to an online-only format. The meeting dates and locations posted here reflect the information available at PSN press time. For the most upto-date information on a particular meeting, please visit the organization or corresponding meeting website – or contact the phone number provided.

35

PSN Presidents Forum Continued from page 7

ida city where work is done and I’ll see one patient a month with a problem that stems from a procedure they had there. It might be appropriate for us to develop general policies.

You shouldn’t let patients go if they’re not ready postoperatively. You need to take care of your patients, see them, follow up and treat complications.

Dr. Rubin: This is a much deeper problem than we all realize. Many of these facilities and practices are not credentialed. Patients tell us the only time they ever met a doctor was right before surgery, and the last time they saw the doctor was on the way to the O.R. Patients tell us they are counseled by these centers to go back home and go to the E.R. if there’s a complication – or find a local plastic surgeon to take care of them. In a lot of their business models, they recruit patients, have staff do all the counseling and hire surgeons literally as itinerant surgeons for the day. We must work with state regulators to address these issues.

challenge them successfully in court. When a group advocating for equivalency of a nonABMS cosmetic surgery board petitioned the Medical Board of California for “equivalency” of their certification with that of the ABPS, we joined the fight and the petition was denied.

Now, can we stop non-plastic surgeons from putting up billboards or advertising cosmetic practice? No. But where there’s infringement or blatant false advertising, we’ve been successful in fighting that.

Dr. Lee: Our advocacy team is working with the state societies’ boards to minimize those infringements. It’s hard to police, but we want to hear about it and work within our organization

talked about nurse practitioners doing liposuction. One of our members has done a lot of work with the Medical Board of California, and my recommendation was not only to put together a group, but a toolbox to share with our members across the country. We can include strategies for success in fighting non-plastic surgeons doing plastic surgery procedures – and we need to do this for truth-in-advertising as well.

Dr. Gangopadhyay: We see the changing demographics of our medical students, our residents and our Society. What measures will you take to improve diversity and leadership for women and minority members of

2021 PSN Presidents Forum Panelists

Dr. Gangopadhyay: How would you attempt to stop or limit practice from other non-plastic surgeons on our set of techniques and surgeries?

Dr. Lee: ASPS immediate-past President Joe Losee, MD, worked on this over the past year – his concern is that we’re going to lose breast reconstruction, which is happening in many parts of Europe. Oncoplastic surgery and implant reconstruction are clearly part of the specialty of plastic surgery, however, we are starting to see institutions provide privileges for these procedures to non-plastic surgeons, and even mastopexy and breast reductions.

Our leadership is working hard to prevent this from happening.

Dr. Rubin: It’s really an issue of working with other specialists further upstream in the process who are gatekeepers for the patients who enter the system. They’re embarking on vertical-integration plans, as a lot of big corporations do. To just say, “Well, we do it better” doesn’t cut it anymore. We need to be part of the multidisciplinary teams. We need to get upstream on a lot of these processes or they’re going to be gone. One area where we’re working aggressively is wound care. We’re making a concerted effort to shepherd good care and make sure we’re closely involved with wound-care centers and educating other providers who then know how to refer these patients to plastic surgeons downstream. We also have to assume more of a position to accept these patients on the front end when appropriate.

As a specialty, I’d like to see us take more leadership positions within health systems that are not specific to plastic surgeons. I’d love to see more plastic surgeons as surgical section chiefs for their hospitals. We hope to facilitate that by providing robust educational offerings in leadership development to our members and residents at all levels.

Dr. McFadden: How do you feel about those who violate truth in advertising? There are ethical violations all the time. I had a personal experience taking a facial plastic surgeon to court for advertising as a plastic surgeon. Do we have an obligation to our members to stop this behavior? Should we go after them legally?

Dr. Rubin: We must aggressively educate the public and continue to do that. Our ability to restrict the advertising of people who aren’t plastic surgeons is not broad-reaching. When someone is specifically using the ASPS logo or claiming they’re a board-certified plastic surgeon when they’re not, we chase them.

We write cease-and-desist letters and can

36

Camille Cash, MD

Noopur Gangopadhyay, MD

to limit this behavior. We have been successful in many states through this advocacy work and encourage our members to continue to work through these established channels.

Dr. Rubin: As I mentioned earlier, there are non-ABMS cosmetic boards with names that sound a lot like they could be an ABMS board. The distinction becomes confusing to patients.

Dr. Lee: When you look at their documentation, they have training that does not appear to be adequate for the complexity, depth and length of training. But for a non-physician, it could seem reasonable. This is where our advocacy team will continue to fight to represent our members as qualified plastic surgeons. But these issues need to be brought to our attention so that we can continue to protect our membership.

Dr. Cash: Is there is an opportunity for ASPS to engage with state societies and say, “Listen, this is what California has identified. This is what Texas is fighting for…” so they can know what to look for and how to respond?

Dr. Rubin: No question. In our Legislative Advocacy Committee meeting yesterday, we

Risal Djohan, MD

Thomas McFadden Jr., MD

ASPS to better represent the population in general?

Dr. Rubin: There’s a concerted effort at all levels of the Society. A lot of work has been done by ASPS/PSF Board Vice President of Membership Steve Williams, MD, on diversity and inclusion, and the Women Plastic Surgeons Forum has done great work in cultivating leaders. It’s bigger than ASPS. We need to be leaders and drivers, but it also has to be executed within our own institutions. At the University of Pittsburgh last year, we founded a diversity committee in our Department of Plastic Surgery led by Carolyn De La Cruz, MD. We made sure she was integrated into everything that we do in the department, and we set a goal to increase the number of underrepresented people in our resident candidate interview pool from 11 percent to 20 percent.

We’re talking about what ASPS can do to attract medical school students to become more interested in plastic surgery – because it’s not going to change until we change the demographics of the plastic surgery community.

Things are changing in a positive way. This table we are at today looks different than it did 25 years ago. We’re making progress; we just need to keep working harder.

Dr. McFadden: When we discuss the fact that there’s not enough diversity, I think what we do frequently is treat the symptom, but not the cause. People are choosing another career for some reason.

Dr. Lee: That’s an important point. We can predict what the world will look like in medicine based on our medical school class, as the majority of students are women. When we think about what our organization should look like in the future, we need to actively find leaders that can represent their constituency groups. We want to make the journey to leadership faster and more efficient, and identify people that are engaged so that we can shift them into those roles when they are ready.

Dr. McFadden: One component that’s never going to go away is that women have children – and that obviously impacts whether they choose a surgical career in any specialty. It adds another dimension to consider.

Dr. Cash: I’d point out that Paris Butler, MD, MPH, gave an excellent presentation about diversity and inclusion, and what the University of Pennsylvania has done strategically to increase underrepresented minorities across a number of specialties. He has excellent data that shows with their efforts to increase diversity, their scores are comparable across the board.

They’re not losing women or losing ground – and they’re not sacrificing excellence or academic achievement to achieve diversity. That’s so important for the members to understand, because when you hear “diversity,” some people immediately say: “We’re going to sacrifice our standards.” It’s frustrating. Many excellent candidates sometimes don’t get welcomed into this specialty or they get overlooked. Dr. Butler looked at where we lose these medicals students in the leaky pipeline of getting that representation from medical students into residents into faculty and full tenure positions and what can be done to stop that.

Dr. Lee: The environments that people practice in are different. In academic environments, we often have meetings at 6 a.m. or 7 p.m. and this is not ideal; many institutions are working to address this issue. That’s the time that you want to spend time with your children and family. We need to think about leadership development as well. How do we identify people that are seeking leadership opportunities and give them the tools and the environment to succeed? Our ASPS Essentials of Leadership program can help speed up this process. It is also important to identify mentors that can help promote and model what leadership should look like.

Dr. Rubin: Dr. Cash, your comment about the pipeline is so accurate. Our diversity committee in Pittsburgh has been researching this: Where do people fall out of the pipeline from medical schools? Big plastic surgery programs – Michigan, Pittsburgh, Harvard, UT Southwestern, etc. – will always have people exposed to and interested in plastic surgery. But there are so many talented candidates at medical schools without strong exposure to plastic surgery. We have to reach out to every medical school in the country and facilitate more exposure to plastic surgery.

To the point about making it more feasible for women to have children and a surgical career, there’s a lot of progress in that area.

Bernie and I are both directors for ABPS, so we’re involved with a lot of educational issues, and helping to facilitate favorable maternity and paternity leave; ensuring that you have facilities available for lactation; and that appropriate opportunities for childcare exist.

Dr. Cash: What’s the current RRC guidance for maternity leave?

December 2021

Dr. Gangopadhyay: The new recommendation is that those 12 weeks are leave – and they don’t need to lengthen their training.

You don’t have to stay an extra few months at the end of your training to finish which, historically, I believe a number of students were subjected to.

Dr. Hanson: Part of that may be on us to show residents and medical students they can do this. You can be in leadership, have an academic career, have private practice and have kids. If you’re considering having children during residency, you do get 12 weeks off – don’t let that be a hindrance.

Dr. Djohan: Significant advancements have been made by plastic surgeons in preventative care and treatment for patients with – or at risk for developing – lymphedema, in patients with breast cancer and other types of cancer requiring axillary/groin lymph node dissection. However, there are no specific CPT codes for such procedures and, therefore, reimbursements are sparse and/or unpredictable. Is there a coordinated plan by ASPS to address this?

Dr. Lee: From my experience in the coding area, there are advantages and pitfalls. Lymphatic surgery, unfortunately, is still considered experimental by many people, As an insurer, why would they go out of their way to create codes for experimental surgery? Even within the lymphatic community, there’s a lot of disagreement over the ideal course of treatment.

We need better science, data and papers – we need to demonstrate that this is not experimental and then we can move into lobbying for appropriate coding and reimbursement.

When DIEP flaps were becoming popular, there was disagreement in the plastic surgery community about whether this was the gold standard. In the same way, insurers felt like this was ”experimental” surgery. Fast forward to now, and the data exists and the environment has changed. Ideally, we want quality outcomes and accurate data and our organization will continue to work on developing coding to support this surgery, as well as any new innovative surgical procedures within our specialty.

Then, with the RUC process, determining the reimbursement for a new code can be very complicated and based on surveys that compare complexity of procedures. Fluctuations in reimbursement can be drastic and our Society will continue to work to represent our members in these discussions.

Dr. Rubin: CMS RUC is a zero-sum game.

If you put in a new code and assign work value to that code – say, 12 RVUs or 20 RVUs – those RVUs have to be pulled back from somewhere else to keep the system level.

Having specific codes does not necessarily guarantee that the work will be valued appropriately – and we have to keep that in mind as we pursue new codes. Our health policy teams work very hard to address these issues on behalf of our members.

Dr. Lee: As an organization, this is high priority. Is it higher than other areas within plastic surgery, like fighting fat-grafting codes? This is where we must figure out what staff resources exist – because if we’re talking about a narrow procedure versus fat grafting, which affects thousands of members, it’s a different conversation.

these decreases – and every medical and surgical specialty is going through it.

Dr. Lee: We work with ACS and the Surgical Care Coalition. There are areas in surgery that are affected disproportionately, and some much higher than others. Many of these moves occur at a very slow pace in D.C. Our goal is to help set Medicare and Medicaid rates and hope that private insurers follow.

Dr. Rubin: This is one of the reasons that employed physician models are becoming more popular. In some settings, the only way that we can keep our advanced reconstructive services running is through hospital support.

By employing physicians, the hospital can run a breast reconstruction service and integrated breast cancer service, and plastic surgeons are part of that. They’re paid appropriately based on the work they’re doing.

Dr. McFadden: What strategies do we have

to enhance the viability of private practice?

Physician reimbursement is less than what it should be or has been.

cacy summit and organized events. The more people that are part of the conversation, the more they will have to listen.

Dr. Rubin: That’s part of the legislative fight.

As a Society, we do not advocate a specific practice model. The majority of our members are in private practice and we want to support everybody.

Dr. Hanson: Would you like to provide any closing remarks?

Dr. Lee: As you’ve seen with the COVID relief bills, many hospitals did well, but how much came back to the individual physicians?

We need to explore ways to improve the viability of solo practice, because that’s the majority of our membership.

Talking to politicians can be tricky and our team at ASPS is well versed in how to align interests. There are specific issues we are trying to fight for – including physician reimbursement – and we continually have to push to get those across. I would encourage more members to get involved in our advo-

Dr. Rubin: I thank each of you so much for being here and for these thoughtful questions.

I encourage you to continue to work with us.

We work for you. We’re here to serve the membership. Please keep the information flowing.

Everything we discussed today is a high priority.

Dr. Lee: We are working on a lot of key initiatives that people may not know about, and we are trying to enhance our messaging and communication. The importance of forums like this is that we can take issues back to the group and say, “These are the high-priority items that we’re hearing from our membership.” As a leadership team, we will use that information, roll up our sleeves and get to work. PSN

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Dr. McFadden: As we’re all aware, reimbursements go down every year. CMS is the primary driver and it seems that private insurance companies follow suit shortly thereafter. Do we have any specific thoughts or strategies to counter this?

Dr. Rubin: This is a perennial fight. We do a lot of advocacy work in Washington fighting December 2021

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CLASSIFIEDS

OPPORTUNITIES

San Francisco-Excellent Practice Opportunity Elegant, new, beautiful large office in modern non-medical building in best location of Nob Hill SF. Successful surgeon in transition. All overhead is fully managed and paid. You can easily customize scope and time in practice. Immediate income from direct referral and database. Own your own practice however you want to configure it.

Contact Helendaniellmpc@gmail.com.

Plastic Surgery Opportunity - Midwest Location Well-established, well-rounded, private practice with Midwest location (Iowa/Illinois).

Competitive salary with both cosmetic and reconstructive variety with excellent quality of life. Accredited in-office OR suite.

On-campus multi-specialty surgicenter with buy-in potential; associateship with early partnership potential. E-mail your resume to psc@plasticsurgeryqc.com or fax (563) 359-4781.

Board Certified/Board Eligible Plastic Surgeon & Microsurgeon Extremely busy, cutting-edge microsurgical breast reconstruction practice seeking to expand its team. Fellowship training and/or extensive experience in microsurgery is a must. Practice performs over 700 perforator flaps per year as well as the full spectrum of breast procedures, lymphedema surgery and cosmetic surgery.

Competitive salary with partnership track.

Located in San Antonio, Texas.

Please email CV to: Practice Administrator HR@prmaplasticsurgery.com

38

Plastic Surgeon - Microsurgery Opportunity at Geisinger in Pennsylvania At Geisinger, our established plastic surgery team works with advanced practitioners, specialty staff, and collaborates with peers and other multidisciplinary providers. Microsurgery experience or fellowship training and be adept at performing these cases including autologous breast reconstruction.

Grow your career by joining our established, innovative team: • Provide a broad range of services including general plastic surgery, cosmetic surgery (breast augmentation, breast lift, abdominoplasty, body contouring, face lift, liposuction, eyelid lift, brow lift), microsurgical and implant-based breast reconstruction, maxillofacial trauma, and cancer/trauma reconstruction.

• Participate in teaching, research, and program development - newly integrated Residency program • Benefit from an established reconstructive and cosmetic referral base, generated from Geisinger and outside/private practice physicians and surgeons Please reach out to Christian Kauffman, MD, Chair Plastic Surgery c/o Sarah Lipka, Physician Recruiter, at slipka1@geisinger.edu or 570-271-5406 EOE NYC/Long Island Expanding Long Island/NYC Practice seeking BC/BE Plastic Surgeon to join our aesthetic/ reconstructive practice. Hand Fellowship preferred. We have two fully equipped and accredited AAAASF O.R.’s and a beautifully designed Med Spa. Competitive salary and benefits offered. Please apply if you feel your skills and experience will add to the meticulous expertise we provide. Please forward CV to: huntingtonmanagementgroup@gmail.com

BC Plastic Surgeon Northern NJ Practice Upscale two-physician plastic surgery practice in Northern New Jersey seeks BC plastic surgeon to join our dynamic expanding group. Spectacular 5,000 sq. ft. office suite; on-site JCAHO certified, State licensed Surgical Center; academic affiliation with UMDNJ. Only ½ hr by car or train to NYC, this bustling suburban practice offers the best of both worlds. Ideal candidate must be experienced in facial, breast, and body contouring. Email: INFO@PSG1.COM Busy Aesthetic Practice in Newport Beach Looking For a Plastic Surgeon Our 100% aesthetic practice is looking for a BE/ BC or Aesthetic fellowship trained plastic surgeon to join our practice. The practice has a 13-year history of excellence in Newport Beach, Calif. and includes a 7,000 sq. ft. clinic, medspa, and AAAASF facility built in 2017.

Must be willing to learn advanced techniques, be able to promote the brand and the reputation of the practice. Competitive compensation models, investment opportunities and partnership track.

Please email CV to practice manager: Shireen@plasticsurgerycal.com Seeking BC Plastic Surgeon for Employment/ Partnership in Charlotte, NC Well-established southeast busy solo cosmetic plastic surgeon seeks BC plastic surgeon to join practice with option for eventual partnership.

Ideal candidate would be 100% cosmetic with proficiency in face and body. Practice includes a medical facial spa and AAAASF certified OR in our own building located across the street from a major hospital. Competitive salary with bonus structure and benefits.

Email CV: manager@natural-lookingresults.com

Boca Raton, Florida - Practice For Sale Turnkey operation of a Plastic Surgery Practice and Medical Spa available for sale in beautiful Boca Raton, Florida. 5,500 square foot facility includes a fully accredited Operating Room by the AAAASF and a beautiful newly renovated Spa. Please email to buyrentpractice@gmail.com.

Aesthetic Surgery Opportunity – Chicago Well-established, leading aesthetic surgery practice seeking a board certified/board eligible plastic surgeon for an exciting, rewarding opportunity in downtown Chicago. The ideal candidate would be fellowship-trained in aesthetic surgery and 100% focused on cosmetic surgery of the face, body and breast. We are looking for a welltrained, highly motivated surgeon. The practice has an on-site surgical facility accredited by the Joint Commission. A competitive productivity-based compensation structure will be offered with major opportunity for growth. The practice offers health insurance, malpractice, 401K, and opportunity for partnership.

Interested applicants please submit updated CV for consideration to: aestheticsurgerychicago@gmail.com Plastic Surgery Opportunity in Beverly Hills Busy, well-established plastic surgery practice in the heart of Beverly Hills is seeking a BoardCertified plastic surgeon interested in aesthetic surgery. This is a great opportunity to work with two respected plastic surgeons in an office that has an AAAASF fully accredited surgery center. The practice will provide a dedicated staff and manage all the marketing so the surgeon can focus on patient care.

Interested candidates can email their CV to beverlyhillsinstitute@gmail.com.

December 2021

CLASSIFIEDS

Patients Are Waiting For You in Syracuse, N.Y. Thriving cosmetic and reconstructive private plastic surgery practice in beautiful upstate New York seeks a BE/BC plastic surgeon. Our 12,000 square foot practice is in a new, state-of-the-art free-standing building with a AAAASF certified surgical center with two ORs. Currently, we employ 30+ dedicated individuals including 2 BC plastic surgeons and 3 mid-levels.

We have a strong and established referral base and offer a ready-made patient base with the opportunity to perform a broad spectrum of surgical procedures, cosmetic and non-cosmetic.

Currently, both surgeons have a four-month plus waitlist. Ultimately, this position offers tremendous growth opportunity for a surgeon looking to join a highly efficient team and can benefit from joining a well-established successful practice.

Non-surgical services on-site include CNY’s largest injectables business, aesthetician, Lumenis Lasers Center of Excellence, Bioidentical Hormone Replacement Therapy, along with IM injection and a full retail area with concierge services. We are offering a very competitive package including a base salary, productivity monthly bonus, 401K, Defined Benefit Program, paid vacation, malpractice insurance coverage and 100% of your health insurance premium.

Email CV to Linda@SyracusePlasticSurgery.com.

Eastern Mass. Faculty Position Lahey Plastic Surgery, Burlington, is seeking a full-time faculty at the Assistant Professor rank, with a particular focus area in both surgical and minimally invasive aesthetic practices. We have a well-equipped outpatient aesthetic center. Interested candidates please forward a cover letter and CV to Dr. Lifei Guo’s office: aimee.rosa@lahey.org

BC/BE Plastic Surgeon Opportunity Busy Cosmetic & Reconstructive Plastic Surgery Private Practice in Houston Memorial Plastic Surgery (MPS), an upscale and thriving private practice in Houston, Texas, is seeking a Board Certified/Board Eligible Plastic Surgeon to join their elite group.

MPS has a ready-made patient base with the opportunity to perform a broad base of surgical procedures, including breast reconstruction and cosmetic surgery of the face, breast, and body - applicants with DIEP flap microsurgery experience and/or high interest in rhinoplasty and facial aesthetics strongly considered.

Located inside a new Class-A medical facility with beautiful decor, private offices, AAAHC accredited surgical suites, and direct access to an onsite AAAHC accredited ASC. Premier location within close proximity to downtown Houston and the world-renowned Texas Medical Center, and offers diverse cultural dining & entertainment options with excellent neighborhoods to raise a family.

Competitive compensation models, investment opportunities, and partnership track.

Submit an updated CV, cover letter and head shot photo to: contact@memorialplasticsurgery.com.

Plastic/Cosmetic Surgery Practice For Sale ASAPS/ASPS B/C plastic surgeon retiring soon, with 40+ years of private practice in Miami, Florida. Nicely appointed 2,700 sq ft office & AAAASF certified operating room. Staff present > 10 years. Prebooked for rest of 2021,150 cosmetic surgeries. Large IG/Real Self presence.

Yearly gross revenue in excess $2 million, with tremendous growth potential. All offers will be reviewed, immediate sell anticipated. Inquiries to VickyPX123@gmail.com.

Charleston, SC Well-established multi-location aesthetic plastic surgery practice with three surgeons currently, is seeking a board-certified plastic surgeon with 3-10 years of experience. Practice is located in Charleston, SC. Three of our offices have AAAHC certified on-site operating rooms, as well as full spa services.

Partnership Opportunity I am seeking a motivated Board Certified/Board Eligible Plastic Surgeon to join a growing, high volume practice with a built-in referral base.

This is an ultra-busy established Las Vegas practice that offers local, national and international patients the full spectrum of aesthetic surgical procedures and services.

Patient satisfaction is our number one priority and we practice the highest standard of care.

You will be working in a 10000 sf facility with two state of the art operating rooms. Our surgical center is both State licensed JAHCO certified.

Fun loving, supportive and professional staff with excellent work environment.

Competitive compensation with benefits.

Interested candidates should submit their CV to info@sweetgrassplasticsurgery.com.

Central NJ Busy Plastic Surgeon office in Central NJ seeks BC/BD Plastic Surgeon, to join team at premiere face and body enhancement center. Practice is approximately 90% cosmetic and 10% reconstructive. This is an employed position with tract to partnership. Ideal candidate has experience in cosmetic and reconstructive surgery. Candidate would be supported by a surgeon with over 20 years of experience and a dedicated staff with the focus, on optimal patient care.

Excellent compensation: productivity bonus, benefits package and malpractices insurance. Qualified candidates should email: PPSMANAGERHR@gmail.com South Florida Well established group practice seeking a board certified/eligible plastic surgeon to join their team. Must be ambitious, outgoing and interested in a long term relationship with future partnership track.

Please submit a letter of interest and CV to mds@plasticsurgerypb.com.

Greater Atlanta Georgia Metro Area Available Immediately Seeking 4th Member Partnership Opportunity (2-3 yrs) Will consider experienced physician or new graduate » Plastic Surgery or Subspecialty

Rainey Thompson rlt@medicalmanagement.com 770-951-8427 ext.247 cell: 770-843-2880

Now conducting virtual and in-person interviews.

State-of-the Art

Facility

Beautiful 14,000 sq. foot facility with state-of-the art equipment & on-site AAAASF surgery center.

Collegial & Supportive

Clinical Team Generous base salary and bonus opportunity.

Comprehensive benefits & relocation package.

Reasonable call, no trauma coverage. Ideal opportunity for candidate with entrepreneurial spirit and partnership aspirations.

December 2021

Maryland Private Practice Opportunity Well established, busy private practice looking for a highly motivated associate for long-term partnership. Beautiful mid-sized town that consistently ranks top 10 in Money Magazine best places to live and is nearby big cities. BC/BE plastic surgeon with fellowship training (cosmetic or micro) preferred but not required. 60/40 reconstructive/cosmetic mix. great work/life balance and excellent schools. Wonderful place to raise a family. Opportunity for university appointments and working with residents. Competitive compensation, excellent benefits and partnership track. For more information email marylandplasticsurgery1@gmail.com.

Palm Beach Gardens, Fla. Pinsky Plastic Surgery is committed to finding an outstanding BC/BE Plastic Surgeon to become a member of our community awarded premier plastic surgery practice located in Palm Beach Gardens, Florida.

The ideal physician will possess the following:

CONTACT

Opportunity

Please email your CV and cover letter to DrStile@Hotmail.com

Our dedicated team of providers excel at providing our patients concierge service and care.

We are equipped with the latest technology and offer a robust list of aesthetic services. Our team of two surgeons, three physician assistants, and one esthetician, is highly skilled and sought after.

» » » » »

Interview

This is a full time associate position with a partnership track. I am offering a competitive salary with bonus structure, malpractice coverage, marketing, CME allowance and 4 weeks paid vacation. You will also receive a comprehensive benefits package that includes 401k, health and dental insurance.

Join Our Team!

Serving the Greater Atlanta Metro Area; located in Fayetteville, an affluent community with a broad range of housing options ranging from country to country-club settings with Golf and Tennis. Excellent schools.

Forty (40) minutes to Atlanta’s cultural and sporting events, shopping and dining. ◊ Practice performs a broad range of cosmetic and reconstructive procedures. ◊ Candidate can expect a full schedule of office and surgical patients; turn-key practice. ◊ Large base of referring physicians including breast surgeons.

Plastic/Reconstructive Opportunity with Partnership Track Long Island & NYC Excellent opportunity with partnership track.

Well-established cosmetic plastic surgery practice with locations in Long Island and Manhattan seeks a plastic/reconstructive board certified/board-eligible surgeon to join our thriving practice.

Modern offices, professional team environment, state-of-the-art and accredited facilities, knowledgeable and professional staff, competitive compensation and benefits.

Greenbergcosmeticsurgery.com To apply, forward CV to docstg@aol.com or call 516-364-4200

• At least an initial interest in reconstructive surgery.

• Cosmetic surgery and ancillary procedures.

• Proficiency in microsurgery is preferred.

• Clinical interest in a full range of breast reconstruction (free flaps, implant-based procedures), and complex trauma reconstruction.

Living in Palm Beach Gardens offers a wealth of lifestyle opportunities: beautiful housing, beaches, sunshine, outdoor activities (golf, tennis, biking, running, swimming, boating, fishing, and more), symphony, theater, fine dining, private schools, parks and children’s activities, international travel, speed train and so much more.

We offer a competitive benefit and relocation package. If you would like to learn more, please email your CV to our Practiced Administrator, Mandy Mulligan at mmulligan@pinskyplasticsurgery.com Florida is Open and Sunny Well established Cosmetic Surgery Practice seeks an experienced BS Plastic Surgeon for full time or part time. Make your own schedule. Independent Contractor arrangement. Fee for service. All cosmetic cases. vmcallister@premierecenter.com

39

CLASSIFIEDS

Plastic Surgeon For Ambulatory Surgery Center Pittsfield, Mass.

Well established plastic surgery practice in Berkshire County Massachusetts seeks a BE/BC plastic surgeon. We value a healthful work-lifestyle balance. Compensation strategies available include either a shared facilities arrangement or a competitive salary. The office encounters a variety of cosmetic, reconstructive, and hand surgical patients with the potential for micro-surgery. The team currently includes two plastic surgeons, and three mid-level providers. The center houses an AAAASF accredited operating room suite and a CLIA certified pathology laboratory. This is a partnership opportunity.

Please email Pam DeCelles at: info@berkshirecosmeticsurg.com Virginia Beach Well equipped Plastic Surgery Practice for sale. 3,000 sq. ft. with operating room. Coastal Plastic Surgery, Ltd. Photos available online.

757-481-7788 For Sale: Chicago Suburbs Office and Surgical Center Attention: Graduating Residents or disenchanted Plastic Surgeons. Valley Plastic Surgery is a 6,400 sq. ft. office surgery center. The surgical center includes: two fully equipped major operating rooms with piped-in gases for both operating and exam rooms, two emergency back-up power supplies, seven minor surgery exam rooms, and three separate waiting areas for patient privacy.

The ADA compliant building also contains a full kitchen, two patient restrooms, male and female locker rooms with separate shower and restroom facilities for staff.

The architecturally designed office can accommodate four plastic surgeons. Patients pass through a unique glass atrium before entering the formal office setting. This beautifully landscaped, single-story, free-standing building has tremendous visibility from the street and is geographically desirable enabling patients to easily navigate their way from surrounding local suburbs and the Chicagoland area.

The outstanding reputation in the community associated with Valley Plastic Surgery Center since its establishment in 1994 has grown from a practice that had mostly reconstructive surgery into a practice that is currently largely cosmetic in nature.

The present owner plans retirement and is interested in the sale of the building and the practice together and would consider extending transition time to a new surgeon or surgeons. V.P.S.C. is located in West Dundee Illinois and is surrounded by multiple busy suburban hospitals. We draw patients from the broader Northwest Suburban areas and the Chicago Loop due to easy and direct tollway access to I-90.

Valley Plastic Surgery Center 350 South 8th Street West Dundee, IL 60118 847-836-3200 vpsc@sbcglobal.net Savannah, GA Four surgeon single specialty plastic surgery practice located in the beautiful city of Savannah seeking new associate who is a team player interested in partnership over a three to five year span. Free standing facility with AAAA certified OR as well a Skin Institute with two aestheticians and a PA dedicated to injections.

We are a broad spectrum general practice but there is ample opportunity for niche development. Ultimate board certification is a must.

Compensation includes base salary with added productivity incentive.

Serious inquiries: rstefanko@savannahplastic.com

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Denver, Colo. – Neck Up Plastic Surgery Join thriving practice in greater Denver metropolitan area with built-in referrals for ‘neck-up’ reconstructive/cosmetic surgery. Focus on what you enjoy and do best! State of art surgery center on site slated to open early 2022.

Physician-owned practice offers future partnership in practice and ambulatory surgery center.

Enjoy practice autonomy with dedicated surgical team and administrative support. Non–surgical services will be incorporated with physician oversight. Practice committed to full marketing strategy to introduce new surgeon to the community. Ideal candidate will have completed a facial plastic reconstructive fellowship or be highly experienced in facial plastics.

Must be board certified (or in certification process) with a minimum of 2 years’ experience.

Highly competitive compensation package including ongoing salary guarantee with production incentive.

If you love the beauty of Colorado and all it has to offer, you are minutes from enjoying a myriad of winter, spring, summer and fall outdoor and cultural amenities, extraordinary shopping, fine dining and exceptional schools from K through graduate education. This truly is an extraordinary opportunity for both professional and personal development. To learn more, email CV to kjordan@jordansc.com or call 314-518-7409.

Seeking Board Certified Plastic Surgeon for Orange County Practice A well-established practice, located in the highly desirable and beautiful coastal Orange County, is seeking a board-certified plastic surgeon to join the practice.

Highlights of this practice: Multi-facility locations from Orange County to San Diego, CA.; A devoted clientele of 30+ years; Fully accredited operating facilities; and 100% Cosmetic practice offering full range of procedures. Requirements: Prefer a board-certified plastic surgeon; California License; Current DEA; Malpractice coverage; ACLS.

Exciting Plastic Surgery Opportunity in NJ We are actively recruiting a Board Certified/ Board Eligible plastic surgeon who desires to develop a well-rounded reconstructive and cosmetic practice with a particular interest in breast reconstruction. Microsurgery experience and/or fellowship is a plus and would allow you to build up your practice quickly.

Compensation is extremely competitive and transparent: starting salary with upside potential. Access to and participation in two modern state of the art surgery centers. You will join a well-managed department with 4 offices, 5 busy plastic surgeons, 3 PAs and highly efficient, professionally managed fully staffed operations.

We offer: • Two Ambulatory Surgery Centers, Urgent Care Centers, Lab and Imaging • Affiliations at local hospitals • Competitive compensation • Shareholder opportunity • Comprehensive benefits package • Generous CME funding • Opportunities for professional growth • Complete administrative and care management support Summit Health’s unique, coordinated care model was designed to provide convenient access to all the services most patients will require. Through an integrated group of providers and comprehensive resources, and with the merger of Summit Medical Group and CityMD, we deliver strong clinical outcomes while ensuring positive experiences for our patients within the New Jersey, New York and Central Oregon regions.

If you are an interested candidate, please reach out to our recruiters at: providerrecruitment@summithealth.com summithealth.com/physician-careers We are a smoke and drug-free environment. EOE M/F/D/V

Please send a letter of interest and CV to info@estheticasandiego.com Plastic Surgery Physician Opportunity Practice Expanding in Beautiful and Sunny Orlando, FL A Plastic and Reconstructive Surgery practice in Downtown Orlando is seeking a full-time Board Certified Plastic Surgeon to join our expanding team. The selected physician will be able to enter an established surgical practice with an incredible reputation that has been built over the years and continue to evolve. Our current and renowned plastic surgery physician has been voted “Best Plastic surgeon in Orlando” by Orlando magazine 6 years in a row.

This opportunity provides the ideal candidate with a wide variety of cosmetic plastic surgery cases including Advanced Facial Rejuvenation, Facial Surgery, Facial Revision Surgeries, Body Contouring, Body Contouring Revisionary Surgeries and Treatment of Keloid Scars. If your desire is to become part of a dynamic, collaborative team where you will be able to excel in providing integrated, multidisciplinary, patient centered care, then we invite you to join our successful group practice.

Candidates must be Board Certified or Board Eligible in Plastic Surgery The position offers an attractive income guarantee plus production incentive along with a generous benefits package.

Send your CV to cthomas@dermcaremgt.com, or phone 954-237-7090, Ext. 1026

TRAINING Aesthetic Surgery Fellowship Position open July 2022, for The Aesthetic Society-endorsed aesthetic Fellowship in Atlanta at The Center for Plastic Surgery at MetroDerm.

Two surgeons very active with Facial Aesthetics, Rhinoplasty, Breast, Body Surgery, Injectables and non-invasives. Also opportunity for MOHS reconstruction.

Georgia medical license and ABPS eligibility required, stipend offered. Please send inquiries Foad Nahai nahaimd@aol.com Microsurgery Fellowship Opportunity Washington University St. Louis The Division of Plastic Surgery and Reconstructive Surgery at Washington University School of Medicine is seeking a qualified candidate for a non-ACGME Microsurgery Fellow for the 202223 academic year to start July 1, 2022.

Chicago Northshore Fellowship Top-Ranked Facial Plastic Surgery Practice on the Northshore of Chicago with exciting Fellowship opportunity Beginning Fall 2021. Primary focus on facial aesthetic surgery with a strong emphasis on rhinoplasty and revision rhinoplasty- Over 400 rhinoplasties performed each year.

The Fellow will acquire significant experience with office-based surgeries, including AWAKE facelifts, brow lifts, blepharoplasties (upper and lower), otoplasties, liposuction, panniculectomies, bodyTite procedures, minimally invasive/non-surgical procedures and injectables. Significant training opportunities with Mohs procedures provided through a dedicated clinic working directly with a team of Dermatologist.

Fellows will learn non-clinical skills in business operations which include: coding, practice management, optimizing clinical flow, and how to engage effectively to retain a high functioning team.

Opportunity to be involved in Practice meetings where P&Ls are evaluated and discussed, and operational decisions are made. The fellow will also be involved in the accreditation process of a new OR facility and the opening of a new 8,000 sq. ft. private surgical institute.

Please contact Brittany Warner via email at bwarner@warnerinstitute.com or call 847-558-8888

Beaumont Integrated Reconstructive Microsurgery and Craniofacial Fellowship (CMF Micro) The Division of Plastic and Reconstructive Surgery at Beaumont Health offers a 1- year Fellowship combining microsurgery & craniofacial surgery.

This training experience is in one practice with Dr. Kongkrit Chaiyasate and his associates.

The Fellow participates in microsurgical cases including perforator flap breast reconstruction, head & neck free flap reconstruction (congenital, traumatic and oncologic), pediatric microsurgery, lymphedema reconstruction (LVA and LN transplant) & extremity free flap reconstruction. The Fellow is anticipated to graduate with 120+ flaps. A one-month elective abroad is provided. The Fellow is expected to take part in facial reconstruction following Mohs resections, implant-based breast reconstruction & complex reconstructive cases.

The Fellow plays a pivotal role in the monthly multidisciplinary Cleft Palate & Craniofacial Clinic.

Each year, the craniofacial team performs at least 30 primary cleft lip & palate repairs, 60 secondary cleft lip & palate repairs including septorhinoplasty, 20 intracranial procedures including cranial distraction, 5 midface & mandible distractions.

The Fellow will be able to develop skills in both fields and be able to bridge the gap using both disciplines for maximum patient outcomes.

This program represents a new collaboration of the established Plastic and Orthopedic Reconstructive Microsurgery Programs at Washington University. This opportunity is best suited to a surgeon seeking a broad-based microsurgical education emphasizing limb reconstruction and salvage and reconstructive microsurgery.

The American Society for Reconstructive Microsurgery has awarded Dr. Chaiyasate with the “2014 Best Case of the Year”, “2017 Best Save of the Year”, “2019 Best Save of the Year awards”, and “2020 Best Case of the Year”. Candidate selection is completed through San Francisco Match Program.

Learn more at plasticsurgery.wustl.edu.

Interested candidates may send inquiries to pamela.wolf@wustl.edu

For Further information please contact Dr. Kongkrit Chaiyasate directly at Kongkrit.chaiyasate@beaumont.edu.

December 2021

CLASSIFIEDS

Paid Fellowship Opportunity for BE Plastic Surgeon - Private Practice in Houston, Texas Established aesthetic and reconstructive plastic surgery practice offering fellowship for BE/ BC plastic surgeon. Fellowship includes strong emphasis on breast and body contouring procedures for hands-on experience and training on breast reconstruction, including DIEP flaps, and primary and revisionary aesthetic breast surgery, liposuction, buttock augmentation, abdominoplasty, and other body procedures.

Fellow will also be exposed to clinic to experience full scale approach to patient care, practice management, and a medical spa, including non-surgical body contouring, lasers, and injectables.

Applicants must have completed a residency in an accredited plastic surgery program, be board-eligible or board-certified in plastic surgery, and obtain a Texas Medical License prior to Fellowship.

Fellowship Start Date: July 2022 Length of Fellowship: 12 Months Location: Houston, Texas Malpractice: Provided Application Deadline: December 2021 Submit updated CV, cover letter and headshot to contact@memorialplasticsurgery.com to apply.

MD Anderson Microsurgery Fellowship Clinical Fellowship positions are available beginning 7/1/2022 at the University of Texas, MD Anderson Cancer Center in oncology-related reconstruction and microsurgery. A wide variety of complex reconstructive procedures are performed each year with a high volume of microvascular cases, especially autologous breast, complex head and neck, lymphatic, and perforator flap reconstructions. Opportunities are available to participate in microsurgery laboratory training and established basic science and clinical research projects. Fellowship duration: 12 months. Please send letter of intent and CV to: Matthew M. Hanasono, M.D. Director of the Microsurgery Fellowship Program, Department of Plastic Surgery, Unit 1488 MD Anderson Cancer Center 1400 Pressler Houston, Texas 77030 (713)794-1247 Email: mhanasono@mdanderson.org

Oregon - Aesthetic Fellowship Opening July 2022 ASAPS-endorsed aesthetic Fellowship that includes a full spectrum of aesthetic surgery services within an established successful private practice setting. The experience entails broad, handson exposure to comprehensive facial surgery (customized face-lifting and rhinoplasty), primary and revisionary aesthetic breast surgery, breast reconstruction, body contouring surgery as well as independent operating experience. It also encompasses exciting and cutting edge non-invasive and minimally invasive technologies treatments including hair restoration and skin resurfacing.

The Fellow will be exposed to our full medical spa with a wide range of technologies, including skin tightening, body contouring and light and laser technologies. The clinical setting is a rewarding experience that emphasizes a full scale approach including patient management, assessment training, practice management, business strategy and leadership. There will also be formal injectable training with hands on experience during the fellow clinic.

This Fellowship also has a strong mentorship component with monthly formal lectures/journal clubs. Educational engagement and research are expected with all expenses covered for accepted papers at the annual ASAPS meeting.

There will also be opportunities to enhance education and training via nationally organized meetings, webinars and local preceptorships.

Applicants to the Fellowship program must have completed a residency in a plastic surgery program accredited by the ACGME and be broad eligible or board certified in plastic surgery by the Fellowship start date and have or obtain an Oregon medical license prior to the start date. Competitive salary & optional call stipend. Health insurance and malpractice insurance are provided. For inquiries, contact niloo@drmovassaghi.com.

Classified Ad Policy

Rates for printed classified ads are based on word count and must be paid prior to publication. Logos, boxes and color enhancements can be designed for additional fee. The editors do not investigate positions of employment and assume no responsibility for them. ASPS reserves the right to accept, reject or cancel any advertisements in its sole discretion.

Ad Rates ■ ■ ■ ■ ■ ■

1 to 50 words: $165 51 to 100 words: $305 101 to 150 words: $440 151 to 200 words: $555 201 to 250 words: $763 More than 250 words: Contact jembrey@plasticsurgery.org for “designed” ad options

Ad placement deadlines ■ ■ ■ ■

Jan/Feb 2022 - deadline 12/1/21 March 2022 - deadline 1/31/22 Apr/May 2022 - deadline 2/28/22 June 2022 - deadline 4/30/22

Designed Ad Rates ■ ■ ■ ■

1/8 page: $930 1/4 page: $1,440 1/2 page: $2,175 Full page: $3,195

To place a classified ad, email: Jeanne Embrey Advertising Coordinator jembrey@plasticsurgery.org 847-228-3364

Visit the Job Opportunity Board plasticsurgery.org/job.

MISCELLANEOUS Fifth Avenue Plastic Surgery Office Space Available Upper East Side, Fifth Avenue plastic surgery office space available for lease by principal. AAAASF certified operating room, consultation and examination rooms. Convenient to public transportation.

Email paulweiss1049@verizon.net. for details.

Statement of ownership, management and circulation 1. Publication Title: PLASTIC SURGERY NEWS 2. Publication No.: 1043-4119 3. Filing Date: 10-13-21 4. Issue Frequency: 8 times annually 5. No. of issues published annually: 8 6. Annual Subscription Price: $90.

7. Complete Mailing Address of Known Office of Publication: 444 E Algonquin Rd., Arlington Heights, IL 60005 8. Complete Mailing Address of Headquarters of General Business office of Publisher: Same 9. Full Names and Complete Addresses of Publisher, Editor and Managing Editor: Publisher: American Society of Plastic Surgeons (ASPS) 444 E Algonquin Rd., Arlington Heights, IL 60005; Editor: Summer Hanson, MD, PhD (ASPS), 444 E Algonquin Rd., Arlington Heights, IL 60005; Managing Editor: Paul Snyder (ASPS), 444 E. Algonquin Rd., Arlington Heights, IL 60005 10. Owner: ASPS, 444 E Algonquin Rd., Arlington Heights, IL 60005

December 2021

11. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 percent or more of Total Amount of Bonds, Mortgages or other Securities: None.

12. The Purpose, Function, and Nonprofit Status for Federal Income Tax Purposes: Has not changed during preceding 12 months.

13. Publication Title: PLASTIC SURGERY NEWS 14. Issue Date for Circulation Data: Sept. 2021 15. Extent and Nature of Circulation: Membership benefit. a. Total No. Copies (not press run) 7,344 b. (1) Mailed outside-County Paid Subscriptions stated on form 3541: 6,974 (2) Mailed in-County Paid Subscriptions Stated on form 3541: 0 (3) Paid Distribution Outside the Mails including Sales through Dealers and Carriers, Street Vendors, County Sales, and other Paid Distribution Outside USPS: 285 (4) Paid Distribution by Other Classes of Mail Through the USPS (1st class): 28 c. Total Paid and/or Requested Circulation: 7,287. d. (1) Free or Nominal Rate Distribution, Out-

side-County as Stated on Form 3541: 0 (2) Free or Nominal Rate In County as Stated on Form 3541: 0 (3) Other Classes Mailed Through the USPS: 0 (4) Copies distributed outside the mail: 57 e. Total Free or Nominal Rate Distribution: 57 f. Total Distribution (sum of 15c and 15e) 7,344 g. Copies Not Distributed: 0 h. Total: 7,344 i. Percent Paid and/or Requested Circulation: 99% 16. Electronic Copy Circulation: a. Paid electronic copies: 0; This Statement of Ownership will be printed in the Dec. 2021 Issue of this Publication Title of Editor, Publisher, Business Manager or Owner: Michael S. Stokes, Publications Director; Date: 10/8/2021 I certify that all information furnished on this form is true and complete. I understand that anyone who furnishes false or misleading information on this form or who omits material or information requested on the form may be subject to criminal sanctions (including fines and imprisonment) and/or civil sanctions (including civil penalties).

Do you have an idea for a PSN article?

The best stories in Plastic Surgery News often spring from a conversation with a plastic surgeon who says, “You know what would be a good story for PSN?” Whether it’s a trend you see among patients, a challenge you see in your practice or simply a topic you’d like to know more about – we encourage you to share it with the editors of PSN for a potential article.

We’re also always on the lookout for interesting hobbies that help you unwind outside the O.R.; unusual ways you earned money during medical school; or accomplishments.

If you’re an ASPS member with an idea for a good story in PSN, please contact Assistant Editor Jim Leonardo at jleonardo@plasticsurgery.org or by phone at (847) 981-5484.

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SURGEON SPOTLIGHT Editor’s note: The bulk of PSN’s pages are devoted to specific elements of our mission statement – to keep members informed of the social, political and economic trends and educational opportunities that affect the specialty of plastic surgery.

DEBONING CHICKEN YIELDS EARLY INTEREST IN SURGICAL CAREER

S

hane Johnson, MD, Hershey, Pa., became intimate with hard work – and minor trauma repair – while toiling as a teenager tasked with slicing raw chickens at a farmer’s market. His work ethic was solidified at that early age by observing a Mennonite Pennsylvania family that had the desire and fortitude to put in 12-hour days, every day.

PSN is pleased to take liberties with the “social” aspect of its mission statement by presenting a good-natured look at the lives of notable members who we believe are making significant contributions to the specialty.

Dr. Johnson became familiar with a physician’s life after cutting off a portion of his finger during work that he began at age 15, at a Lancaster County, Pa., farmer’s market owned and operated by the Rittenhouse family. It was the only job that would employ someone his age. “We’d cut and debone whole chickens using a boning knife sharpened several times every day – so they were like razors,” he says. “I didn’t have experience with a sharp knife, so I suffered numerous cuts over time. I once sliced-off the end of my left index finger and about ¼-inch of it was just hanging off.”

The mother of his close friend was a family practice doctor who liked to do small surgical procedures, so he drove to their house on his lunch break. “She didn’t have any anesthetic, but she had a suture kit,” he recalls.

“She scrubbed my finger and put a couple of stitches in the tip, then I went back to work. From a farmer’s standpoint, that’s totally the norm; minor injuries you just deal with and then get back to work. She was one of my heavy influences for going into medicine.”

Deboning chicken may not build surgical Dr. Johnson takes a moment to pose with one of his skill, but some continuity does exist, Dr. earliest career inspirations.

Johnson says. “There’s a tactile sense in both situations – over time, your hands do the work based on the information your brain knows about the anatomy that you’re working on. In some ways, its repetitive motion and reinforcement from the repetitive motion of doing certain mechanical tasks with your hands.”

The Rittenhouses, a settler family that has a Philadelphia square named in their honor, “were the ones who taught me the meaning of hard work,” Dr. Johnson says. “They lived an hour away and got up at 4 a.m., got products ready and packed their truck, drove for an hour, unloaded and then prepped everything so that by 7 a.m., it was ready to go at the market – then did all that in reverse at the end of the day, working until 7 p.m. On non-market days, they cared for the farm and worked 12 hours per day.

“As a teenager who just worked to make money for gas, I didn’t understand the long-term effect of hard work,” he adds. “Occasionally, I’ll wonder why I have my strong work ethic – and I know it was acquired by seeing how hard they work for what they have. What I didn’t realize at the time was the more valuable skill I had learned: the lifelong influence of a farmer’s work ethic on my ability to succeed through nine years of postgraduate training and ultimately as an academic surgeon.”

His approach to work was also but less emphatically shaped by work on an asphalt truck one summer during his “off year” in college, which took him to London for six months. “I laid asphalt and did seal-coating,” Dr. Johnson says. “I stood in a dump truck of asphalt with an outdoor temperature of 95 degrees. My boots would melt – and we worked 20 straight days because it didn’t rain. But at 20, you can work 20 days in a row and be fine. When I became a resident, it wasn’t as hard as paving was on the body.” PSN

10 YEARS AGO IN PSN As ASPS members’ online presence continued to grow through websites and new forays into social media, so too did user-driven ratings sites that could prove a useful asset – or a practical threat – to a plastic surgeon’s name and practice. Protecting your online reputation and using review-based websites to your advantage was covered in the December 2011 issue of PSN: “Opinions are opinions. There is defamation per se, assumed defamatory without requiring proof of damages (convictions, sexual misconduct, etc.). For instance, a post that claims: ‘Dr. Reisman has been convicted for beating up his patients’ might be actionable. But you can’t sue against an opinion, no matter how baseless it may be.”

– 2011 ASPS Professional Liability Insurance Committee Member Neal Reisman, MD, JD Bellaire, Texas PSN

42

In this issue, we present ASPS member Laura Figura, MD, Sioux Falls, S.D. Dr. Figura is a member of the ASPS Health Policy Committee as well as the Coding and Payment Policy, Healthcare Delivery and Patient Safety subcommittees, in addition to having served on many past Society committees and panels. In the aftermath of her recent move from Pennsylvania to South Dakota, Dr. Figura carved-out time to answer the following questions for PSN: If I had to start my career over, I would... Choose to be a plastic surgeon. Most days I really enjoy my job and some days I love it.

Plastic surgery involves a fair amount of sleuthing – and having grown up on “Columbo” and “Perry Mason,” I love the challenge of figuring out a diagnosis, what may have gone wrong in a prior surgery or how to manipulate tissues to get the desired effect.

The single-greatest influence on my decision to become a plastic surgeon was... My older sister, Mary Ellen. She’s 12 years older than I – and when I was about 12, she was a burn nurse at Columbus Children’s Hospital. She would always tell me that the plastic surgeons did such a good job with burn reconstruction and that helped turn the crisis around – in terms of pain and overall suffering for these precious children. I grew up knowing that this was a noble, worthwhile profession.

The best thing I ever purchased for my office was... A water cooler.

The worst thing I ever purchased for my office was... A laser that I didn’t use nearly as much as I thought I would.

Laura Figura, MD

The first website I check in the morning is... None, as I check e-mail and get news sent to me from sources I trust. I like to run through happenings around the country before I get out of bed.

The best dish I cook is... Multigrain pancakes with mini-M&Ms. It’s the only way I can get my kids to eat things they wouldn’t normally. I grind fresh oat, flaxseed, pecan flour and wheat germ in place of half the flour, and use coconut oil instead of vegetable oil.

I couldn’t operate without my... My Olsen-Hegar suture cutting-needle driver combo and my bifocals. It stinks to get old.

The best part of next weekend will be... A cross-country meet with my son, Charlie, and a gourmet tasting party at our church.

The best vacation I ever took was... To Kenya this summer. It was a gift to my children from their grandparents – but since my kids are young, my husband and I tagged along. It was the place I never knew I absolutely needed to go. The land is like “Hawaii meets the Bahamas” with some rolling prairie (savannah/bush) mixed in – beautiful and exotic. English is the official language and the people are very warm, friendly and entrepreneurial.

Of course, the animals were amazing and we got to see The Big Five. One of the best parts was seeing four cheetah brothers just hanging out and posing for photographers like it was no big deal.

The last book I read was... Dragon Teeth

by Michael Crichton. I had purchased it some time ago for my Mom and picked it up on a whim to read while we were driving to the Black Hills. I was surprised to find that the book was historical fiction set in Deadwood, S.D., in the heart of the Black Hills. What a fantastic read!

I couldn’t operate without my... Music, which has followed me into the O.R. for 25 years. During residency, I’d bring portable speakers to the O.R.; now I access music on my cellphone.

The biggest surprise I ever had in the O.R.... Dr. Figura’s husband, Drew, and sons Charlie (center), Sam and Ben Came about two years out of training join her at the equator during a trip to Kenya in June. when I was dissecting a latissimus dorsi myocutaneous flap for a breast reconstruction – and I found intraoperatively that she had no muscle. There had been no prior axillary surgery, and on exam she had well-developed anterior and posterior axillary folds, but where the muscle would be there was only a fibrofatty layer and no thoracodorsal vessels. I just kept raising this tissue carefully and successfully transferred it on the serratus branch to reconstruct the breast. I went from feeling the worst panic to walking out like a titan. PSN December 2021

To all who attended or exhibited at PSTM21 in Atlanta...

See you next year at

OCT. 28-31, 2022

PlasticSurgeryTheMeeting.com December 2021

43

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For MemoryShape® Implants: Patient Educational Brochure – Breast Augmentation with MENTOR® MemoryShape® Breast Implants and Quick Facts about Breast Augmentation & Reconstruction with MENTOR® MemoryShape® Breast Implants. For MENTOR® Saline-filled Implants: Saline-Filled Breast Implants: Making an Informed Decision. These brochures are available from your surgeon or visit www.mentorwwllc.com.

It is important that you read and understand these brochures when considering MENTOR® Breast Implants.

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