Plastic Surgery News, April/May 2022

April/May 2022

DISPATCHES FROM UKRAINE ASPS International Members work under attack while a Society staffer helps rescue her parents from Kyiv.

Page 23

ASPS member creates a child’s ear in a new way Page 7

SHARE and Smile Train join forces for future growth Page 8

Fight continues for coverage of congenital anomalies Page 14

PERIODICAL POSTAGE PAID AT ARLINGTON HEIGHTS IL AND ADDITIONAL MAILING OFFICES Plastic Surgery News ISSN 1043-4119

Designed for

*

1,

IN FAT PROCESSING

HIGH-QUALITY ADIPOSE TISSUE1,*

ANGELICA

Actual aesthetic surgery patient with fat transfer.

REVOLVE™ System used for fat processing.

Individual results may vary.

TIME SAVINGS2,† PREDICTABLE RESULTS1,* Retention data based on animal model. *Correlation between these results and results in humans has not been established.

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#

COMMERCIAL DEVICE FOR FAT PROCESSING in the U.S. for aesthetic and reconstructive procedures‡

For more information, please contact your Allergan Aesthetics representative or visit WWW.REVOLVEFATGRAFTING.COM/HCP.

FOLLOW @REVOLVESYSTEM Based on time to complete procedure (from lipoaspiration to fat injection) compared to centrifugation.

†

‡

Market share data through November 2020.

Indications and Important Safety Information INDICATIONS The REVOLVE™ Advanced Adipose System (REVOLVE™ System) is used for aspiration, harvesting, filtering, and transferring of autologous adipose tissue for aesthetic body contouring. This system should be used with a legally marketed vacuum or aspirator apparatus as a source of suction.

If harvested fat is to be re-implanted, the harvested fat is only to be used without any additional manipulation. REVOLVE™ System is intended for use in the following surgical specialties when the aspiration of soft tissue is desired: plastic and reconstructive surgery, gastrointestinal and affiliated organ surgery, urological surgery, general surgery, orthopedic surgery, gynecological surgery, thoracic surgery, and laparoscopic surgery.

IMPORTANT SAFETY INFORMATION CONTRAINDICATIONS Contraindications to autologous fat transfer include the presence of any disease processes that adversely affect wound healing, and poor overall health status of the individual.

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.

This device will not, in and of itself, produce significant weight reduction. This device should be used with extreme caution in patients with chronic medical conditions such as diabetes, heart, lung, or circulatory system disease or obesity. The volume of blood loss and endogenous body fluid loss may adversely affect intra and/or postoperative hemodynamic stability and patient safety. The capability of providing adequate, timely replacement is essential for patient safety.

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.

Results of this procedure will vary depending upon patient age, surgical site, and experience of the physician. Results of this procedure may or may not be permanent. The amount of fat removed should be limited to that necessary to achieve a desired cosmetic effect. Filling the device with adipose tissue over the maximum fill volume line can lead to occlusion of the mesh resulting in mesh tear.

ADVERSE EFFECTS Some common adverse effects associated with autologous fat transfer are asymmetry, overand/or under-correction of the treatment site, tissue lumps, bleeding, and scarring. Potential adverse effects associated with REVOLVE™ System include fat necrosis, cyst formation, infection, chronic foreign body response, allergic reaction, and inflammation.

REVOLVE™ System is available by prescription only.

For more information, please see the Instructions for Use (IFU) and User Manual for REVOLVE™ System available at www.allergan.com/RevolveIFU or call 1.800.678.1605.

To report an adverse reaction, please call Allergan at 1.800.367.5737.

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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April/May 2022

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See carecredit.com for details. ©2022 Synchrony Bank April/May 2022

PSN2022CA 3

IN THIS ISSUE FEATURES 07 FDA issues warning about Renuvion/J-Plasma device

Plastic Surgery News

Agency reports claims of second- and third-degree burns, infection and significant bleeding following off-label use.

07 Creating a new ear for a 5-year-old boy ASPS member Nicholas Bastidas, MD, discusses his efforts to sculpt cartilage from an adult rib cage for his patient.

08 New SHARE, Smile Train partnership will speed educational growth worldwide

April/May 2022 Vol. 33 No. 3 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.

ASPS PRESIDENT

Smile Train provides $100,000 to The PSF’s program and helps bolster research programs and future capacity building.

09 FDA insight on breast implant safety

J. Peter Rubin, MD, MBA rubipj@upmc.edu CHIEF MEDICAL EDITOR

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

Binita Ashar, MD, and Cynthia Chang, PhD, of the FDA discuss the agency’s efforts toward improving patient safety.

11 Military Plastic Surgeons Forum expands parameters for inclusion Lt. Col. Justin Fox, MD, says engagement and participation in the forum won’t be restricted to active military members.

17 Cementing the best research today for a better tomorrow

ASSOCIATE MEDICAL EDITORS

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

Scot B. Glasberg, MD scotbg@gmail.com EXECUTIVE VICE PRESIDENT

The PSF past President Andrea Pusic, MD, MHS, reflects on a career defined by research and global outreach.

19 The PSF announces its 2022-23 roster of Visiting Professors

Michael Costelloe mcostelloe@plasticsurgery.org STAFF VP OF COMMUNICATIONS

Mike Stokes mstokes@plasticsurgery.org

The nine Visiting Professors for the 2022-23 year share their presentation topics for the coming academic year.

MANAGING EDITOR

Paul Snyder psnyder@plasticsurgery.org

23 COVER: Perspectives on the situation in Ukraine

SENIOR NEWS EDITOR

Jim Leonardo jleonardo@plasticsurgery.org

ASPS International members and staff share perspectives on shelling, shortages and safe passage in Ukraine.

ASSOCIATE EDITOR

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

Anu Bajaj, MD; Christopher Killingsworth, MD; Jeffrey Kozlow, MD; Neal Reisman, MD, JD CONTRIBUTING WRITERS

Tyler Neese; Jun Magat, Peggy Pissarreck

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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 President’s Message 06 Editor’s Message 10 CPT Corner 12 On Legal Grounds 12 An Ethical Matter 14 Legislative Update 4

15 Practice Management Insight 28 Late-Career Perspectives 31 Letters to the Editor 33 Calendar 34 Classifieds 38 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.

2022 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.

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April/May 2022

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April/May 2022

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PRESIDENT’S MESSAGE

A new era for member engagement and inclusiveness in ASPS

By J. Peter Rubin, MD, MBA ASPS President

T

he strength of our organization is our membership.

You, the members of ASPS, drive the amazing progress and innovation integral to plastic surgery. Your input, energy and guidance are essential for the Society to fulfill its mission of facilitating a surgical community, enhancing competence, promoting the highest standards of professional conduct, providing avenues and resources for contribution, and communicating values and standards across the specialty and the populations we serve (these are the five “C’s” of the ASPS mission).

I’m pleased to announce that a new governance structure is being established that will enable broader, more inclusive representation and engagement by Society members. Prior to becoming ASPS president, I spent several years on a range of committees and on the Society’s Board of Directors (BOD), working with countless dedicated colleagues who had given and continue to give the tremendous gifts of their time and skill to this organization. Among the many lessons I’ve learned in my time with ASPS is the simple fact that we are at our best when the wide swath of our membership is truly engaged.

In March, the BOD approved a proposal to restructure the Society’s governance model.

The vote was the culmination of an incredible amount of work and sets in motion a series of steps to overhaul not only the way that decisions are made at the leadership level, but make these decisions more inclusive and representative of our Society’s membership.

As you might have read in the December issue of PSN, the work took root in late 2020 and continued with a task force led by ASPS immediate-past President Joseph Losee, MD, who recognized that many of the decisions that pertain to the future and function of our organization are made by the smaller and more agile Executive Committee (EC), which has rendered our 29-member BOD more of

a group that reviews decisions already made by the EC. When calls were made in the past for more representation at the leadership level, it became apparent that expanding the BOD didn’t change the nature of its work, as the EC remained the effective decision-making body.

So the Governance Task Force was charged with finding a way to change the top-down structure of ASPS to a bottom-up one that would not only be more representative of membership, but make the newly constructed BOD a more nimble entity that could meet more frequently and have a stronger role in navigating the Society’s future. This change also addresses persistent requests to add members from subspecialty societies, member sections, managed societies and others for greater representation at the board level.

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 will have three subcouncils: the Subcouncil of Member Sections, the Subcouncil of State/Regional Societies and the Subcouncil of Specialty Societies – each of which will elect its own chair, vice chair and secretary to succeed up the ranks each year. In this evolved governance concept, each of the three subcouncil chairs will also hold an official voting seat on the reformulated BOD (composed of the ASPS and The PSF presidential lines and board vice presidents) to provide representation of the constituent entities of the COR. The result is that these subcouncils will evolve to have a coordinated role with full representation, monthly communication and active, quarterly meetings to formally move time-sensitive insights and recommendations forward for consideration.

The benefits of this new structure are numerous. Not only do we avert overpopulating the current BOD (which meets only twice a year) with more stakeholders that could possibly make action even more cumbersome, but

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 Leadership: Chair, Vice Chair and Secretary of each Subcouncil

Trustees

Advisory Requests

Membership: All Delegates from each Subcouncil

Appellate and Advisory Body

sory

Advi

ests

Requ

Subcouncils State and Regional Societies Charge: To facilitate communication of and collaboration on the issues affecting the Society’s membership at the state and regional level through recommendations 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.

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

Subspecialty Societies

Member Sections

Charge: To represent the subspecialty practices within the membership of the Society and facilitate the generation and presentation of recommendations 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 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 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.

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.

Delegates must be Active Members.

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

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.

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: Education and Academic Affairs

Board Vice President Liaisons: Membership and Research

the new framework with chair, vice chair and secretary for the three subcouncils potentially serves as a training ground – and entirely new pathway – for future Society leaders. Most importantly, it creates an invaluable mechanism for the interests of our members to be transmitted to the BOD, and it establishes a flexible structure in which new groups within our specialty can be represented while growing or expanding groups will have representation proportionate to their size.

In the coming months, governance staff and counsel will work on bylaws and standard operating procedures for the restructure, which will then be reviewed by the Society’s Governance Committee. After that review, the Bylaws Committee will make its own recommendations and pass those on to the BOD, with a membership vote on the restructure ideally taking place later this year. Of course, schedules can change and PSN will keep you abreast of further developments to this timeline as the process unfolds.

The amount of coalition building and

Judicial Council

Membership Denials

Ethics Committee

outreach put forth in this process has been incredible. Although this isn’t the first time ASPS has attempted to undertake this kind of structural overhaul, the work of keeping members informed and engaged along the way has been truly unique. Dr. Losee and the task force not only took the time to engage with and take into consideration ideas from various leadership levels, but also committees and general membership. The result is a blueprint for decreased bureaucracy at a minimal price tag while raising new opportunities for participation. It’s a level of transparency and inclusivity aligned with our ASPS values.

As an organization, ASPS has been working in recent years on a solidified infrastructure that not only provides increased engagement, but rapid feedback for your thoughts, questions and ideas. Communication and collaboration remain cornerstones to any healthy organization – and we want your ideas and input on how to make our Society better on every possible front. We continue to work for you, our valued members. PSN

EDITOR’S MESSAGE

Continue the discussion on wellness and burnout – for all our sakes

By Richard Baynosa, MD PSN Associate Medical Editor

I

n my first official column as the new associate editor for PSN, I’d like to thank ASPS and all of you for the opportunity and the honor of serving in this role. PSN just happens to be the most widely read news publication within our specialty, so I would like to use that distinction as an opportunity for dialogue and soliciting feedback and commentary from our readers. Not only do I plan to read all the responses on my editorials, but I also hope to incorporate some of the comments in subsequent editorials to truly look at these issues in a longitudinal manner and share our readership’s viewpoints as well. We represent a diverse specialty that works on every part of the body, so there are countless perspectives and viewpoints to consider on any topic – all of which are valid. These viewpoints will hopefully add to our communities’ outlook, just like learning new surgical techniques can add to our armamentarium of different ways to solve

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any given aesthetic or reconstructive problem.

With that in mind, I’d like to focus on the always timely topic of wellness and burnout. The concepts behind wellness and burnout are intimately intertwined.

Perhaps the first organized attempt at improving overall wellness in the medical profession occurred in residency training with the advent of the 80-hour work week. Although initially instituted to decrease the risk of medical errors in trainees, this hours limitation was a revolutionary concept in medicine that focused the medical communities’ attention on the well-being of medical professionals – including the need for adequate rest and activities such as exercise and social interaction outside of the hospital. Although selecting 80 hours as a maximal workweek was arbitrary and initially met with skepticism, it soon became clear to most medical practitioners that countless hours spent working in a hospital for continually decreasing compensation was not as fulfilling as it once seemed. More physicians burned out, and there was a corresponding need to increase the volume of work to counterbalance the decreasing reimbursement year after year.

Many academic surgeons decided to go into private practice, while some private-practice surgeons sought employment in hospitals or healthcare organizations. Even some late-career surgeons returned to an academic practice with the hopes that the grass would be greener on the other side. Some found more fulfillment with the change of scenery, although it wasn’t always the case.

All-around well being The definition of wellness is “the state of being in good health.” However, in today’s society, wellness refers to social, spiritual, emotional, familial, occupational, intellectual and even financial well-being – not just how you’re feeling physically on a particular day. Although healthcare organizations have increasingly identified the importance of prevention and early detection over chronic care and late treatment in improving physical health, the same cannot be said about the other non-physical aspects that contribute to wellness. It stands to reason that taking a preventive approach to these various aspects of well-being would be significantly impactful

and could proactively help address the issue of burnout through prevention.

Unfortunately, there’s no “one-size-fits-all” solution. As varied as the different subspecialties are within the field of plastic surgery, there are countless ways to achieve balance and satisfaction in our personal and professional lives. The differences in what’s important for wellness could be grouped together based on generational, occupational and even gender similarities, but wellness can often be based on things that we want as much (if not more) than the things that we need. Due to the individual nature of what constitutes mental, spiritual and physical wellness, institutionally mandated exercises and/or events to satisfy arbitrary requirements for wellness are sometimes received poorly, if not considered contrary to actual wellness. Herein lies the institutional dilemma for leaders passionate about promoting wellness and preventing burnout: We can agree on the goal, yet disagree passionately on how to get there.

It might seem like I’m pessimistic about the prospects of achieving wellness in plastic surgery, but nothing could be further from the Continued on page 32

April/May 2022

FDA issues safety warning on Renuvion/J-Plasma device

T

he FDA in March issued a warning to consumers and healthcare providers regarding the use of the Renuvion/J-Plasma device by Apyx Medical for certain aesthetic procedures. Specifically, the FDA warned against using the device for procedures intended to improve the appearance of the skin through dermal resurfacing or skin contraction.

Although the FDA cleared the Renuvion/J-Plasma device for general use of cutting, coagulation and ablation of soft tissue during open and laparoscopic surgical procedures, the agency reiterated that the use of the device has not been determined to be safe or effective for any specific procedure intended to improve the appearance of the skin. Moreover, the FDA noted that it received reports describing serious adverse events when the Renuvion/J-Plasma device was used directly on the skin and potentially life-threatening adverse events when the Renuvion/J-Plasma device was used under the skin.

ASPS/PSF Board Vice President of Education Scott Hollenbeck, MD, notes that while Society leadership has heard from members about safe off-label use of the device, doctors and patients alike need to heed the agency’s warning.

“While numerous surgeons have anecdotally commented on the safe and effective use of this device, the FDA safety warning should be reviewed by any healthcare provider considering its use,” he says. “Until there is more data, surgeons and patients should be informed and aware of this information.”

The FDA provided the following recommendations for healthcare providers: • Be aware that the use of Renuvion/J-Plasma is not cleared or approved by the FDA for aesthetic skin procedures.

• Be aware that the use of Renuvion/J-Plasma for aesthetic skin procedures may result in serious and potentially life-threatening adverse events.

Further action

• Do not use the Renuvion/J-Plasma device for dermal resurfacing or skin contraction, alone or in combination with liposuction.

• Report any problems or complications experienced by patients from procedures with Renuvion/J-Plasma to the FDA.

• Discuss the benefits and risks of all available aesthetic skin procedures with your patient. If you are performing an aesthetic procedure, inform your patient which devices you plan to use.

The agency reiterated many of these recommendations for patients, adding that in addition to patients who are considering aesthetic skin procedures, those considering liposuction also need to ask whether their provider plans to use the Renuvion/J-Plasma device during the procedure.

• Review the Apyx Renuvion/J-Plasma labeling and user manual for proper use of this medical device.

Among the reports received by the FDA that describe serious and potentially life-threatening adverse events are instances of secondand third-degree burns, infection, change in skin color, scars, nerve damage, significant bleeding, as well as air or gas accumulation under the skin, in body cavities and in blood vessels. In some cases, these reactions required treatment in an intensive care unit.

The Renuvion/J-Plasma system includes the Plasma/RF Handpiece and Plasma Generators, and the devices use radiofrequency energy and helium to generate plasma. The plasma can be used to cut, coagulate and eliminate soft tissue with heat during surgery.

In its March statement, the FDA reported that it is working with the manufacturer to evaluate all available information about the use of Renuvion/J-Plasma for aesthetic skin procedures and to inform patients and providers that the device has not been determined to be safe or effective for these procedures.

The FDA will continue to monitor reports of adverse events. The FDA will keep the public informed if significant new information becomes available.

“FDA warnings should always be taken very seriously,” says ASPS/PSF Vice President of Development Scot Glasberg, MD. “They usually revolve around unknown risk and often make a device’s use in a particular situation ‘off-label.’ While devices can be used in this manner at the discretion of the physician, the requirements regarding informed consent and liability enter a different realm. Surgeons should consult their liability carriers and their attorneys for caution when using devices for which the FDA has published a warning letter.”

If you think you had a problem with your device, the FDA encourages you to report the problem through the MedWatch Voluntary Reporting Form. PSN

N.Y. plastic surgeon uses adult rib cartilage to create boy’s ear

By Jim Leonardo

N

icholas Bastidas, MD, New York, recently completed a unique ear reconstruction surgery on a young boy suffering from left-ear microtia. Dr. Bastidas sculpted cartilage from an adult cadaver rib cage to give Luca Vacchio, age 5, his new ear in a procedure that required him to be under anesthesia for less than an hour. Other plastic surgeons have used allografts in the past, Dr. Bastidas notes, but the real difference with this particular procedure was the relatively minimal low-dose radiation processing that was utilized.

Dr. Bastidas, associate professor of surgery in the Zucker School of Medicine at Hofstra-Northwell Health, met Luca in early 2021.

“He’s a beautiful little boy with a hemifacial microsomia, an underdevelopment of one side of his face – and missing an ear almost completely, as well as part of his jaw and some soft tissue on that side,” Dr. Bastidas tells PSN. “It’s a pretty common problem, affecting one in every 4,000 children – which makes it the second-most frequent facial anomaly after cleft lip and palate.”

Dr. Bastidas performed similar reconstructions using porous, polyethylene implants, but these were limited by their need for a fascial flap, their stiffness and the complete absence of sensation. One young patient developed an ulcer on his new ear because he regularly slept

April/May 2022

Before-and-after photos demonstrate the work done by Nicholas Bastidas, MD, to create an ear for 5-year-old Luca Vacchio. (Photos courtesy of Cohen Children’s Medical Center – Northwell Health) on it but couldn’t feel the wound develop, he notes.

Until Luca’s procedure, Dr. Bastidas had been using tiny segments of cadaver cartilage for rhinoplasty reconstruction and small ear-defect repair, so he asked supplier MTF Biologics to send him a section of adult ribs 5-8.

“I thought that if they could give me enough of this cartilage, then why not make a whole ear out of it?” he says.

Dr. Bastidas assembled Luca’s ear in a nearby room with the help of a 3-D model provided by the Northwell 3-D lab.

“I worked for about 90 minutes to sculpt the ear and suture it together before he was even in the O.R. – then he went under, I

made the incision to place it, I put it in with a couple of drains and in less than an hour he was done,” he says. “After one hour in the recovery room, he went home with just Tylenol and Motrin for pain relief. He took one dose that night, and by the next day, he didn’t need it.”

Luca had lost enough weight prior to receiving the implant that “there ended up being enough skin that we were still able to see the beautiful details of the ear construction upon implantation,” Dr. Bastidas says.

One step remains on Lucas’ journey: In April, he will undergo a procedure to remove the original tissue still attached to his head and to elevate and create a space behind the new ear.

Dr. Batidas adds that his recent cadaver-based cartilage reconstructions revealed an unexpected benefit.

“What we’ve shown with him and several others through a year-and-a-half of data is that you could fabricate an ear from cadaver cartilage without seeing the immune rejection that you’d get from other transplants,” he says.

“Cartilage is very unique because it doesn’t present proteins that cause rejection on the outside of the cells; the proteins are only on the inside of the cells.

“I’m beginning to look at benchmarks to see if there are any signs of rejection or repopulation of cells,” he adds. “When you put the dead tissue in, are you seeing the host putting new cells into it? So far, the data shows there’s incorporation and actually re-integration – where you’re getting your own cells to populate the skeleton of cartilage from the deceased.”

Dr. Bastidas says he’s thankful to have the skills and the opportunity to improve children’s lives. “Prior to the procedure, they’re usually very self-conscious and very shy, and they often grow long hair to hide their ears,” he says. “After the reconstruction, they reanimate – they come in with shorter hair, they feel more like the other kids and they definitely come out of their shell. For me, it’s fun, detailed, interesting and artistic surgery – but it’s also very powerful to see these kids come to life afterward. Now they feel that they’re just like everybody else.” PSN

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SHARE program adds Smile Train as new partner

By Paul Snyder

A

T

he PSF’s Surgeons in Humanitarian Alliance for Reconstructive, Research and Education (SHARE) program is looking to expand its impact on capacity-building and training future generations of plastic surgeons around the world with the help of a new partner.

SHARE announced in March that Smile Train, the world’s largest cleft charity, signed on as a partner to support The PSF’s program. The partnership includes $100,000 in support to SHARE; inclusion in the SHARE Alliance advisory board; the ability to nominate five surgeons to take part as Global Learners in SHARE; and the inclusion of Smile Train representatives to act as Global Educators.

“We’re absolutely thrilled about our collaboration with Smile Train and the opportunity to work with this international leader in global plastic surgery outreach and capacity building,” says Amanda Gosman, MD, one of the leaders of the SHARE program.

“Our partnership will provide much-needed support to many of our clinical and research program initiatives, and hopefully it will inspire future partnerships to broaden the reach of our capacity-building efforts.

The Smile Train grant will provide support for our Global Fellows, monthly assemblies, virtual and in-person skills courses, research conferences and microgrants.”

The SHARE program, which officially launched in 2020 with its first class of Global Fellows in sub-Saharan Africa, seeks to enhance collaboration to improve care and surgical capacity in regions with limited numbers of plastic surgeons but high incidences of conditions requiring plastic surgery treatment. The program is tailored to local learners and their environment through three core components: Global Learners, Global Educators and Global Researchers.

Smile Train is the first partner to sign on to support SHARE after The PSF provided opportunities to welcome strategically aligned, surgical outreach organizations

It’s time to nominate your Patient of Courage

to be a part of the initiative. Under The PSF’s structure, organizations can support SHARE at the Supporter ($25,000), Collaborator ($50,000) or Partner ($100,000) levels. Each tier offers a variety of benefits that allow the supporter to become involved with SHARE. The PSF past President Andrea Pusic, MD, MHS, who was instrumental in creating the SHARE program, says the Smile Train partnership opens the door to new training opportunities.

“This generous support from Smile Train helps SHARE to launch a number of exciting new initiatives, including our microsurgery training program and in-country mentorship opportunities for ASPS members,” she says.

Esther Njoroge-Muriithi, MD, Smile Train senior vice president of global medical programs, says the organization is delighted to partner with SHARE and support five Global Fellow candidates for the upcoming 2022-2024 cohort, as well as bolster research, clinical-skills training and surgical care.

“Over the past 20-plus years, Smile Train has pioneered, championed and scaled novel and innovative learning opportunities for

our partners and the global cleft community,” she says. “We know that investing in the training and education of leaders in plastic surgery – particularly in low- and middle-income countries where there exists a high unmet need for safe surgical care – is investing in the future of their patients, their trainees and the communities where they work. The impact is limitless.

“It’s our hope that this marks the beginning of a replicable opportunity for mentorship to young and upcoming plastic surgeons, who will in turn become mentors themselves, propagating the learning and leadership cycle,” Dr. Njoroge-Muriithi adds.

ASPS members who are interested in participating in SHARE as a volunteer, or in gathering further information about the program, can go to ThePSF.org/SHARE. Dr. Gosman says the new partnership bodes well for the program’s future – and its global impact.

“We look forward to growing the SHARE program in partnership with Smile Train and hope to build a collaborative, global community for plastic surgery education and research around the world,” she says. PSN

SPS is accepting nominations for the 2022 Patients of Courage: Triumph Over Adversity Awards through May 1.

Since 2003, the Society has honored more than 60 reconstructive plastic surgery patients at Plastic Surgery The Meeting through the annual Patients of Courage program, a mainstay of Opening Ceremonies at Plastic Surgery The Meeting. Reconstructive surgery patients often suffer through specific trials, tribulations and challenges as they recover from life-changing surgeries and rebuild their lives. From breast cancer survivors and burn victims to cleft palate patients and wounded soldiers, the program pays tribute to brave reconstructive patients who continue to persevere during adversity and pay it forward through charitable work while using their experience to serve others in their community.

This year’s award winners will be recognized at Opening Ceremonies of Plastic Surgery The Meeting 2022 in Boston on Oct. 28. ASPS members must nominate patients (previously or currently under reconstructive care) who carry an optimistic outlook on life and positively affect people around them, despite the difficulties of their reconstructive procedures.

How to nominate ASPS members or their staff are asked to submit a nomination letter – no more than two pages in length – about each nominee.

Patients must have been treated and currently reside in the United States, with the exception of U.S. military patients.

Nominations will not be considered unless they include specific, mandatory information.

Please complete the nominations form online at plasticsurgery.org/PatientsofCourage and provide the following information: • The patient’s name, age and contact information (address, phone and e-mail, for internal use only) • A short description of treatment (lengthy descriptions of surgical treatments are discouraged) • An explanation of how the patient successfully recovered • An explanation of how the patient turned his or her journey into a positive, life-changing experience • A description of how the patient gives back to others in the community • Details about this unique patient/ doctor relationship

Benign and Malignant Breast Module Topics selected from ABPS Continuous Certification Exam performance deficiencies related to breast topics, including:

• Confirmation that the nominee will allow ASPS to visit his or her hometown to film a short video about how the patient overcame adversity • One current .JPG photo of the patient clothed, or one pair of before-and-after photos; a photo of the patient participating in his or her charitable work is preferred • Signed patient authorization forms releasing the patient’s information and photos to ASPS (links are at the top of the page)

Visit Ednet.PlasticSurgery.org!

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Email your application to PSN Associate Editor Kendra Applewhite at kapplewhite@plasticsurgery.org. Nominations are due by 11:59 p.m. CST on May 1.

To learn more about the Patients of Courage program, please visit plasticsurgery.org/PatientsofCourage. PSN

April/May 2022

FDA perspective

Improving patient-surgeon dialogue for better breast implant outcomes

By Binita S. Ashar, MD, MBA; and Cynthia J. Chang, PhD

Editor’s Note: The FDA provided this article to PSN in February 2022. Updated information from the agency related to breast implants can be found at: fda.gov/medical-devices/ implants-and-prosthetics/breast-implants

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upporting patient access to safe and effective medical products while protecting the public health is the FDA’s mission.

Every year, roughly 300,000 patients in the United States choose breast implants for augmentation, post-mastectomy reconstruction or gender-affirming surgery. Although patients clearly want access to breast implants, the agency is keenly aware that breast implants will continue to be subjected to the highest level of the agency’s review prior to their marketing. We also will continue to help provide patients who consider breast implants with the information they need to make an informed decision about the benefits and risks of these devices.

From our discussions with patients and healthcare providers, as well as the experiences shared by stakeholders during the two-day General and Plastic Surgery Devices Advisory Committee meeting in March 2019 (fda. gov/advisory-committees/advisory-committeecalendar/march-25-26-2019-general-andplastic-surgery-devices-panel-medical-devicesadvisory-committee), the FDA became aware that many patients felt they hadn’t been given complete information at the time of their implant surgery and were dissatisfied with the information received in follow-up care. Recognizing that more could be done to better inform patients of the benefits and risks of breast implants, the FDA following the 2019 meeting took a series of steps toward this goal.

Due to the importance of patients receiving clear information about the benefits and risks of breast implants to inform their decision-making, a final guidance for breast-im-

plant manufacturers was developed. Breast Implants – Certain Labeling Recommendations to Improve Patient Communication was issued by the FDA in September 2020, recommending that breast implant manufacturers incorporate labeling changes to their breast implant devices – including a boxed warning and a patient decision checklist. It’s important to note that these labeling recommendations are intended to enhance, but not replace, the physician-patient discussion of the risks and benefits of breast implants that uniquely pertain to individual patients. The boxed warning is prominent and informs patients that breast implants are not considered lifetime devices, that the chance of developing complications increases over time and that some complications will require additional surgery.

In addition, the warning alerts patients that the development of a cancer of the immune system called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has been associated with breast implants. Although the rates are not well defined, BIA-ALCL occurs more commonly in patients with textured breast implants than smooth implants, and that some patients have died from it. Finally, it states that patients receiving breast implants have reported a variety of systemic symptoms such as joint pain, muscle aches, confusion, chronic fatigue, autoimmune disease and others, and that some patients report a complete resolution of symptoms when the implants are removed without replacement.

In the months following release of the agency’s final guidance, the FDA worked with breast-implant manufacturers as they revised their device labeling to include language as recommended in the guidance. The FDA then went a step further: In October 2021, the agency issued orders restricting the sale and distribution of breast implants to help ensure that patients considering breast implants are provided with adequate risk information so they can make fully informed decisions. Specifically,

Make a difference, join a committee

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SPS invites Active, Life Active and International members, as well as Candidates for Membership and qualified Residents to improve the practice of plastic surgery by applying to participate on one or more of the Society’s 76 committees for the coming year.

You can start by logging into plasticsurgery.org, and clicking on “My Account.” From there, select the “Membership” tab, then click “Committee Application” from the drop-down list. Residents interested in committee service may refer to the special instructions on the Residents & Fellows Forum Committees page.

Successful candidates will have the opportunity to make a difference in the future of plastic surgery by influencing health policy, research, quality issues, leadership and professional development, as well as ethical behavior. The application deadline is 11:59 p.m. CDT on May 31.

For answers to frequently asked questions about committee service, information, applications, descriptions and other resources, visit plasticsurgery.org/committees. Those interested can also contact ASPSCommittees@plasticsurgery.org with questions unanswered by the FAQ. PSN

the sale and distribution of each manufacturer’s breast implant is restricted only to healthcare providers and to facilities that provide information to patients through the patient brochure “Patient Decision Checklist.” The checklist must be reviewed with the prospective patient by the healthcare provider to help ensure that the patient understands the risks, benefits and other information associated with implantation of the specific breast implant.

The updated labeling was approved in October 2021 and is currently available online.

Based on the FDA’s actions, your role as the implanting physician is, among other things, to provide the prospective patient with the patient decision checklist as a source of information for your joint discussion in which all of the following points are reviewed: • Considerations for a candidate for successful breast implantation • Risks of breast implant surgery • Risk of BIA-ALCL • Systemic symptoms • Breast-implant specific risks • Recommended follow-up • Questions for the physician, options following mastectomy and breast implant options The patient must be given the opportunity to initial and sign the designated portions of the patient-decision checklist to document that they have been informed of the risks, benefits and other information associated with the device and have determined to proceed with the implantation. The implanting physician must sign the designated portion of the patient decision checklist to document that they have discussed the risks and benefits

of the device, as well as the risks and benefits of available alternatives and have addressed all questions from the patient.

Labeling for breast implants also now includes updated silicone gel-filled breast implant rupture screening recommendations; a description of materials used in breast implants and chemicals that can be released from breast implants; and patient device cards.

In addition to approving the manufacturers’ updated labeling and implementing the restrictions on the sale and distribution of these devices, the FDA updated its website with information on the status of breast-implant manufacturer post-approval studies.

These activities are intended to strengthen patients’ access to the important safety information needed to make informed decisions about their personal health.

ASPS has long been a valued collaborator with the FDA on breast implant safety, through activities such as the establishment of the Patient Registry Outcomes For Breast Implant and Anaplastic Large Cell Lymphoma Etiology and Epidemiology (PROFILE) and the National Breast Implant Registry (NBIR).

Through our interactions, we know the Society shares the FDA’s commitment to making a difference for women’s health. Your continued partnership in helping to imple-ment the breast implant restrictions will help ensure that women have the most complete and upto-date information available when making very personal decisions about whether breast implants are right for them. PSN Dr. Ashar is director of the Office of Surgical and Infection Control Devices in the FDA’s Center for Devices and Radiological Health. Dr. Chang is a biomedical engineer for the FDA.

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April/May 2022

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CPT CORNER

Common themes and questions from the annual coding course “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.

be reported with 19380 (revision of reconstructed breast) which would include the capsulectomy; tacking the pectoralis major to the chest wall; creation of the new pocket; and soft-tissue envelope revision. If a new size or shaped implant is placed, ASPS supports the reporting of 19342 as well, although current NCCI edits may not allow this despite the language in the CPT book.

By Jeff Kozlow, MD; Scott Oates, MD; David Schnur, MD; and Eric Payne, MD

T

he ASPS Coding Workshop, held this year in February, was a virtual event that included more than 200 participants.

Although holding the course virtually allows increased flexibility and the opportunity for attendees to limit travel, it can also make the ability to answer questions and interact with the proctors more difficult.

For this month’s CPT Corner, we decided to highlight themes found in the most common questions asked during the course. These questions are likely those that would similarly be considered by our membership.

Q: If a patient would like to use a plastic surgeon, or a separate provider for a “better” closure result after mastectomy, would the plastic surgeon be able to code a repair?

A: Technically, no. The closure of the mastectomy is included in the mastectomy code and is not separately billable for a routine closure.

The design of the mastectomy incision would include appropriate excision of skin by the mastectomy surgeon. It would be more appropriate in these situations for a co-surgeon modifier (-62) to be used on the mastectomy code. If there are extenuating circumstances (e.g., severe macromastia) requiring a plastic surgeon to perform unique work, we strongly urge preauthorization to avoid potential denial of payment or concerns about unbundling.

Q: How can you determine the wRVU for a specific code?

A: The Medicare Physician Fee schedule includes the RVUs for each CPT code. The fee schedule can be located at cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/PFSlookup/ index.html.

Q: If we perform a new patient consult such as skin cancer and document a consult note and then perform excision same day, is this modifier -25?

A: In order to separately report the E&M code, it’s important to perform an appropriate level history and documentation that goes beyond what’s required to perform the excision. For example, if a patient is referred to you for a basal cell carcinoma of the arm and, after a brief discussion and review of the pathology/ location, you then perform the excision – that work is included as part of the “pre-time” for the excision.

However, if you see a melanoma patient and perform a complete history, a skin exam with lymph nodes and then provide melanoma education prior to then offering an excision, that E&M service would be separately reported with a -25 modifier along with the appropriate excision/repair codes. There are increasing insurance pressures to not allow -25 in these situations although it’s still ethically appropriate. The -25 modifier is placed on the E&M code and not the excision/repair codes.

Q: What code would be used for coding a CO2 laser for scars?

A: Current guidelines would be to use either the Category III codes 0479T/0480T or an unlisted Level 1 CPT code. Insurance coverage for these procedures varies and requires

review of the Explanation of Benefits if expecting reimbursement.

Q: When would it be appropriate to report the surgical preparation codes (1500x) when performing a post-Mohs reconstruction with a skin graft or local flap?

A: There’s some minor work of preparing a wound bed that’s part of both the skin graft and adjacent tissue transfer codes. For a sameday Mohs closure, the removal of the Mohs hemostatic char or trimming the skin edges is considered bundled work. However, if the remainder of an entire nasal subunit requires excision to optimize the reconstruction, this can be separately reported if this work is significant.

Q: What would be the appropriate reporting for the excision of a keloid scar?

A: The appropriate reporting would be to use the benign skin lesion excision codes (114XX) based on the size and location of the keloid. A simple repair would be considered bundled. An intermediate or complex repair would be separately reported if the criteria for these codes are met. If a local flap is used for closure, then use of adjacent tissue transfer codes 14xxx would be appropriate, but the excision work and 114xx would not be separately reported.

Special Update: HCPCS S-codes

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he 2021 CPT Book changes related to breast reconstruction continue to go through refinement in each of our practice and insurance contracts. One notable change for some surgeons was the formal inclusion of a DIEP flap in CPT 19364 – a position that had been long held by the AMA CPT editorial panel and CMS. Despite never being intended for long-term usage, the separate HCPCS S-codes (S2066-S2068) became frequently used by surgeons and insurers in their coverage policies. At the most recent HCPCS meeting, there was a request by one of the insurers to remove these codes from the HCPCS code set. However, based on support from ASPS, the HCPCS committee decided to keep S2066-S2068 as part of the HCPCS code set until Dec. 31, 2024, to allow sufficient time for surgeons and insurers to continue with current contracts and develop future agreements on an appropriate time schedule. PSN

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Q: Can you code for implant removal in the setting of doing a breast reconstruction?

A: Typically, it would not be appropriate to report the removal of a tissue expander or implant when replacing the previous device with a new tissue expander or implant. The exception would be the removal of a ruptured implant including the contents (19330), or if a complete capsulectomy is performed (19371), which also includes the implant within the capsule. Do not bill 19330 in addition to 19371 for an intracapsular rupture.

Q: A patient undergoing a DIEP flap had a previously placed tissue expander. Can I separately report the removal of the tissue expander?

A: The removal of an uncomplicated tissue expander would be considered part of the work of a DIEP flap (19364), as the work would be similar to creating the pocket in a delayed reconstruction. The difference in wRVU associated with 19364 compared to the non-breast reconstruction free flap codes is due to the work involved in preparing the breast mound and shaping the reconstruction.

Q: How do I report the use of an “autoderm” sling created from the residual inferior mastectomy skin?

A: If a de-epithelialized “autoderm” flap is used instead of a biologic implant, this could be reported separately with adjacent tissue-transfer code(s) (14000-14350), as appropriate, based only on the area of the transposed “autoderm” flap. It’s important that additional incisions are made within the soft tissue to allow the transposition of the flap to within the breast, in order to meet the requirements for an adjacent tissue transfer. The de-epithelialization alone does not constitute an adjacent tissue transfer and would be considered bundled with the closure following an implant placement.

Q: A patient with previous implant reconstruction in the submuscular plane undergoes revision to the pre-pectoral plane due to animation deformity with an associated capsulectomy, revision of the soft tissues and new implant placement. How would this be reported?

A: This procedure would most appropriately

Q: How would you code removal of a failed DIEP/SIEA flap?

A: It would be most appropriate to use the debridement codes (1104X) based on the area debrided (and we are sorry to hear that the flap failed).

Q: Would either LeFort or cranial vault distractions involving two distractors be coded bilateral – or would the osteotomy be single and the distractors then be bilateral?

A: The LeFort CPT codes are bilateral in their descriptors, so it would not be appropriate to use the -50 modifier. However, the distractors are not bilateral and have a Medically Unlikely Edit (i.e., the number of times the code can be reported) equal to 2. So, we would not use a -50 but rather report the distractor code twice or on two lines with a -59 or -XS modifier code to show separate sites. PSN

MA learning module available on EdNet

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ultimodal analgesia (MA) plays an important role in plastic surgery, as it’s a method of pain management that combines various groups of medications for pain relief. Given the importance of MA to the specialty, the ASPS Patient Safety Subcommittee Task Force created a free eLearning module on the subject that’s currently available on EdNet. This course is divided into three sections: introduction and history; use of MA in plastic surgery; and patient education and application.

Course objectives include identifying elements for successful, multimodal pain management and the advantages of multimodal analgesia; differences between pre-emptive, preventive and multimodal analgesia; research on pain management for plastic surgery procedures; medication usage, drawbacks and interactions of multimodal analgesia; and a discussion on how surgeons unwittingly contribute to the opioid epidemic and what can be done to reduce it.

Those who complete the course will receive 0.75 Patient Safety Credits. For more information about the course, please contact Marta Zielinski at mzielinski@plasticsurgery.org. PSN April/May 2022

Military Plastic Surgeons Forum expands sights, inclusion efforts in 2022

By Paul Snyder

I

t can sometimes be difficult to quantify success in a group’s first year, but when people who aren’t part of said group are expressing their support or a desire to help, it’s a good sign that things are on the right track.

Such is the case for the Military Plastic Surgeons Forum, one of the Society’s newest forums that was officially recognized last year. Air Force Lt. Col. Justin Fox, MD, chair of the Military Plastic Surgeons Forum Steering Committee, says the forum had its official unveiling at Plastic Surgery The Meeting 2021 in Atlanta, where forum members took part in the Opening Ceremonies and were able to interact in person for the first time.

“We held our first panel and our first reception, and it was an opportunity to meet people in person who I’d only talked to on the phone or via Zoom,” he says. “We also had the opportunity to engage with military surgical residents who were interested in plastic surgery, as well as interact with retired military surgeons. It was a great way to cap off a couple years’ work of getting the forum formalized.”

The forum recently held its first steering committee meeting of 2022 and although it’s still a relatively new group, Dr. Fox says discussion among members quickly turned to making the collective more inclusive.

“What we learned in talking to non-military ASPS members over the last year is that while they aren’t serving, they’ve had personal or family connections and experiences with the military at different time in their careers that are important,” he says. “We feel a lot of support from members of the Society, and

we’re at a point where we want celebrate this support.”

The Military Plastic Surgeons Forum is expanding its parameters for inclusion to celebrate not only the military members, but the support, legacy and history of ASPS members and the field of plastic surgery within the military.

“Our push this year is to reach out to people and hear their stories – whether it’s family or personal experiences with the military – so that those experiences can be recognized,” Dr. Fox says. “The other facet is celebrating the organizations that support military plastic surgery through military-civilian partnerships.

Many of us work with civilian healthcare organizations. For example, Wright Pat-

Members of the Military Plastic Surgeons Forum serve as the Color Guard at Opening Ceremonies for PSTM21 in Atlanta.

terson Medical Center in Ohio has partnered with Kettering Health to sustain a robust reconstructive surgery service for our patients.”

Dr. Fox notes that other areas around the United States have similar partnerships, including Las Vegas, San Diego and Baltimore. He says that members of the forum want these types of partnerships to be better recognized and celebrated in the years ahead.

“I don’t have a quantitative measurement for how we would define success in our first year,” Dr. Fox says of the forum.

“But the number of people who’ve come up and shared their support for our group or told us their stories is pretty spectacular.” PSN

ASSI Haynes Breast Retractor ®

The proximal teeth help to hold the tissue on tension while scoring with the cautery

Permits the surgeon to easily modify an implant pocket – Especially scoring the capsule to adjust the shape or treat contracture

Your vote counts!

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ll ASPS Active and Life Active members are encouraged to exercise their right to review and vote on the proposed amendments to the ASPS Bylaws, The PSF Bylaws and the ASPS Code of Ethics. The secure, online Bylaws ballot can be accessed at psnextra.org. The deadline for voting is May 31.

Amendments that pass will go into effect June 1.

Questions about the ASPS or The PSF Bylaws amendments or the ASPS Code of Ethics may be directed to bylawsinquiry@ plasticsurgery.org. PSN

ASSI.ABR83826 Haynes Breast Retractor 90x32mm slotted blade, with teeth

ASSI.ABR84026 Haynes Breast Retractor 90x32mm slotted blade, with teeth, w/fiber optic The slotted blade allows the surgeon to use the cautery to cut up close to the base of the Retractor

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April/May 2022

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ON LEGAL GROUNDS

A solid revision policy is a solid insurance policy for your practice “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.

By Neal R. Reisman, MD, JD

T

he unhappy patient is an ever-present concern for any plastic surgeon. Failing to recognize patient expectations, failing to deliver results that were discussed or asking yourself whether the patient’s expectations were just too unrealistic are all points of lingering reflection for many surgeons. Of course, the leading cause of patient litigation is doctors failing to meet expectations, so it behooves us to spend an appropriate amount of time preoperatively to recognize what the patient seeks and honestly evaluating whether we are skilled enough to deliver. Some patients will never be satisfied and might never hear what is discussed in these pre-op consultations – especially if it relates to unrealistic expectations. Should a patient develop a complication that was discussed and included in the informed-consent document, you’re still likely to hear an argument along the lines of: “You discussed this, but I never believed it would happen to me.”

Avoiding these pitfalls can be divided into three areas: patient selection, surgery aftercare and revisions. Complete and open pre-op discussions about a patient’s expectations should result in appropriate patient selection. If you

cannot reach a level of comfort after several visits, you should consider declining the patient.

I often will use the excuse that “I don’t believe I’m skilled enough to provide that result” – and while many of us are not comfortable saying we aren’t skilled enough, it’s ultimately wiser than attempting to achieve unrealistic expectations. It’s also a bad idea to add language in the informed-consent document that would acknowledge the patient’s higher risk for the procedure. Although you might think that additional language will protect you, it can create an argument in writing that the patient never should have been accepted – and it could establish an expectation for a substandard result.

You should have a written revision policy that clearly defines what revisions can be considered, for how long and to what financial extent. Such a policy could cover surgical revision when mutually agreed upon for up to a year after the initial surgery without surgeon’s fees. There might also be additional charges for the anesthesia and facility if necessary.

The paperwork should specify that the policy is only applicable if all post-op directions are followed and all appointments are kept. The one-year time limit can be somewhat flexible (I’ve been less strict about it in the wake of the COVID-19 pandemic), but seeking a revision three years after a procedure is unacceptable.

Some surgeons charge for every revision no matter the course or time, but there should be a balance between creating loyalty and appearing greedy (and losing an unhappy patient). If such a policy is discussed and written in advance, most patients are typically appreciative.

Procedures that can benefit from this policy could include a mastopexy where the patient already demonstrated laxity of their breast skin. Further stretch is to be anticipated and a quick, under-local office surgery to tighten and remove the post-op stretch at an appropriate time frame often results in a happy and referring patient. The facelift patient who waits too long before the procedure is another example.

Even with a SMAS lift, skin laxity will usually occur within a year. Sometimes an office procedure under local to tighten and remove the stretched skin (not to redo the procedure) helps restore their youthfulness.

A revision policy should not indicate that you acknowledge substandard care or results.

Healing always includes some form of scarring, swelling and patient variance. There are patients who believe that aging will be prevented by a facelift or that sagging will be prevented by a mastopexy. This is why pre-op discussions are important. A friend told me of a facelift patient who threatened litigation because the facelift did not last five years. She was a 67-year-old woman. Although some procedures are often associated with a possible secondary-revision procedure (rhinoplasty), a clear, written inclusion of the policy is still important. Specific procedures may warrant specific additional comments to be appropriate.

The language in the informed-consent document should be specific and include a description of what services might be included, a mutual agreement of patient and surgeon – as well as how long such an agreement will last after surgery, what expenses are included and

what expenses are the patient’s responsibility.

This policy will only be honored if all post-op visits are kept and if all post-op instructions are followed. A patient who did not follow safety instructions, smoked and missed most of the aftercare visits only to reappear 11 months after surgery demanding a revision is not to be honored. A loyal patient with normal expectations is desired and ultimately less expensive than a new patient with unknown expectations.

Deciding whether to offer revisions could also be tied to business disruptions. Most businesses face some sort of disruption over time – sometimes by simply not recognizing customer loyalty and remaining competitive in the marketplace. Think of Intel, which has long been a leader in the computer processor world. Years ago, AMD created a competitive challenge. To avoid disruption and having AMD take the lead in the market, Intel created the Celeron processor, a less-expensive alternative. This move effectively blocked AMD’s disruption. Now imagine convincing your board that you will design a less-profitable product to compete with your own product.

Intel’s evaluation of its marketplace and service to its customer base resulted in continued market dominance. Revision policies can be viewed in the same light. You might lose some revenue through that revision, but the patient receives good will and might avoid disrupting your business – a valuable choice, especially in the always evolving world of negative reviews. Just make sure the policy is written accurately, fully discussed and documented in advance. PSN

AN ETHICAL MATTER

Staying true to yourself and your patients on the insurance tightrope

By Anu Bajaj, MD

Editor’s Note: “An Ethical Matter” is written by Anu Bajaj, MD, who served as the Ethics Committee chair in 2018. Readers are encouraged to submit queries to her at anukbajaj.mac@mac.com. The views expressed in this column are those of the author and should not be considered legal advice. The ASPS ethics and compliance resource page can be accessed at plasticsurgery.org/ethics for more information on ethics and social media.

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hen I sat down to write this month’s ethics column for PSN, I experienced what I would consider to be a serious case of writer’s block. I tried recalling issues that we received when I was on the Ethics Committee. I reached out to friends, asking if they had ethical concerns that might get the wheels turning and I perused the ASPS discussion board. The topic that seemed to crop up repeatedly pertained to billing and determining costs for aesthetic (cash pay) vs. reconstructive (insurance) procedures.

As plastic surgeons, we deal with ethics on a daily basis (e.g., informed consent, whether an elective surgery is worth the risk, whether a patient is a good candidate for surgery, when is a procedure cosmetic vs. reconstructive, when another revision becomes one – or more – too many, etc.), but the billing question continually throws us into a grey area. Consider, for instance, whether a diastasis repair could be billed to insurance. We routinely perform many procedures for which we must ask this question, including breast reductions, revisions of breast reconstruction, symmetry procedures,

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gynecomastia, rectus diastasis repairs and more.

The ASPS website defines reconstructive vs. cosmetic procedures in this manner: “Reconstructive surgery is performed to restore function and normal appearance, and correct deformities created by birth defects, trauma or medical conditions including cancer… Cosmetic surgery is performed to enhance overall cosmetic appearance by reshaping and adjusting normal anatomy to make it visually more appealing. Unlike reconstructive surgery, cosmetic surgery is not considered medically necessary.”

What is not mentioned is that this distinction of “medically necessary” can influence who pays for the surgery. Traditionally, patients pay for cosmetic procedures and insurance pays for reconstructive procedures. Some might (and do) think that this is just a matter of greed on a physician’s part, but the reality is more complex. As the AMA’s Journal of Ethics notes, the core ethical principles that we must adhere to as physicians are respect for autonomy, beneficence, nonmaleficence and justice.

Respect for patient autonomy is related to the informed-consent process and ensuring that patients understand their choices. Beneficence is the concept of practicing medicine with good intent. Nonmaleficence is the concept of doing no harm – our actions must always be in the best interest of the patient. Justice is the concept that “patients be treated similarly and fairly, with the result that benefits, risks and costs are equally distributed among them.”

Most of us became surgeons with the intent of doing good and helping people. In other specialties, there may be a more clearcut benefit with surgery – removing a tumor

or removing a diseased organ. Plastic surgery, however, remains unique in that we help people improve their quality of life – reconstruction after cancer, a breast reduction, increased confidence after an abdominoplasty, etc.

What, then, about the concept of justice? In our desire to provide benefit for the patient, we might want to do the gynecomastia surgery, or the small breast reduction or the fifth revision for a breast reconstruction patient. But are these procedures really medically necessary?

Will they improve the function of the patient – and should insurance pay for it? Every time we evaluate a patient, we must determine if their desire for surgery meets criteria for medical necessity for reimbursement by insurance.

Some surgeons may prefer to submit all claims to insurance, but I believe that it is our duty to remain diligent about what we submit.

There is an inherent conflict of interest in the process. We are paid to do surgery – and probably receive more money for cosmetic procedures than for reconstructive surgery.

Surgeons are more likely to prefer that their patients pay cash for a procedure rather than go through insurance. Some surgeons may try to play it both ways – make the patient happy and still reap a financial benefit. I’ve heard of patients who were able to obtain a breast reduction through their insurance and their surgeon would charge for liposuction of the axillary rolls in addition to the reduction to get around the poor reimbursement. This is the kind of solution that doesn’t address the ethical considerations.

What makes these day-to-day issues challenging is that many aren’t specifically mentioned in our Code of Ethics. Moreover, what is acceptable to submit to insurance can also vary geographically. For example, Kaiser in California will routinely cover gynecomastia

procedures, all breast reductions and breast asymmetry procedures – the physician is the one who determines medical necessity. In Oklahoma, the practice is very different. Even after a pre-determination, payment may be denied; or worse, future payments from the insurer are essentially garnished. I recall doing a browlift on a patient who had a merkel cell carcinoma of her temple; the temporal nerve was resected. I initially received payment, but two years later, I had to justify why this browlift was medically necessary or return the money. The downside is that on some occasions when the physician fights for the patient and performs the surgery, the insurance company can still come back months later and deny the claim – at which point, the patient is out of the picture.

I don’t believe that the pool of money in the healthcare system is infinite – we have to acknowledge that healthcare is a valuable resource. As such, if everyone submits everything for insurance coverage, it stands to reason that sooner or later, the money will run out. Which brings us back to the ethical principle of justice (not to mention the legal issues related to insurance fraud if a claim were ever to be investigated) – all patients should ultimately be treated fairly and equally. Although we might want to please our patients by considering labeling some concerns as reconstructive, we still have to consider the effect on the greater good. If someone has their mastopexy covered by insurance, it could mean that another patient is not having their 1,000-gram breast reduction.

We often find ourselves walking the tightrope of conflict of interest. Like it or not, we have to keep walking. It is important to be mindful of our core ethical principles so that we can be true to both our patients and to ourselves. PSN April/May 2022

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The ASPS designates each enduring material for the number of AMA PRA Category 1 Credits™ listed. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

April/May 2022

13

LEGISLATIVE UPDATE

ASPS continues to fight for expanded congenital anomaly coverage

By Tyler Neese

S

everal efforts by ASPS are underway at state and federal levels to advance policy that would expand coverage for individuals suffering the effects of congenital anomalies.

Federal landscape Through several years and sessions of Congress, ASPS has remained a leading advocate on the federal issue of congenital anomaly coverage. Chief among these efforts is advocating for the passage of the Ensuring Lasting Smiles Act (ELSA), a bill on which ASPS collaborated with Sen. Tammy Baldwin (D-Wis.) under the leadership of The PSF past President Arun Gosain, MD, who specializes in surgical correction of craniofacial and vascular anomalies. ELSA would require all private group and individual health plans – including plans regulated by the Employee Retirement Income Security Act of 1974 – to cover medically necessary items or services

that result from congenital anomalies or birth defects. It also stipulates that such coverage include items and services to functionally improve, repair or restore any body part medically necessary to achieve normal body functioning or appearance, and it clarifies the

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

inclusion of adjunctive dental, orthodontic or prosthodontic support.

The Society is actively working with bill sponsors and the ELSA Coalition – composed of 40 patient advocacy and healthcare provider groups – in the 117th Congress to advance the bill, and it was tipped as one of the Society’s top federal priorities at the 2021 Virtual Advocacy Summit. ASPS led the ELSA Coalition in sending letters to the U.S. House and Senate recognizing March 3 as World Birth Defects Day, highlighting the importance of ELSA and calling on members of Congress to cosponsor the legislation and support its immediate passage. In the letters, the coalition noted the bipartisan support for the bill – with 40 cosponsors in the Senate and more than 300 co-sponsors in the House – and lauded its ability to “provide patients with more certainty in accessing medically necessary treatments.”

Efforts to recognize World Birth Defects Day were also supported by a social media campaign on Twitter, through which the Society reiterated its call for all members of

Congress to support ELSA. The campaign utilized the hashtags #WorldBirthDefectsDay, #EnsuringLastingSmilesAct, #ELSA and #PlasticSurgery to further increase the visibility of the issue. ASPS also tweeted messages of appreciation to the bill’s sponsors in Congress, including Sen. Baldwin, Rep. Anna Eshoo (D-Calif.), Sen. Joni Ernst (R-Iowa) and Rep. Drew Ferguson (R-Ga.), along with coalition partners National Foundation for Ectodermal Dysplasias, American Academy of Oral and Maxillofacial Surgeons and the American Dental Association.

Thanks to the efforts of the Society and its ELSA Coalition partners, Rep. Eshoo, chair of the House Energy and Commerce Health Subcommittee, filed a motion to place the bill on the House Consensus Calendar, an action that can only occur once a measure surpasses 290 votes – further confirmation of the overwhelming support the legislation enjoys in Congress. The legislative milestone starts a 25day clock, after which the bill will be placed on the Consensus Calendar and will remain there until considered by the House or reported out of the committee of primary jurisdiction. The House healthcare committees of jurisdiction have signaled that they do not plan to mark up the bill, so the Society expects it to be called for a House Floor vote soon.

State landscape Ongoing efforts at the state level to increase congenital anomaly coverage recently resulted in both legislative and regulatory actions. Although most of the introduced bills and regulatory concepts include provisions to effectively expand coverage, the Society and its state association partners remain diligent in requesting amendments to proposed legislative language Continued on page 32

Thank you, PlastyPAC contributors

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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 January and February help play a key part in the specialty’s success on Capitol Hill.

• ASPS urged state lawmakers in Colorado and South Dakota to oppose bills that would expand the scope of physician assistants and allow them to practice independently after just a few thousand hours of collaborative practice.

• The Society, alongside the Arizona Society of Plastic Surgeons, urged the governor to veto legislation that would expand the scope of dentists to allow them to provide Botox and dermal fillers for cosmetic purposes.

• ASPS, in conjunction with the Plastic Surgeons Society of Alabama, Utah Plastic Surgery Society and Virginia Society of Plastic Surgeons, shared opposition to bills in their respective states that would expand the scope of optometrists and give the boards of optometry broad significant rulemaking authority.

• The Society co-signed a letter alongside several other medical associations, including the Virginia Society of Plastic Surgeons, the AMA and the American Academy of Family Physicians, in opposition to a bill permanently reducing the years of clinical experience necessary for nurse practitioners to practice autonomously in Virginia.

• ASPS joined the Louisiana Society of Plastic Surgeons in opposing a bill that would give nurse practitioners independent practice.

• The Society worked with the Illinois Society of Plastic Surgeons, the New York State Society of Plastic Surgeons, the New York Regional Society of Plastic Surgeons, and the Northwest Society of Plastic Surgeons to oppose bills in Illinois, New York, and Idaho that would create a practitioner category of naturopathic doctor, as well as provide expansive scope and significant power to a specific naturopathic board.

• ASPS partnered with the Illinois Society of Plastic Surgeons in requesting amendments to a bill that would not provide expansive enough coverage for congenital anomalies.

• In collaboration with the New York State Society of Plastic Surgeons and the New York Regional Society of Plastic Surgeons, ASPS opposed a state bill that would create a new category of providers in the state called laser hair removal technicians and give them significant scope when utilizing lasers.

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Alabama Kitti Outlaw, MD

Kentucky David Kirn, MDu

California Debra Johnson, MDI Gordon Lee, MDu George Sanders, MD Ryan Stanton, MD Douglas Sunde, MD Winnie Tong, MD H Amy Wandel, MD Steven Williams, MDI Michael Wong, MDu Matthew Zeiderman, MDn

Louisiana H Holly Wall, MD

Connecticut Andrew Chen, MD Catherine Ly, MDn Florida Nicole Le, MDn Peter Marzek, MD H Andrew Rosenthal, MD u Ernesto Ruas, MD Devinder Singh, MDu Illinois Jeffery Flagg, MD, DDS Arun Gosain, MD Kansas W. Thomas Lawrence, MD

Maryland Michele Manahan, MDu Michele Shermak, MD Massachusetts Theodore Calianos, MDu Janice Lalikos, MDu Michigan Geoffrey Hespe, MDn Ellen Janetzke, MDI Christian Vercler, MD Mississippi Marc Walker, MD, MBAs Missouri Paul Mills, MD New Jersey H Gregory Greco, DO Charles Pierce, DO, MPHu Casey Sheck, MDn Nikita Shulzhenko, MD

New York Ashley Amalfi, MDu Jeffrey Ascherman, MD Glenn Becker, MDu Keith Blechman, MDI H Heather Erhard, MD Alan Matarasso, MD Evan Matros, MDI Ash Patel, MBChBs Malcolm Roth, MD Thomas Sterry, MDI

Tennessee Ellis Tavin, MD Ravi Viradia, MDn

North Carolina H Lynn Damitz, MD Brett Phillips, MD, MBAs Kristen Rezak, MD

Utah Paul Tenzel, MDn

Ohio Spencer Anderson, MDn Demetrius Coombs, MDn Edward Davidson, MDu Gregory Fedele, MDu R. Michael Johnson, MDI Anne Taylor, MD, MPHI Oregon Elisa Burgess, MD

Texas C. Bob Basu, MD, MBA, MPHI Warren Ellsworth, IV, MDu Patrick Hsu, MDI Emily Kirby, MD Janak Parikh, MDn Aldona Spiegel, MDI

Virginia Victoria Vastine, MDI Washington Elizabeth Peterson, MDu Cristiane Ueno, MD Wisconsin Michael Bentz, MD John LoGiudice, MDI

Pennsylvania Jeffrey Gusenoff, MD Elizabeth Moroni, MDn

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

April/May 2022

PRACTICE MANAGEMENT INSIGHT

Time, value, money: Is an MBA a good investment for you?

By Christopher Killingsworth, MD

Editor’s Note: “Practice Management Insight” is a new column presented by members of the ASPS Practice Management Committee. It is provided with the understanding that while the authors may present opinions on financial planning, the column is not a substitute for obtaining the services of a financial advisor or other appropriate professional.

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hysicians are painfully aware of the ever-increasing challenges in the business of medicine. In a 2020 survey, the AMA reported that for the first time ever, less than 50 percent of physicians were in private practice.

As plastic surgeons, we are somewhat insulated from the direct erosion of our revenue potential due to our exposure to the elective cosmetic surgery market, but we still feel the effects through reconstructive surgery exposure. Given this hostile business environment, does it make sense to earn an MBA? If you’re in solo private practice, the answer is maybe. The time, value and cost of pursuing the degree is not necessary if you stick to a low overhead strategy. If you’re part of a larger organization (a larger group or academic practice), the business decisions you make are multiplied by the number of providers in the practice.

Depending on your personal commitments, an MBA could prove beneficial. To help decide if pursuing an MBA is a good choice, we will examine the decision based on three factors: time, value and money.

Time In a busy plastic surgery practice, time is scarce – and your most valuable resource. Managing your time appropriately to generate the most revenue possible is key to financial performance. Splitting your time between work, family and an MBA will be difficult.

If you are in the prime of your career, you are likely very busy and finding the time to attend classes in person is almost impossible.

Given the time commitment necessary for adequate surgical training, we enter the workforce later in life and often have plans for a family.

Although there may be time for education early in your career, if you consider the time

April/May 2022

Age when starting an MBA

30

40

50

Minimum profits per year needed to break even

$7,597.10

$9,032.46

$11,888.61

and stress of being present for a young family, attending a weekend/executive MBA (in person) program could seem unreasonable.

Unless you earn an MBA before starting practice, an online course could be the more palatable option. With on-demand lectures and generous time windows for exams and projects, the flexibility provided by online courses can make obtaining an MBA more conducive to your schedule. The lack of in-person networking is certainly a disadvantage in this scenario, but while most of us are not looking to work at a Fortune 500 company, we may likely be looking to apply the knowledge gained to our business.

Value The question you must ask yourself is whether earning an MBA will provide additional value to your business. The short answer: A resounding yes. Earning an MBA will help you make better business decisions in each of the following facets: Understanding business concepts • Accounting: The basic language of assessing business performance. It is difficult to understand how businesses (yours or other investments) perform without basic accounting.

• Economics: Maximize profits by accessing the consumer surplus and understanding opportunity cost.

• Finance: Understand how to evaluate if a project/purchase will be financially worth the risk by using the concept of the time value of money.

• Marketing: Avoid commodification.

Build brand equity and customer loyalty.

• Human resources (organizational behavior): Understand how to manage employees for best performance and decrease turnover.

Confidence in decisions • As surgeons, we are all well trained to make medical decisions. However, we have no formal training in making prudent business decisions.

• As a leader of a group practice, making decisions based on my limited business experience was no longer enough.

Effective communication • Business, like medicine, has its own language.

• We are not well equipped to fully understand how bankers, hospital executives and other business people communicate with each other, and this puts us at an obvious disadvantage.

Money Aside from the actual cost of earning an MBA, you must also personally consider the toll of the extra time. If you study online, the flexibility of the program might not decrease your productivity in the practice. However, free time away from surgery will be divided, affecting your amount of free time and bandwidth for personal relationships to some extent, which you have to weigh according to your personal life.

In making financial judgments, consider how long you will be in practice, your cost, your investment alternatives and how much you think you will increase profits each year.

Generally, the younger you are and the less it costs for tuition, the more it makes sense.

In the table to the left, we do very basic considerations on an MBA’s worth based on age.

The metric used is the net present value (NPV) of the project and it considers the outflow and inflow of money, the cost of capital (or the rate at which you borrow money to pay) and the time value of money. If the NPV is positive, the value created is more than the cost of capital – and you should do the project.

We assume the average cost of an online MBA is $60,000 (a wide range of $7,000$120,000), you retire when you are 65 years old and you borrow money at a 6 percent interest rate to pay tuition (if you do not take out a loan, the NPV will be even higher). We also conservatively assume you make extra profits per year based on your newly acquired business acumen. We then compare those values to the alternative of placing the money used for the MBA in a diversified portfolio returning an average return of 7 percent per year. Remember that timing is everything and 7 percent is a historical average only.

Adding it all up When making the decision to pursue an MBA, you need to weigh the utility and value of the knowledge against the cost in time and money. If you are in practice, an online MBA would likely be the best option due to the schedule flexibility. The knowledge obtained from an MBA will help you make better business decisions, an important asset if you are part of a group practice or a large organization.

Even though the financial projections show that only a modest increase in yearly profits are needed to break even, one should consider the impact on your time in the calculation.

Given the right personal life scenario, earning an MBA adds a tremendous amount of value to your practice and provides a considerable return on investment. PSN Dr. Killingsworth is a member of the Practice Management Committee and is in private practice in Atlanta. He will be an MBA Class of 2023 graduate from the University of Florida. He can be contacted at chris@horizonmedicalpartners.com.

15

MWSPS meeting returns to in-person programming, sets records plastic surgeons, with selected residents and medical students presenting their abstracts.

By Jacqueline K. Luna-Montes

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ot only did the Seventh Annual Meeting of the Mountain West Society of Plastic Surgeons (MWSPS) mark a return to in-person programming for the organization, but it also set a new registration record and received a record number of abstract submissions.

“This year’s event was a huge success with record attendance,” says MWSPS-immediate past President Jay Agarwal, MD. “The educational programming was outstanding and the weather was perfect for skiing in Utah. It was great to see everyone in-person again, and we’re already looking forward to next year’s meeting.”

The meeting took place in February at The Cliff Lodge, Snowbird, Utah, bringing together plastic surgeons, residents and medical students primarily from the Mountain West region: Arizona, Colorado, Montana, New Mexico, Nevada, Utah and Wyoming. Registration, like membership, wasn’t limited to those states, however, as guests from throughout the country gathered to partake in a mix of educational programming, as well as skiing, snowboarding and connecting with colleagues.

Thought-provoking presentations Ian McCammon, PhD, this year’s featured keynote speaker, delivered “Evidence for Heuristic Traps in U.S. Avalanche Accidents: Implications and Applications,” which provided

Awards for excellence

Some of the sights from this year’s MWSPS meeting in Snowbird, Utah, including (clockwise from top): the ski run; the Saturday night dinner at The Cliff Lodge; a presentation by Justin Sacks, MD, MBA; and a presentation by The PSF President Bernard T. Lee, MD, MPH, MBA. evidence that unconscious mental shortcuts, or heuristic traps, can play a central role in decision-making prior to avalanche accidents.

The presentation provided perspective to plastic surgeons when faced with making oftentimes crucial decisions from consultation to the O.R. to recovery.

Over the course of the meeting, various presentations covered practice management, breast reconstruction, facial feminization, and innovations in plastic surgery technology and body contouring. The final day of the meeting again provided the customary platform that MWSPS cultivated for future generations of

In addition to providing plastic surgeons the opportunity to bring their research to a wider audience, the top 10 presentations will, as usual, be published within a special PRS Global Open MWSPS Supplement. The award for this year’s top oral presentation went to Charles Hwang, MD, Harvard University, for “Downregulation of VEGFA Impairs Post-Traumatic Senile Muscle Regeneration.”

Dr. Hwang received a $500 gift card to REI as well as an invitation to present at PSTM22 in Boston.

Residents and medical students were also given the occasion to present their abstracts as a poster. This year’s top poster award went to Merodean Huntsman, BS, University of Utah, for “Targeted Muscle Reinnervation for Symptomatic Neuromas of the Superficial Radial Nerve: An Anatomic Study.” A complete list of winners can be found at MWSPS.org.

Next year’s meeting location has not yet been announced, though MWSPS members will be the first to receive this information, as well as to gain early access to the reserved-room block. Membership is open to eligible plastic surgeons and residents within the Mountain West region – as well as those outside the region. To learn more, visit mwsps.org/join. PSN

RESIDENTS: Submit Your Abstracts for #PSTM22 DEADLINE: April 29 Authors of the top-rated 50 resident abstracts will be invited to present live podium presentations in dedicated sessions at #PSTM22

PlasticSurgeryTheMeeting.com/Residents

16

April/May 2022

The PSF Distinguished Career Researcher Award

A focus on the present for the future of plastic surgery around the world

By Paul Snyder

A

ndrea Pusic, MD, MHS, didn’t follow a traditional path into plastic surgery.

In fact, The PSF past president’s journey to the specialty began where few others have: in the Canadian Arctic where she worked as a primary care doctor.

“It was essentially a fly-in medical service where we looked after Inuit patients north of Churchill, Manitoba, and on Baffin Island,” she recalls. “It was anything but a standard practice, but during that time I started to realize how much I enjoyed caring for patients and doing procedures.”

One of the procedures that Inuit women in the area needed were Caesarean sections, so Dr. Pusic traveled to South Africa for further obstetrical training. At the time, South Africa was still in the throes of social unrest, so she also had immediate exposure to treating patients who had suffered severe burns.

“The burns were horrific, but I found burn surgery to be very rewarding,” she says. “Back in the Canadian Arctic, I was also handling a lot of hand and facial trauma cases and complex lacerations. It all started to come together for me that this was plastic surgery – and that this was what I loved.”

Dr. Pusic returned to training with a growing desire to pursue plastic surgery but says the competition in her native country of Canada to secure a plastic surgery residency spot was intense. So she began a general surgery residency at Dalhousie University in Halifax, Nova Scotia, where she worked alongside some of plastic surgery’s foremost practitioners, including Don Lalonde, MD, MSc, the first Canadian plastic surgeon to be elected chair of the American Board of Plastic Surgery. He’s also past president of the Canadian Society of Plastic Surgeons.

“I remember doing a fibula flap with Dr. Lalonde and I thought it was the coolest thing I’d ever seen,” Dr. Pusic says. “I enjoyed the big cases, the small cases – it solidified that this is what I wanted to do.”

Dr. Lalonde says he was immediately struck by Dr. Pusic’s work ethic.

“It’s a five-hour drive from Halifax to New Brunswick, and she did that to do a rotation with us,” Dr. Lalonde remembers. “She was an intellectually curious surgeon and a brilliant woman. Even then, you could see her leadership potential – it didn’t matter what kind of person you are or what you did, she had an innate ability to bring out the best in you.”

Dr. Pusic pursued a master’s degree in epidemiology and biostatistics at Johns Hopkins University where she found more plastic surgery mentors in Paul Manson, MD, and The PSF past President Carolyn Kerrigan, MD, MHCDS, who provided an early touchpoint in fortifying Dr. Pusic’s career-long interest in patient-reported outcomes (PROs).

“I was at McGill University in Montreal as a professor, and I had a resident working on a research project who was good friends with Andrea,” Dr. Kerrigan recalls. “My resident said, ‘I think our project could be even better if we had Andrea’s opinion as well.’ So we collected data in Quebec and Andrea provided data from Baltimore for this project that examined the outcomes of breast cancer reconstructive procedures. I was so impressed by her curiosity, her scientific rigor and her writing ability that I told her I wanted to stay in touch and continue to collaborate where we can.”

After her time at Johns Hopkins, a plastic surgery residency opportunity became available at McGill, and while Dr. Pusic says she wanted the spot badly, she was nervous about her chances given that she was pregnant with her first son when she interviewed for the position.

April/May 2022

The PSF past President Andrea Pusic, MD, MHS “I still remember thinking, ‘There’s no way in the world they’ll accept me, because by the time I start, I’ll have a child,’ but Dr. Kerrigan was part of the interview committee and she has five children of her own,” Dr. Pusic says.

“They were very welcoming, and I knew it was the right program for me.”

Pushing research further For as much as reconstructive procedures attracted Dr. Pusic to the specialty, she says that research – specifically focusing on PROs – fueled further motivation for her, and ultimately, plastic surgery at large. That research took root during her first few years in plastic surgery practice at the University of British Columbia in Vancouver, British Columbia.

“Once that idea of ‘We really need to know whether we’re succeeding or not from a patient perspective’ took hold, that became a new passion,” she says. “But none of my work on PROs would’ve happened without the support of The PSF. At the time, it was an idea that was still kind of ‘out there,’ but The Foundation got behind it.”

Since that time, the PRO measures developed by Dr. Pusic and her team, including the BREAST-Q, FACE-Q and CLEFT-Q, have become gold-standard outcomes measures used in research and clinical care around the world.

“Andrea is magical in the way she can put together a research team,” Dr. Kerrigan notes.

Reflecting her commitment to patient safety, Dr. Pusic’s next big focus was to lead the development of the National Breast Implant Registry (NBIR), a cornerstone of The PSF’s registry portfolio. Dr. Pusic launched the NBIR in 2018 as she began her presidential term with The PSF. “Establishing the NBIR was a huge amount of work, but The PSF never wavered in its belief that this was critical to patient safety – and the FDA was a great partner every step of the way,” she notes. “It required a lot of determination on our end to keep its development on track, which is why I was so pleased when we recently hit the 50,000-patient mark. This milestone is clear evidence that the NBIR has surpassed an important inflection point and will continue to increase patient safety and product innovation going forward.”

Her involvement with ASPS and The PSF on various committees and in fortifying research put her on track of The Foundation

leadership, though she notes that attaining the presidency wasn’t an early goal.

“My motivation was always to contribute and make an impact in what I was doing,” she says. “When I was a member of the Clinical Trials Committee, for example, the members of that committee had great ideas and my focus was making sure those ideas were put into action.”

The benefit of that approach was not only getting NBIR off the ground, but also having a wide-ranging knowledge of the research work in The PSF portfolio and the organization’s continued commitment to patient safety, all of which benefited the specialty when the FDA held public hearings on the safety of breast implants in 2019.

“I consider it extremely fortuitous that Andrea was the president of The PSF during my year as the Society’s president,” says ASPS past President Alan Matarasso, MD. “She’s thoughtful, sincere, fair and non-judgmental.

On top of that, she’s insightful, hard-working and has demonstrated her ability time and again to advance the agenda of plastic surgery for the welfare of our patients. It was truly a pleasure and honor to work with her.”

At home and abroad Since the days of her formative experiences with plastic surgery in the Canadian Arctic and South Africa, and even now as the chief of plastic and reconstructive surgery at Brigham and Women’s Hospital in Boston, Dr. Pusic remained committed to helping patients in the developing world. Through various organizations, she’s not only traveled to treat burn patients but also to teach breast reconstruction and other procedures in India, Bangladesh and several African countries.

This commitment to helping patients – and furthering the development of plastic surgeons in those countries – found a new organizational structure during her The PSF presidential term through the creation of Surgeons in Humanitarian Alliance or Reconstruction, Research and Education (SHARE), which in 2020 began teaching its first class of Global Fellows in sub-Saharan Africa. The program seeks to enhance collaboration to improve care and surgical capacity in regions with limited numbers of plastic surgeons but high incidences of conditions requiring plastic surgery treatment.

Although the COVID-19 pandemic threatened to derail the project right as the

initial flights to Africa were being booked in early 2020, SHARE leadership looked at the situation and turned it into a positive.

“It forced us out of our standard way of thinking,” Dr. Pusic says. “We realized we could actually do more teaching and mentorship virtually. It’s been incredible to see these young surgeons who are either residents or in early practice who are thrilled to be part of the SHARE program and able access ASPS educational materials as well as mentorship and virtual teaching from our members. Even though we’re not physically together, there is a great connection and commitment between SHARE mentors and Fellows. It feels like we travel to Africa and back in the space of a few hours on a Zoom call.”

The commitment not only to improving research for the benefit of patients but also steering future generations of plastic surgeons prompted The PSF immediate-past President Gayle Gordillo, MD, to bestow The PSF Distinguished Career Researcher Award upon Dr. Pusic at Plastic Surgery The Meeting 2021 in Atlanta.

“Andrea’s been a pioneer in PROs research in plastic surgery and a thought leader in the registry space for the specialty – developing collaborative relationships with the FDA, breast implant manufacturers and other international plastic surgery organizations,” Dr. Gordillo says. “It’s hard to describe how impactful her work is. I can recall being at a plastic surgery meeting in Japan a few years ago and the young plastic surgeons there just flocked to her. They were so eager to speak to her – she truly is a superstar. I was kind of an outsider looking in, but it really brought home for me the global impact of her work.”

Dr. Gordillo adds that she also felt compelled to bestow the honor on Dr. Pusic as an example of a true female leader for other women in the specialty. Providing that example to other female plastic surgeons is something Dr. Pusic says she felt was important since taking her place in plastic surgery residency as a brand new mother. Her husband, Martin Pusic, MD, whom she met during her time in the Canadian Arctic, is a pediatric emergency medicine physician, so she knows well the constraints that careers in medicine can put on family time. When asked what advice she might have for young women facing the prospect of continuing a career in plastic surgery and raising a family, she answers by saying that she remembers the anxiety.

“I think a lot of young women who go into plastic surgery want to do everything really well, and when you’re faced with having a child, the question becomes: How do I do that and still do everything else?” she says.

“I don’t know what the right answer is, but I went for a run yesterday with my 25-yearold son, and he spontaneously started talking about our family and said that he thought we were great parents. I said, ‘That means a lot, because I feel like we weren’t around as much as other parents. I was at work a lot and when I was home, sometimes we were really tired.’

But his comment was, ‘You and Dad modeled it for us. We learned a lot by watching you and seeing what you prioritized. You prioritized us, but you also prioritized doing things to help others and making contributions.’

“Kids are watching,” she continues. “I think the important thing is to be as present as you can for them and just do your best. I would always try to give them my full attention for the time that I was home – and it was easier to do this before we all had phones and email and constant distractions. If I walked in the door and there was only an hour until bedtime, maybe it might mean sitting together and watching cartoons for that hour. Just be there when you can. And you can.” PSN

17

IN MEMORIAM

A heartfelt tribute to our wonderful friend – and a true innovator

By Steve Byrd, MD

I

t is with a heavy heart that I write in remembrance of my dear friend, John Tebbetts, MD, who passed away at age 75 in March. Prior to our time as established plastic surgeons, John and I went through medical school, general surgery residency and plastic surgery residency, and we served together as junior faculty at the University of Texas Southwestern Medical School. Our friendship spanned 54 years and, over that time, we skiied a lot of powder, glided off more than a few mountains, rode double and single track on dirt bikes, floated a lot of rivers and caught a lot of fish.

Those who knew John best knew that he brought the same verve for his hobbies away from the O.R. as he did in his practice.

“There was an undeniable genius in both his analysis and his technical dexterity,” says Sam Hamra, MD, who worked alongside John for many years. “His commitment to the ‘absolute’ endorsed no middle ground when he defended his philosophy. His impulsive and inquisitive nature allowed him to master and excel when attracted to innumerable, difficult challenges – from tying flies to racing motorcycles. He was indeed a unique gift to plastic surgery and, moreover, truly loyal to his friends.”

John was a perfectionist in all things that he pursued. In plastic surgery, these characteristics were most notably seen in his work in breast surgery and rhinoplasty. He authored

several publications and books that paved the way for better and more predictable outcomes – establishing himself as an inspiration not only to colleagues but to generations of plastic surgeons that would follow.

“He was one of the most creative and artistic surgeons I ever encountered,” says Fritz Barton, MD. “Unrestrained by conventional thought, he viewed the nearly impossible as an opportunity. The only acceptable outcome was perfection. Only a few talents such as John Tebbetts come along in any generation.

I count myself fortunate to have been a colleague and friend of a fellow iconoclast.”

When we were junior faculty, John was a core member of the Dallas Rhinoplasty Society, headed by the late Jack Gunter, MD. At the time, I “chaired” the Vail Ski Symposium and John said he wanted to present open-tip suturing techniques. I remember him showing me his presentation – a dual projection with slides on one screen and video on the other (this was a forerunner to Powerpoint).

When it ended, I said I wanted to see his before-and-after patients. He told me he didn’t have any, but that the technique would speak for itself. When the time for his presentation arrived, I was sitting in the front row. It was a bloodless, fully draped, fresh cadaver with open-tip exposure. For every suture, there was a paired video clip that showed vector movement with both shaping and rotation, as well as projection changes. He closed the skin back over the cartilage and that was it. Much of the

John Tebbetts, MD audience gave John a standing ovation and several doctors came up to personally congratulate him on his results. He looked down at me and winked. Not a single patient was involved, yet it was the best and most talked about presentation at the symposium.

“His passion was contagious and he inspired a generation of plastic surgeons to be better,” says ASPS past President Rod Rohrich, MD, who is also the immediate-past

editor-in-chief of PRS. “John never hesitated to challenge the norm or refine it in a new and better way – a rare breed in the world of medicine. He lived life like there was no tomorrow and never followed in anyone’s footsteps; instead, he created an amazing path for all of us to follow. All of us who knew him will miss him and be forever grateful that he made us better plastic surgeons. That is his legacy.”

Among his many hobbies away from plastic surgery, photography was one that not only reflected John’s true talent but also his determination, endurance and imagination.

He captured many unbelievable wildlife prints that required long hikes in freezing mountain snow and sitting long hours in selfmade blinds – often waiting for a shot that never came. I recall a photograph he took of a group of horses galloping across a river in Montana. He was lying in waist deep water with a brand new Nikon camera as the horses stampeded across the river right over him.

It destroyed the camera, but the shots were awesome. Although many would grumble over the destruction of their new camera, John reasoned that, ultimately, the camera was insignificant – the photographs were a once-in-a-lifetime capture.

Days before he died, John was building a racing drone about the size of a bumble bee. He was trying to integrate the controller pathways into his iPhone. I don’t think he got it done – and I now find myself wishing I had been there to help him complete that last project. PSN

A fine surgeon and singer: Remembering Philip Stoddard, MD, 1936-2022

P

hilip B. Stoddard, MD, passed away peacefully at home on March 10, attended by his wife, Carol, and his daughter, Ashley. He was 85. He leaves behind a large community of patients, singers and glider pilots whose lives he touched.

Born in Batavia, N.Y., to Beverly and Clarence Stoddard, Dr. Stoddard attended Dartmouth College, where he cultivated a lifelong love of singing as a member of the

Dartmouth Glee Club and the a cappella group The Aires.

After pursuing his MD at the University of Rochester and attaining board certification in general surgery, Dr. Stoddard served as a surgeon in the U.S. Air Force. He went on to complete his residency in plastic surgery at the Harvard Beth Israel Hospital in Boston before opening his private practice in Springfield, Mass. Dr. Stoddard touched

countless lives over his 50-year career in the Springfield area.

His proudest achievement was the Cleft Lip & Palate Clinic, steering it through many changes before finally bringing it to the Springfield Shriners Hospital for Children.

Over the course of his career, Dr. Stoddard served as president of Baystate Medical Staff and president of the Hampden District Medical Society. He was awarded the Robert

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M. Goldwyn Lifetime Achievement Award from the New England Society of Plastic and Reconstructive Surgeons in 2014, as well as the 2007-2008 Senior Volunteer Physician of the Year by the Hampden District Medical Society. Dr. Stoddard was also recognized as a Rotary Club Paul Harris Fellow in 2008 for his work with Rotoplast.

Dr. Stoddard always found great joy in music and loved the opera. He was an Philip Stoddard, MD active choral singer throughout his life, most recently singing with the Pioneer Valley Cappella, the South Hadley Chorale and the Springfield Symphony Chorus. He also sang with the Federated Community Church of Hampden choir every week. His other great love was flight, and he could often be found in the cockpit of his glider, flying over New England.

In addition to Carol and Ashley, Dr. Stoddard is survived by his sisters, Clare Strickland and Alison Weeden. The family extends thanks to the wonderful caregivers Diane, Donna and Peter of Baystate Hospice for their comfort and care.

In lieu of flowers, Dr. Stoddard’s family has requested memorial donations to the Springfield Shriners Hospital for Children at 516 Carew St, Springfield, MA 01104 or online at donate.lovetotherescue.org/give/119312/#!/ donation/checkout?c_src=lttr-home. Please designate all gifts to go directly to the Springfield branch. PSN

April/May 2022

The PSF announces its Visiting Professors for 2022-23

T

he PSF is pleased to announce the 2022-23 Visiting Professors who will be visiting various plastic surgery training programs in the upcoming academic year.

The host request period for these Visiting Professors is open until May 3. Interested training programs can request a Visiting Professor and find out additional information at thepsf.org/programs/visiting-professors. Questions about the Visiting Professor program may be directed to Angela Oswald at aoswald@plasticsurgery.org.

The Visiting Professors and their respective lectures and topics of discussion are listed below.

James Bradley, MD • Facial Feminization Surgery: Surgical Techniques, Outcomes and Development of a Transgender Facial Surgery Practice • Craniofacial Syndromic Patient Management Including Midface Procedures • Rhinoplasty: From Evaluation To the O.R. To Revision Management • Alternative Uses of Craniofacial Techniques: Obstructive Sleep Apnea, Aesthetic Surgery and FFS • The Use of Artificial Intelligence in Outcomes Research • Facial Cosmetic Surgery: West Coast and East Coast Practices

Tae Chong, MD • • • • • • •

Reconstruction of Complex Pelvic and Perineal Defects Form and Function in Chest Wall Reconstruction Reconstruction of the Lower Leg – Incorporating the Reverse Sural Flap Safety in Microsurgery Optimizing Aesthetic Outcomes in Microsurgical Breast Reconstruction Salvaging the Compromised Free Flap Surgery as First Line Treatment of Keloids

An Algorithm For Augmentation Mastopexy Patient Stratification in Breast Augmentation Implant-Based Breast Reconstruction Latissimus Flap Breast Reconstruction Treatment of Gynecomastia Fat Grafting in Breast Surgery Breast Reduction – The SPAIR Technique Making the WISE Pattern Work For You Management of the Inframammary Fold Management of Capsular Contracture

• • • • • •

History of Hand Surgery in the Modern Era Business and Practice of Hand Surgery for the Plastic Surgeon Nerve Injury and Management: The Latest and Greatest Flexor Tendon Injuries and Management: A Paradigm Shift An Update on Biologics in Hand Surgery Wrist Arthritis: What Works Scaphoid Fractures and Nonunions Distal Radius Fractures for the Plastic Surgeon Hand Fractures: Beyond Plating and K-wires

Samuel Lin, MD, MBA • • • • • • • • •

Soft Tissue Preservation Techniques For the Deviated Nose Necklift Techniques in Avoiding the Overtightened Neck Functional and Aesthetic Rhinoplasty Starting an Aesthetic Practice in Academics Plastic Surgery and Innovation Restarting an ACGME Residency Program Teaching Professionalism in the Era of Social Media Becoming R01 Funded Combining an MBA With an MD in Practice

April/May 2022

Facelift Necklift Browlift Buccal Fat Pad Excision Abdominoplasty Male Body Contouring Rhinoplasty Technique in Blepharoplasty (video)

Restorative Jaw in a Day with Complete Virtual Planning The Military Transgender Experience Deliberate Practice: Integrating Systems-Based Tools To Challenge Dogma Bridging Models: Military-Civilian Partnership Now and in the Future 20 Years at War: Modern Contributions to the Plastic Surgery Experience Ethical Humanitarian Care

Christine Rohde, MD • Clinical Research Techniques, Moving Beyond the Retrospective Review • Randomized Controlled Trials in Plastic Surgery, Bringing Level I Evidence To Research • Leadership and Faculty Development in Plastic Surgery • Contralateral Symmetrizing Procedures After Unilateral Breast Reconstruction • Breast Reductions: Technique Evolution, Tips and Tricks • Optimizing Aesthetics in Head and Neck Reconstruction

Sonu Jain, MD • • • • • • • • •

• • • • • • • •

Eamon O’Reilly, MD

Dennis Hammond, MD • • • • • • • • • •

Alan Matarasso, MD

Jason Souza, MD • • • • • • • • •

Building an Orthoplastic Program: A Blueprint For Construction Hierarchy of Needs: A New Framework for Lower Extremity Reconstruction Hierarchy of Needs: A Framework For Amputation Care Make Wings Not War: A Conceptual Approach to Advanced Amputation Care Osseointegration: Nuts, Bolts and Bones Targeted Muscle Reinnervation After the Honeymoon: Coming to Terms with a Challenging Problem Beyond Limb Salvage: Maximizing Function and Minimizing Pain Following Combat-Related Trauma Cancer and Combat: Fighting Two Wars With One Skillset Lessons Learned and Philosophies Adopted From Mentors and Patients

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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. ALS148047 10/21

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April/May 2022

Evidence.

It’s what AlloDerm™ RTM is made of.

With the confidence that comes from having more scientific* and clinical publications than any other ADM over the course of 25 years, know that your patients will receive the safety and quality you expect from AlloDerm™ RTM—the industry leader.1-4 Thanks for making AlloDerm™ RTM your ADM of choice. *Correlation of these results, based on animal studies, to results in humans has not been established.

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.

To report an adverse reaction, please call Allergan at 1.800.433.8871.

To learn more, visit www.AlloDerm.com Follow @AlloDermHCP

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. Wainwright DJ. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns. 1995;21(4):243-248. 2. Data on file, Allergan Aesthetics; Search Performed on PubMed in August 2021. 3. Data on file, Allergan, 2021; Number of AlloDerm™ RTM Units Sold. 4. Data on file, Allergan Aesthetics, June 2021; Plastic Surgery Aesthetic Monthly Tracker.

April/May 2022

21

Scott Spear Innovation in Breast Reconstruction Fellowship

Taking a closer look at breast microbiomes in reconstruction participate is because they’re skeptical of being randomized to receive a shorter course of antibiotics. However, several patients have also voiced that they strongly prefer to receive the shorter course of antibiotics.

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.

FOCUS ON PLASTIC SURGERY RESEARCH

THE RESEARCHER

PSN: Why do you think they respond in that manner?

Dr. Barnes: Antibiotic duration preferences have been highly variable, and it would be interesting to create a survey to better understand the various patient perspectives on antibiotics and other prophylactic measures.

Laura Barnes, MD Title: Plastic Surgery Research Fellow, Division of Plastic Surgery, University of California-San Francisco Award: Scott Spear Innovation in Breast Reconstruction Fellowship Project: Microbiome and Association with Implant Infections PSN: What are you trying to measure through your study of the microbiome and infection related to breast implant-based reconstruction?

Dr. Barnes: Implant infections in breast reconstruction pose a great threat to the reconstructive process and outcome. Prior research has shown that the breast has a unique microbiome; however, it’s never been investigated with respect to reconstructive outcomes. Prior research has also shown the gut microbiome to be unique in women with breast cancer.

We aim to determine the feasibility of sampling the breast microbiome through tissue samples and through serial aspirates from tissue-expander seroma ports. We also aim to determine the correlation between the gut microbiome and the breast microbiome.

In our pilot study, we’ll randomize one-half of the patients to receive 24 hours of prophylactic antibiotics and one-half to receive seven days of prophylactic antibiotics. With this

Clockwise from top: Dr. Barnes in her O.R. at the UCSF Breast Care Center; holding recently collected microbiome samples; and with her husband, Glen, and 7-month-old son, Liam, taking a break from hiking in the Marin Headlands. design, we’re investigating the impact of antibiotics on both the breast and gut microbiomes.

PSN: How far along are you in your research?

Dr. Barnes: We’re currently in the pilot phase of our study. We’ve recruited more than half of the pilot cohort, and we’re currently running the microbiome analysis on our first batch of samples.

PSN: What do you see as your study’s practical applicability?

Dr. Barnes: If we find a relationship between the breast and gut microbiome – and further, a relationship between the breast microbiome

AUG. 25-27, 2022 Simulation Sessions Aug. 26-28 PROGRAM CHAIR:

Matthew J. Trovato, MD

and the propensity to develop a serious, reconstruction-threatening infection – we could use a gut-microbiome sample preoperatively to determine patients at increased risk of infection. A future study may be designed to determine a method such as probiotic administration to positively impact the gut microbiome preoperatively. The data from this study may also be used to determine a patient’s need for prophylactic antibiotics on an individualized basis.

PSN: Has anything unexpected surfaced?

Dr. Barnes: The primary reason that potential candidates for this study have declined to

“Well formatted course with good chance for interaction and practice.”

“This course taught me to tackle the oral boards in a comprehensive, planned approach as opposed to just studying.”

“Gave me a good foundation of cases to study and format.”

“It was wonderful to learn from so many different and varied faculty.”

- 2021 Course Participants

PSN: Who are your mentors on this particular project?

Dr. Barnes: My primary mentor on this project is UCSF Assistant Professor of Surgery Merisa Piper, MD. She has been an enormous support, helping brainstorm through the kinks at all levels of the project – from getting buy-in from all breast and reconstructive surgeons at our institution to figuring out how to keep it productive during the COVID surges.

PSN: What did you want to be when you grew up?

Dr. Barnes: When I was growing up, I loved sewing. I would design and make clothes for myself to wear for various occasions and holidays, and I said at that time that I wanted to be a fashion designer.

PSN: What’s your favorite research project, outside of your The PSF research work?

Dr. Barnes: In college, I worked in a lab using MRI imaging techniques to evaluate the neurologic changes seen in patients with HIV infection. During this time, I read about new processing technologies that allowed quantification of the connections between different areas of the brain. I sought mentors and was able to develop an independent study investigating the impact of HIV infection on the brain connectome. This was my first, major experience in scientific research.

PSN: How do you spend your time away from the lab?

Dr. Barnes: I spend as much free time as possible with my husband, Glen, and 7-month-old son, Liam. We love spending time outdoors, exploring the parks of San Francisco and hiking in the Marin Headlands. We also have three cats we adopted when I was in medical school in New Orleans: KitKat, Achilles and Duke.

PSN: What tunes are most often heard in your O.R.?

Dr. Barnes: I enjoy working to a Glass Animals album. My son loves Taylor Swift, so she’s a hit in our home.

DIRECTLY PROVIDED BY:

PROGRAM CO-CHAIR:

Sami Khan, MD

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

22

April/May 2022

Standing strong ASPS International members and staff shine a light on the professional and personal demands of living and working in a country under seige – and the difficulties of keeping families safe as Russian missile strikes target more cities throughout Ukraine.

Interviews by Jim Leonardo & Paul Snyder

April/May 2022

23

Dr. Badiul (center) in 2014 with Keyian Paydar, MD (from left); ASPS past President Gregory R.D. Evans, MD; Joseph Gryskiewicz, MD; and Garrett Wirth, MD; at the University of California-Irvine.

‘Continuous work without a day off’ An interview with ASPS International Member Pavlo Badiul, MD, PhD, DMedSc Dnipro, Ukraine Can you tell us a little about your situation in Ukraine right now?

I’m with my wife, my 12-year-old daughter and my 5-year-old son in Dnipro, a city in east-central Ukraine. My city isn’t currently a war zone; we’ve only sustained three rocket attacks. But many of the wounded from other cities around the country are being sent to us. I teach burn treatment and plastic surgery basics to residents at Dnipro Medical University, but my clinical base is the Burn and Plastic Surgery Centre, where I’m treating many battle casualties – mainly burn and gunshot wounds and landmine blast trauma – which are very complicated and usually combined. But we’re ready for this – we’ve had a lot of experience since 2014 [when Russia forcibly annexed the Crimean Peninsula in Ukraine].

I was born in Dnipro, and I’ve spent most of my life here. I graduated from Dnipro State Medical University in 2001 and since then have practiced at the Burn and Plastic Surgery Centre.

What has been your experience in America with plastic surgery training?

I became an ASPS International Member in 2013 and was named as an international scholar the following year. I spent nearly four months at University of CaliforniaIrvine, where I learned at the side of ASPS past President Gregory R.D. Evans, MD, and his team, which exerted an enormous influence on my professional development.

At that time, Russia’s aggression against Ukraine in the east had just begun. Dnipro became a frontier city to the hostility zone and we received a lot of wounded.

On my return from America, I was able to advance new treatment methods in the clinic and develop a reconstructive microsurgery strand that allowed for the successful treatment of complex combat trauma. My colleague and I in 2020 published Perforator Flaps in Reconstructive Surgery in Ukrainian, where technical aspects of reconstruction with main flaps were presented. This book has become of great use for our colleagues in Ukraine.

Can you tell us about working while Dnipro was under rocket attack?

Early on Feb. 24, the citizens of Dnipro were awakened by the sound of explo24

sions as the Russian military launched missile strikes at our airport and several defensive sites in the city. After that, there were more attacks on the city. For now, there are no hostilities in Dnipro – that’s why a lot of wounded are evacuated to the city for medical aid. Several times a day we hear air raid alerts, but the city currently functions almost in a normal mode, and we carry out our duty and treat our wounded.

What types of injuries have you been treating in the past few weeks?

Our patients are predominantly soldiers, but there are civilians, too. I don’t know the general casualty load. My department has hit its capacity of 40 patients – more than 20 of them are wounded soldiers. Their injuries are very complex, and many are combined traumas: fractures, burns, vast landmine and gunshot injuries, many traumatic limb amputations. Most of the injured in 2014 experienced lower-limb trauma; today, there are a lot both lower- and upper-limb combination trauma, which I suppose is due to the use of different weapons. We perform a lot of surgery using flaps, and a lot of microsurgery.

What are some of the unique demands of practicing reconstructive surgery in a nation under attack?

Right now, plastic surgery is exclusively for treatment of the wounded. We don’t do any aesthetic procedures; we’re only performing reconstructive surgery. It’s continuous work without a day off. We need to be ready to perform complex surgeries at any time – and we need to continue with a surgery in progress even when air raid alerts sound. We don’t take cover. We’re short of nursing staff. Our young residents help us a lot – but people are very tired.

We need medical equipment, instruments and medicine. Although some European countries have been helping us, there have been problems tied to the delivery of many of these items.

For example, there’s a great demand in negative-pressure wound therapy devices – they’re necessary for fast wound preparation for plasty, but we’re in short supply.

Do you think the Russian people are being misled by their government to support this unprovoked invasion?

I have friends, colleagues, and even relatives among the Russians. After the war started, I was supported by all my friends and colleagues from all over the world – and only from a few Russians. The Russian propaganda sources have been using messaging against the Ukrainians for many years – and not just against the Ukrainians. Such messaging was aimed at many other nations around the world. We definitely know that the majority of Russians support the invasion into Ukraine.

This is the impact of Russian chauvinism.

Certainly, Putin and his propagandists feed the people of Russia with false information, but Russian people like the information they get. They attacked Ukraine under the pretense of helping the oppressed Russian-speaking people in Ukraine, and that we’ve been shelling and destroying Russian-speaking cities and killing Russian-speaking people. This scheme has been used many times, starting with the attack on Finland in 1939. Of course, there are right-minded, adequate people with high moral standards among the Russian people, but they are at the minority.

They write to tell me they understand everything, but they are afraid to speak out against this aggression.

(Above) Plastic surgeons and staff (Dr. Badiul is fifth from left) at the Burn and Plastic Surgery Centre in Dnipro, Ukraine; and (below) a landmine injury with defect of femoral bone and pelvic fracture, with an TDL free flap. (Photos courtesy of Dr. Badiul)

What should PSN readers know about your situation that hasn’t been addressed?

I’m deeply grateful to ASPS for its support during this terrible situation – the Society is composed of highly professional members who have shown they will support other members in need. I’m also grateful to the Society for my PSF International Scholar designation, professional development and education.

Some European countries are helping us with consumables and medicines, but we still have a great need for support in the form of medical equipment, instruments and medicine. Although we get some targeted aid, much is still lost, diverted or taken to the wrong places. I hope this article will help us gain the help we need.

We really appreciate the support, interest and help of ASPS. PSN

April/May 2022

‘We will prevail’ An interview with ASPS International Member Ihor Chmelyuk, MD Kyiv, Ukraine Can you tell us a little about your situation in Ukraine right now?

I work in private clinics in Kyiv – in one I am the head of the clinic and chief of general and plastic surgery, and in another I am a leading plastic surgeon. On Feb. 24, my family awoke to the sound of explosions and decided to leave immediately. We have two small daughters and obviously their safety is paramount.

I’ve been through this kind of situation before. I’m originally from Luhansk, and Russians took my homeland in 2014. I used to work under the constant sounds of artillery fire, mine throwers and gunshots in town. I used to sit in the bus on the way to and from work, hearing mortars explode, closing my eyes and hoping our bus would not be hit. Some of those buses were hit and none of the passengers survived.

So on the morning of Feb. 24, my wife and I took our daughters and packed both our cars with clothes, food and our dog and headed to western Ukraine. We spent about 20 hours on the journey and reached Khmelnitskiy, but unfortunately, rental rates were about 10 times higher than usual, so we moved on to Chernivtsi, closer to the border. We changed apartments four times before we settled.

Due to the constant movement and stress of the situation, my wife and children all came down with colds – not COVID, thankfully – but it’s been a hell of an adventure. We only finally settled last week, got diagnostics for my wife’s pregnancy and are now doing remote learning for my kids.

How has this affected your kids?

It’s put a different kind of stress on them – too active, a little aggressive, bad sleep. It’s getting better now. Having to do remote learning via a MacBook is not enough – they are too unfocused, and obviously asking a lot of questions about rockets, planes, sirens and Russians. We try to explain everything as it is without fairy tales, but also without violence or brutality. You take every day bit by bit.

Do you plan to stay in the country?

I do. I want to continue to work here – it is my country, my one and only. I had an offer to cooperate with a Canadian medical project in Lviv and some other private clinics in Chernivtsi, but I have not decided yet. I want to get back to Kyiv when it will be safer for my children – and I want to help there. We will wait for the victory and we will prevail.

Given your experience in Luhansk, did the recent actions by the Russians surprise you?

I’m sure the Russians prepared for this invasion for a long time. I think we knew it would happen, but we were hoping it might be confined to the east. We didn’t expect Belarus would betray us and let them enter, and we never thought there would be so many rockets fired upon us.

It was a shock when the attacks started in Kyiv. And now every day, you wake up shocked and go to bed stressed. The Russians are behaving like absolute animals in the towns that they’ve occupied. They

rob, rape, torture, kill and destroy. It’s unbelievable.

Is there anything in particular that the American plastic surgeon community needs to know about the situation in Ukraine right now?

We are seriously in need of special individual medical kits and supplies for our medics that are on the front line. We’ve waited a month already and received nothing. It’s such a pity.

Obviously you feel duty-bound to protect your family at this moment, but as a medical professional, how does your mindset change in times like these?

I know that I would be very useful operating on wounded soldiers and civilians because I already have the experience from 2014, but at the moment I cannot go to the front line. I’m planning to resume practice in western Ukraine – and I will absolutely provide free help to the wounded and Ukraine refugees. I also want to help organize surgical help in a new clinic here in Chernivtsi or Ivano-Frankivsk, maybe in Lviv. There’s a company called Dobrobut that has an extensive network of private clinics in Kyiv and they’re willing to open more clinics in the west.

The most important thing to me, though, is to return to Kyiv and renew my practice there so that I can help all the people there who have fallen into financial crisis as a result of the war. I want to help restore the city. PSN

Help provide medical supplies to Ukraine

T

he PSF is urgently seeking help to provide surgical, first-aid and other medical supplies desperately needed to treat the wounded in Ukraine. ASPS is in communication with its member surgeons in Ukraine as well as the Ukrainian Medical Association of North America to contribute medical supplies to airlift and transport these items to hospitals and medical facilities.

The situation is devastating as the Russian military continues to bomb residential communities and civilian infrastructure in Ukraine, leaving countless citizens, including children, soldiers and the elderly, seeking emergency medical care.

The Ministry of Health of Ukraine provided the following list of supplies desperately needed, but virtually any and all surgical or emergency care products – specifically painkillers, blood containers, bandaging materials and surgical kits – will be useful.

• Sets for intraosseous access

• Surgical power generators

• Kits for lumbar puncture

• Antibiotics

• Tracheostomy sets

• Microvascular anastomotic coupler devices and couplers

• Tracheal intubation kits • Sets for drainage of the pleural cavity • Immobilization tires of various types and sizes

• Individual casualty care kits

• Syringes with needles (different volumes)

• Combat application tourniquets

• Catheters for peripheral veins (different sizes)

• Emergency trauma dressings

• Systems for transfusion of infusion solutions

• Cyclone hand-operated resuscitators

• Non-sterile bandages (different sizes)

• Hyfin chest seals

• Elastic fixing bandages (different sizes)

• Medic trauma packs

• Sterile materials for anti-burn measures • Hydrogel anti-burn bandages of different sizes

Supplies that are needed include:

• External fixation devices

• Stomach wash kits

• Wound dressings for burns

• Sets for catheterization of the bladder

• Suture materials

• Traction tires

• NPWT dressings and devices

• Portable oxygen cylinders

• Surgical instruments (scissors, forceps, needle holders, instruments for microsurgery)

• Central vein catheterization kits

April/May 2022

Emergency-care items that are needed include:

Anesthesiology department needs include: • Radical Pulse CO-Oximeters • Central venous catheter sets • Perifix One 401 Filter Sets • IV catheters with injection ports • Spinal needles for spinal and diagnostic punctures • Armored endotracheal tubes (different sizes) • 3M Tegaderm IV Advanced Securement Dressings

• Defibrillators Traumatologist needs include: • External fixator sets • Steinmann and Schanz pins (any diameter) • Orthopedic power tools • Orthopedic instrument sets • Plates and screws.

Please contact Angela Oswald, ASPS membership coordinator, at aoswald@plasticsurgery.org for more information or instructions on where to deliver supplies to help the people of Ukraine.

If you do not have access to these supplies, please share this message with any colleagues who may.

“As plastic surgeons, we dedicate our careers to healing trauma, painstakingly trained to restore the form and function taken from patients through injury, disease or genetic anomaly,” says ASPS President J. Peter Rubin, MD, MBA. “When we see the images of this incursion and its associated atrocities being indiscriminately inflicted on civilians, we are programmed to do everything in our power to help.

“ASPS joins the rest of the world in its desire for an immediate end to the conflict,” he adds. PSN

25

My family’s story of escaping evil

By Yassie Dunn, MBA, CPM

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(Top) Yassie’s mother, Nataliia Sukhodulska, and father, Iurii Siedov, aboard a minibus leaving Lviv, Ukraine, for Warsaw; and (above and below) anti-war street posters in Warsaw.

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hen the nuclear accident occurred at Chernobyl on April 26, 1986, I was 11 years old and living in my native city of Kyiv, the capital of Ukraine, which is located about 60 miles south of Chernobyl. My father, a nuclear physicist, knew the danger of what had transpired. Radiation is a hidden enemy – you cannot see it, you cannot feel it and yet it destroys you. It is a danger that permeates everything and knows no borders. The entire world sensed that something was terribly wrong in Ukraine, even as the government continued to insist that everything was fine and citizens were advised to go out and enjoy fresh April air. Although able to himself leave, my dad sent his wife and three young daughters (we were 7, 11 and 12 at the time) to safety. We spent the first two months in the pioneer camp (similar to a Girl Scouts organization) near Moscow before our mom moved us to the Republic of Georgia, where we spent two more months with family friends and in another pioneer camp. After four months of travel, we had nowhere to go and eventually had to return to Kyiv to start school on Sept. 1 of that year.

A couple weeks ago, I sat with my older sister, Natasha, in a Georgian cuisine restaurant in Warsaw, and the memories came flooding back. We tried to determine what the odds would be that twice in a lifetime, my family would be refugees, forced to flee imminent danger for survival. We were waiting for our parents to cross the border into Poland after they left Kyiv as the Russian military closed-in on the Ukrainian capital and obliterated nearby towns. I don’t know that we ever determined the exact probability, but I can say that for the second time in our lives, we counted ourselves lucky and grateful.

I immigrated to the United States in 1999 and became a naturalized citizen in 2005. Although my mother loves to travel and visited us on multiple occasions, my father has only been to the United States once, luckily returning to Ukraine in February 2020, right before the COVID-19 pandemic took hold around the world and curbed travel for more than a year.

The U.S. Embassy paused its work in Kyiv for the duration of the pandemic, meaning we were unable to renew his visitor visa to the United States.

Fast-forward two years to February 2022 as the entire world watched the buildup of the Russian troops on the Ukrainian border. U.S. analysts warned about potential war, but my family (and many others in Ukraine) did not believe that actual war would occur. My two sisters and I made impassioned calls to my parents, urging them to leave Kyiv and relocate – at least temporarily – to western Ukraine, but our parents did not want to listen. My dad, 78, is still lecturing at the Kyiv State University and did not want to leave his students. With growing horror, we listened to reports of the conflict growing increasingly violent and dangerous. We also learned that a 40mile convoy of Russian troops was closing in on Kyiv.

Every day, I felt increasingly certain that their window to get out was rapidly closing – and increasingly helpless from the other side of the world. There were a lot of tears, several long phone calls with family members and close friends, and many sleepless nights.

Escaping Armageddon For better or worse, the direness of the situation became apparent to my father as February turned to March, and Russian forces decimated the nearby cities of Irpin and Bucha. My parents could see and hear the non-stop shelling that lit up the sky in the direction of those cities. Kyiv also faced attacks, with the TV tower and other parts of the city taking direct hits. There were many casualties. In Kyiv, curfew was implemented – at times lasting 35 hours or longer, making it impossible for my parents buy food or simply walk their dogs.

On March 5, my parents finally headed to the train station to find what my father called “Armageddon.” The platforms were overloaded with residents from the very young to the elderly and pets, all trying to get aboard standing room-only rides that in normal conditions took

up to eight hours (and now would take longer because of the war) to get to Lviv, located close to the Polish border. Both my parents are in their late 70s and because of his medical condition, my dad cannot stand or walk for too long – let alone run from platform to platform to try to better position themselves to an approaching train for the chance to board.

As more trains arrived to Kyiv packed with people fleeing the eastern cities of Ukraine that were under severe bombing, such as Kharkiv and Sumy, my parents abandoned the idea of escaping by train.

My cousin, Yuri, 35, who could not join them (Ukraine barred men between ages 18-60 from leaving the country) helped my parents secure a ride with a volunteer Christian church group that carries supplies from the West and transports refugees back to Lviv.

Meanwhile, Natasha and I boarded a flight from Chicago to Warsaw to try to get as close to Ukraine as we could, given that the country’s airspace had been closed to commercial air traffic. I did not yet know where we would stay or what the next steps would be – all I knew is that somehow, we would be together on safe ground. We adopted an attitude to “be resourceful” that served us well many times on this journey.

My parents, their two dogs and a family friend had made the roughly 350-mile journey to Lviv in a minibus. The volunteer group told them to wear warm clothing, pack very little (essentially phones, chargers, government documents and a few precious photos). No suitcases, no changes of clothes – essentially packing only what could fit in a purse. It was only when my parents reached Lviv that they made a sobering discovery: In their haste to leave, they grabbed expired passports.

My cousin came to the rescue again and retrieved the right passports from my parents’ apartment and managed to deliver them by courier to Lviv. However, that added several days to my parents’ wait in Lviv without a change of clothes – and with Russian forces also beginning to attack that city. Nine days passed between the time they left Kyiv and the moment April/May 2022

(Left) Reunited in Warsaw at last after a nine-day journey out of Ukraine, with family friend Olga Zachek (front row, right), who traveled with Yassie’s parents from Kyiv; and (above) Yassie and her sister, Natasha Stevens (far right), pose with their parents and dogs in Warsaw.

we reunited in Warsaw – and as happy and emotional as that reunion was, it was also heartbreaking. They spent nine days in a warzone waiting. When my sister and I finally laid eyes on our parents, they seemed lost and displaced. To me, they resembled little orphans, and not the confident people I remembered from before.

It’s been an incredibly traumatizing few weeks. Despite the warm embrace I’ve known since childhood, the tears in my eyes were as much a reaction to their exhausted, smile-less faces. These are elderly people who had to leave their entire lives behind, not knowing when they might return – or what they might return to.

This is to say nothing of the bureaucratic hoops we had to jump through to get our parents into the United States. I consider the United States of America the greatest country on earth, and I feel extremely privileged and proud to possess a U.S. passport (which stands for freedom: freedom of travel, freedom of expression, freedom to be who you are). Still, I know that even this great country has its own problems, the bureaucracy being one of them. I can go on and on about the difficulties we encountered on this trip, starting from applying for a U.S. tourist visa for my father, to trying to transport our dogs to the United States as the CDC last summer barred Ukrainian dogs from entering the United States.

What was extremely disappointing is that as U.S. politicians promised “swift” support (and I am quoting Vice President Kamala Harris, who visited Warsaw and met with Polish President Andrzej Duda on March 11), the reality remains that support to Ukrainian refugees has been (and still is) extremely slow. I know that when you’re on safe ground, as my family was in Poland, more than a month of non-action in granting special status for the Ukrainian refugees (which, at the time of writing, is estimated at 4 million and growing every day) might not seem that long, but when you are escaping bombs and unsure whether you will see the next morning, the word “swift” takes on a whole new meaning. I described my experience and actions that needed to April/May 2022

be implemented in two open letters to President Joseph Biden and U.S. Secretary of State Antony Blinken. Although I did receive a well-written reply from the White House, it was a template response that did not address the refugee problem.

I was happy to read in the press that there was some progress for Ukrainian refugees after President Biden’s visit to Poland on March 25-26. The president promised that the United States will accommodate 100,000 Ukrainian refugees, and he also visited the Ukraine/Poland border to meet with people fleeing the war. This gives me hope. Despite all my family’s trials and tribulations, we know we are lucky. My sisters and I joined forces to help our parents and their elderly friend to escape the war, we were able to advocate on their behalf and provide a loving home while they’re in the United States. This is not the case for so many of my native countrymen – mostly the women, children and elderly who are fleeing the war. The domestic pet problem is another heartbreaking issue, as there are now a lot of abandoned animals throughout Ukraine.

Hopes for a greater future This unprovoked and sadistic war is horrible and heartbreaking. I see no end to this any time soon. Still, in my heart, I know that Ukraine will win this war.

Ukrainian is not a nationality anymore; it’s a state of mind. Remember that this isn’t a case of one country against another; it’s a handful of evil individuals who crave world domination and believe they can achieve it because they possess nuclear weapons.

This is a tragedy for Russia as much as it is for Ukraine. Although some segments of the Russian population support this war, many do not – but they are too intimidated to do anything about this.

My father is an ethnic Russian who lived his entire life in Ukraine. My mom is Ukrainian. My sisters and I identify as 100 percent Ukrainian; we were born and raised in our beloved Kyiv, a city with more than 1,500 years of history and rich culture. I, like all Ukrainians, want noth-

ing to do with Putin, his evil regime or his distorted and sick outlook on life.

In conclusion, I want to express my sincere gratitude to those who deserve it the most: • The Ukrainian Armed Forces, which are outnumbered and outgunned, but remain the bravest army in the world; • Ukraine President Volodymyr Zelenskyy, for not abandoning his country in its greatest time of need, but continues to exhibit such a courageous resolve and patriotism that makes any Ukrainian proud that they belong to this great nation; • The volunteer network of citizens in Ukraine, who disregard their own safety while rescuing their fellow Ukrainians by delivering them to safety, and providing supplies and transportation to those on the front lines; • The people of Poland, who opened their county to their Ukrainian sisters and brothers in need. From day one of the war, they allowed anybody with the Ukrainian passport to stay and legally work in Poland for the next 18 months. Poland was the first country that came to the Ukrainians’ aid; • The ASPS Leadership team, members and colleagues who personally provided a lot of moral support to me and my family. I know I’m blessed beyond measure, and I thank you all from the bottom of my heart.

(Above) Yassie with her parents and the family dogs at Warsaw Chopin Airport, before flying to the United States; and (below) anti-Putin street art in Warsaw.

I believe in a great future for Ukraine and its people. The road to peace seems long and perilous now, but if my life’s experience has taught me anything, it’s that fortune favors the resilient. Slava Ukraini!

Glory to Ukraine! PSN

Yassie Dunn is the ASPS Senior Manager of Member Engagement.

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LATE-CAREER PERSPECTIVES

How to succeed at your end-of-career transition and life beyond

By Enrique Fernandez, MD

O

ne morning you wake up with a yawn, smile and thoughts about coffee. Then your mood changes as you realize the end of your career is imminent. Maybe you smile again because you have had a successful career and expect to succeed in the next phase of your life, too. Then the questions start to circle. How do I also succeed at this? When should I start to prepare? What does preparation entail? What steps should I take and in what order? More questions likely follow.

It’s possible that you’ve researched a little and spoken to some colleagues, but most of your anxiety about an end-ofcareer transition is sparked by the realization that you have not begun to deliberately prepare for what’s next.

Nevertheless, life’s experience equips you with skills, wisdom and confidence – although that can still be small comfort as you head into uncharted waters, and the significance of not having structured preparation for this unfamiliar, major life event will make itself evident one way or another.

What I know is true I know more than a few people who believed they were prepared for retirement because they thought they were financially secure, even though there were other questions that needed answers, and finding those answers seemed to continually be put off.

Maybe they were comforted by having a retirement “plan” and figured their various hobbies and/or the pursuit of lifelong interests would provide happiness. Unfortunately for many, as time marches on, disenchantment can quickly become a companion to empty boredom. Arriving at the next phase of your life with an idea and knowledge of financial security is common, but it often leads to disappointment. Why, then, is it so common? I believe there are two root causes.

The first is not recognizing that experiencing an optimal lifestyle is based on fulfilling your needs and desires – to find a way to have ongoing experiences that fulfill your purpose in life. It’s important to have fun and take up interests that your career may have long deferred, but that alone might foster a feeling of being unfulfilled.

The second problem is that most retirement financial planning focuses primarily on developing assets, growing and protecting them. For you to be able to have a successful transition, however, this is simply not enough.

It’s essential to first create a post-career lifestyle plan that examines and lists your needs and desires. The next step is to create a post-career financial plan to determine whether your retirement plan assets will support the lifestyle plan. If it does, you can proceed with confidence. If it does not, you can make the necessary adjustments to one plan or both. As your plans take shape, you might decide to accelerate or delay your end of career date.

Timing is everything The post-career lifestyle plan should be created when you find yourself thinking about the end of your career with more frequency – and it should be completed in short order. For many of you, this will probably be about five years in advance of your projected end date. Once this plan is completed, you can proceed to create your post-career financial plan.

The key to creating an effective lifestyle plan is to have a clear methodology designed to identify experiences that you consider necessary, as well as those that are desirable. The great thing about identifying these experiences is that you are able to incorporate them into your plan on your terms. Once identified, your lifestyle plan can be customized further to describe the how, when and where factors that will bring them to your life.

Clarity of thought in this matter is recognizing that diligent financial planning and achieving financial security is not an end in and of itself. It’s an essential component of a successful next phase of your life – and the means to support your path to lasting renewal and fulfillment. PSN ASPS Life Member Enrique Fernandez, MD, provides more retirement preparation insight online at enriquefernandezmd.com.

Photo of Anna Maria Island at the Gulf of Mexico in 2011

by Dr. Fernandez.

An unorthodox approach: Deciding to build up while winding down

By James N. Romanelli, MD, MBA

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long expected to sunset my practice after 30 years or so, having fulfilled most financial goals: kids educated, office space paid off, retirement funded. Instead, at 65 years of age, I signed a 10-year lease on triple the office space (11,000 square feet) and we’re building-out that space to include eight exam rooms, three O.R.s and two overnight-stay suites.

This commitment took root in the pleasure of a plastic surgery practice, good health and finding great surgeons to work with. My practice remains extraordinarily rewarding – it’s still a joy to hear patients say: “You’ve changed my life.” I reduced my clinical workweek to four days and have little if any on-call. On Fridays, I work on the business of the practice and play a little golf – and my golf game reminds me I’m better off not retiring. Absolutely priceless has been the encouragement and support of my wife, Justine Lachmann, MD, an academic cardiologist.

My unusual expansion plan also flows from my decision to practice with other surgeons.

In 1990, I joined an extraordinary surgeon in my community, Alan Kisner, MD. After 10 years together I went solo, but in 2017, I was fortunate to find an excellent young surgeon, John Layliev, MD, to join me. He became a great partner, and on the strength of that partnership, I re-branded my practice from Romanelli Cosmetic Surgery to North Shore Cosmetic Surgery. With the right marketing team and website partners, we made that transition without any decline in consults or procedures.

There’s synergy in practicing with other surgeons, and I highly recommend it – pro-

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Dr. Romanelli (right) with his North Shore Cosmetic Surgery partner John Layliev, MD. vided you find the right partners. We are adding another fine surgeon this year, Yee Cheng Low, MD. It became apparent that our one AAAASF-certified O.R. was not sufficient to meet the needs of our largely cosmetic practice.

Our new facility has the capacity to support five surgeons. All three O.R.s support general anesthesia, and ancillary systems include a hospital-grade sterilizer and a high-capacity battery back-up system. (Putting a generator on the roof of the three-story building was prohibitively expensive.)

We’ll begin with no more than two simultaneous anesthesia rooms but can flip rooms to reduce turnover time. The third room will be utilized for cases under local, thus leaving examination rooms open. We chose a location

convenient for our patients and staff, adjacent to major traffic arteries.

Planning and executing this project was fortified by my experience running an AAAASF facility and the assistance of great advisors (business, financial, banking, architectural, interior design and vendors). Also key has been the input of my partner and our staff, each consulted on how to optimize patient care within their areas. There were 14 revisions to the layout of the space before the first metal stud was placed.

In 2016, I returned to school to complete the Executive MBA program at NYU Stern, which provided the tools to better manage the practice. The experience also gave me the knowledge and confidence to successfully take on this capstone project of my career.

I understand the questions that might come with taking on this kind of project at this stage in my career, chiefly: “Why take on debt and a 10-year lease at age 65?” By building a larger group practice, it’s possible to work less without increasing my overhead percentage. Plus, having additional O.R. and exam room capacity is the only way we can we grow the number of surgeons, so this is an ideal platform to further grow the practice.

At some point I will want to work three days a week. Practicing with other surgeons makes that more practical. Plus, I find that plastic surgery practice as a group is more enjoyable.

We learn from and rely upon each other.

Certainly, however, there are risks – disability, economic recession and practice disruption among them. These are managed by running the numbers, having a cushion and aligning incentives so that the practice is maintained and grows. Specifically, I analyzed the worstcase scenario: Can I still retire if I’m no longer able to practice and no one wants the lease?

Less severe scenarios were reviewed: How can we manage our expenses if cosmetic revenue declines by, say, 20 or 40 percent? My thesis is that a senior partner who supports the development and surgical volume of exceptional young partners will build a group that thrives.

Will I practice beyond the 10 years of the lease? Probably not. Nevertheless, the four five-year extensions will allow for that possibility. More likely, my partners will continue the practice within the space and the North Shore Cosmetic Surgery brand will continue. PSN Dr. Romanelli is the founder of North Shore Cosmetic Surgery, and chief of staff at Huntington Hospital, Northwell Health, in Huntington, N.Y. April/May 2022

SESPRS 65th Annual Meeting to focus on the present and future

By John T. Lindsey, MD

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he Southeastern Society of Plastic and Reconstructive Surgeons (SESPRS) 65th Annual Meeting, scheduled to take place June 11-15 in Orlando, will offer top-notch programming for aesthetic and reconstructive surgeons alike.

For doctors focused on enhancing or extending their cosmetic knowledge and skills, there will be panels on facelifting, blepharoplasty and rhinoplasty, as well as presentations on lasers and body contouring – including a laser workshop conducted by ASAPS Visiting Professor John Hoopman, MD, at 6 a.m. June 12.

The facelift panel will cover optimization of outcomes, endoscopic approaches and nonsurgical finishing touches. A panel on blepharoplasty will tackle different approaches to the lower eyelid, including a presentation on management of eyelid complications. The rhinoplasty panel will cover aesthetic and functional considerations and feature a presentation on mid-vault repair after component dorsal reduction.

More panels and programming For those favoring the more reconstructive side of our specialty, programming will include a panel on targeted muscle reinnervation focused on improving pain and function following amputation. A presentation on local versus free flap alternatives

for reconstruction of common defects will feature audience participation. A panel on abdominal wall reconstruction will cover prehabilitation; use of autogenous materials; a review of mesh applications; and vascularized composite allotransplantation (VCA). A facial reconstruction panel will feature presentations on Mohs reconstruction; soft-tissue reconstruction; computer-aided design (CAD); computer-aided manufacturing (CAM); and reanimation.

This year, SESPRS will also hold timely panel discussions such as “Incorporating Transgender Surgery Into Your Practice Safely” and “Incorporating Headache Surgery into Your Practice.”

As usual, the annual meeting will feature the perennially popular “Just the Facts” and patient safety panels, as well as Hot Topics.

We will also have 14 residents representing southeastern plastic surgery training programs vying for the coveted Glancy Award, as they will put forth their best institutional research projects for evaluation and discussion. As with all presentations, SESPRS members are encouraged to review the abstracts and data in the annual program to better prepare for the Q&A sessions. Audience participation – along with camaraderie, networking and learning – has always been a hallmark of SESPRS tradition, and this year is no exception, as additional time has been provided for these interactions.

Medical students from schools

throughout the southeastern states will once again showcase their work in the Medical Student Poster competition. Most of these students are interested in pursuing careers in plastic surgery, and they also will interact with SESPRS members in order to gain valuable insights into the specialty. All SESPRS members are encouraged to participate in the evaluation and grading of these poster presentations. The first round of both resident and medical student poster grading will be held Saturday afternoon, and the second round will be on Sunday afternoon. Residents and students will be present during these times to defend their work.

Lectures and lifestyles This year’s Upchurch Lecture will be delivered by Renato Saltz, MD, and the Pickrell Award Lecture will be given by Bruce Shack, MD, a longtime member and past president of SESPRS. The SESPRS annual meeting remains the epitome of combining academic excellence in a family-friendly learning environment. That tradition continues with this year’s keynote address, “From Penguins to Plankton – the Dramatic Impacts of Climate Change on the Ant-

arctic Peninsula,” by James McClintock, MD, the Endowed Professor of Marine and Polar Biology at the University of Alabama-Birmingham. This presentation will be a voyage to Antarctica through the eyes of a renowned investigator who recently returned from his 15th research expedition to the continent, continuously compiling decades of data and both photographic and videographic documentation. His research has been continuously funded by the National Science Foundation and has been featured in National Geographic, The Smithsonian, Discover, Scientific American and The Wall Street Journal, as well as on The Weather Channel and many others. Dr. McClintock, the author of several books including Lost Antarctica: Adventures in a Disappearing Land, will hold a limited book signing after his address. Spouses and children are encouraged to attend.

The SESPRS Program Committee would like to thank everyone for contributing to this year’s activities and presentations and helping to fulfill our mission statement: “To maintain professional excellence in the specialty of plastic surgery through quality education.” We look forward to seeing everyone in Orlando.

To register, visit sesprs.org and click on the Meetings tab.

Dr. Lindsey is SESPRS vice president and 65th Annual Scientific Meeting program chair.

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PS2 can help improve your performance reviews, process tracking, goal setting and benefits management.

April/May 2022

Learn more at ps2pm.com 29

ASPS welcomes newest members to its ranks The Society welcomed the following surgeons into ASPS on the March 2022 ballot for Active, Associate 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 Arizona

Matthew Mino, MD

British Columbia, Canada Kathryn Isaac, MD, MPH

California

Brandon Richland, MD Sepideh Saber, MD Derek Ulvila, MD Eric Wang, MD

Florida

Vincent Chavanon, MD Craig Forleiter, MD

Georgia

Stephanie Farber, MD Paul Ghareeb, MD

Mississippi

Laura Sestokas Humphries, MD Hossein Nasajpour, MD

Hawaii

Missouri

Christopher Tokin, MD

Thuan Nguyen, MD

Massachusetts

New York

Jeffrey Lee, MD

Michigan

Mihaela Elena Rapolti, MD

South Carolina Dustin Eck, MD

Texas

Ira Savetsky, MD

Alexander Kaminsky, MD, MPH

Rhode Island

Jonathan Brower, MD

FOR ASSOCIATE MEMBERSHIP California

Ali Roham, DO

Michigan

Amy DeRosa, DO

New Jersey

Pennsylvania

Arnoldo Topete Gonzalez, MD Jose de Jesus Dominguez Gonzalez, MD Eduardo Cartagena Sotres, MD Isaac Baley Spindel, MD Jose Luis Flores Valdivia, MD

South Korea

Portugal

Mario Secorun Redon, MD

Steven Davis, DO

FOR INTERNATIONAL MEMBERSHIP

Brazil

Lucas Cunha De Andrade, MD Joao Carlos Pereira Filho, MD Thiago Calado Pereira, MD Ludmila Rodrigues Ribeiro da Silva, MD Daniel de Morais Tavares, MD

Dominican Republic

Enrique Almonte Checo, MD Jesus Abreu Montero, MD

Egypt

Ahmed El Sharkawy, MD

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Italy

Fabio Quatra, MD

Japan

Ken Arashiro, MD

Mexico

André Baldin, MD Arnulfo Andrei Rios Cantu, MD Esteban Espinosa Corona, MD Stephan Davalos, MD Carlos Medina Flores, MD Luis Cesar Valencia Garcia, MD

Eduardo Miguel Craveiro Matos, MD

Russia

Sergey Zorin, MD

Svetlana Feldman, DO

Bumjin Park, MD Jung Youl Park, MD

Spain

Switzerland

Ramin Ipaktchi, MD Christian Zuber, MD, DO

April/May 2022

LETTERS TO THE EDITOR

Readers on the ‘COVID excuse’ and on recent PSN coverage ‘The Great American Resignation’ – or is it ‘The Great American Excuse for Incompetency?’

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e in the United States just passed the two-year anniversary of the start of the COVID-19 pandemic, and the healthcare crises, professional burnout, global economic shutdown, supply chain disruptions and vaccines crises that followed. Recent estimates suggest that roughly 28 percent of the “pre-pandemic” workforce never returned to employment. It has also been estimated that a similar amount of pre-pandemic employees who were financially able to retire did just that. This second group represented the most experienced senior employees in their field – often those responsible for training and mentoring the upcoming employees, and managing difficult issues or problems that might arise in their companies. At the time of writing, there are 5 million more job openings than there are unemployed people in the country, with an additional 94,000 resignations in February 2022 (for a total of more than 4 million resignations since the pandemic started).

I recently tried to assist one of my patients in settling an unpaid medical insurance claim. Either my staff or I actually telephoned every available number – only to be put on hold for hours or to hear something along the lines of: “You are number 132 in the queue.” We left messages and emails, continually receiving the new universal response of “Due to the COVID-19 pandemic, we are unavailable to answer your call or address your concerns at this time.”

I noticed that my office utility bills during the mandated office shutdown were much higher than expected, seeing that the office was closed. These higher-than-normal statements continued even after our office reopened. We contacted our utilities companies and learned that “Due to the COVID-19 pandemic, we didn’t have personnel available to read the utility meters, so we billed you the same fee for the same month in the prior year.” This has continued for more than two years, with an additional 30 percent now being added as an estimate of usage.

I’m sure that we all have similar stories. Whether it’s UPS losing breast implants, lost insurance checks in the mail or the perpetual automated response of “Mailbox full, try another number,” frustration seems to be the “new normal.” The extra costs associated with PPE, plexiglass dividers, disinfectants and

air-purification systems are unfortunately passed on to the patients. My own patients express concerns about my increased fees that are spurred by manufacturers raising prices on injectables, neurotoxins, implants and other surgical supplies. The increases continue now due to supply-chain issues and the rising price of gasoline.

How long will this continue? It is my belief that all forms of industry and government will use the COVID excuse for incompetency and inefficiency for years into the future. And, unfortunately, they’ll probably use the same excuse to hike prices whenever they so desire.

– Stephen A. Chidyllo, MD, DDS West Long Branch, N.J. Recognizing female leadership

I

was delighted to see the March issue of PSN and the recent website accolades for women plastic surgical leaders. However, I was unhappy to see the omission of Delora Mount, MD, as the first female president of ASMS. Cranio and maxillofacial surgery is perhaps the most male-dominated subspecialty of plastic surgery, which only amplifies the accomplishments of Dr. Mount. I hope that in the future, female leaders in maxillofacial plastic surgery will not be so overlooked.

– ASMS past President Andy Wexler, MD Pacific Palisades, Calif. PSN

65th ANNUAL SCIENTIFIC MEETING SOUTHEASTERN SOCIETY OF PLASTIC AND RECONSTRUCTIVE SURGEONS

MEETING HIGHLIGHTS Keynote Lecturer James McClintock, PhD From Penguins to Plankton – The Dramatic Impacts of Climate Change on the Antarctic Peninsula Upchurch Lecturer Renato Saltz, MD The Tripod of Fulfillment

FINDING THE SOLUTIONS NOW AND

SOCIAL ACTIVITIES Saturday, 11th Welcome Reception Sunday, 12th Theme Dinner - Cuban Flair

FOR THE FUTURE

Monday,13th Special SESPRS Dedicated Pool Day Tuesday, 14th Black Tie Dinner Dance

June 11 - 15, 2022 | The Four Seasons Orlando, Florida Remember to Register soon at www.sesprs.org

April/May 2022

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Editor’s Message

Continued from page 6

truth. The focus on the topic has never been more pronounced and several institutions have made burnout prevention a paramount goal.

Again, how we achieve that is up for debate, but I believe all parties recognize time as a necessary factor. Time to see your doctor or dentist for a regular check-up. Time to share a meal with friends and colleagues. Time to spend away from the hospital to enjoy nature, city life, a different location – or even just the comfort of your own home. Time to spend with family and friends and time to meet new ones.

Time is a precious commodity in the world of a plastic surgeon. We must not only make time to see patients in clinic and perform surgeries in the O.R., but also manage practices, handle administrative duties, perform research, write papers, travel to meetings, learn about the newest techniques and products,

and still carve-out the hours to focus on our own well-being. At my home institution, the University of Nevada Las Vegas, our motto is “work hard, play harder, but first work hard.”

Nevertheless, as the song says, there are only 525,600 minutes in a year.

Setting strategy The ability to prioritize is important to any plastic surgeon – determining which patients should be scheduled sooner, which resident needs more time to get them up to speed, which industry reps we need to meet and so forth. It follows that any organized plastic surgery efforts to improve wellness must prioritize the methods that will be most important to all. Again, this is easier said than done, as generational or geographical preferences will differ, but identifying what makes sense to the most amount of people is crucial.

For example, at UNLV, we failed miserably

at scheduling required wellness events. They were poorly attended and criticized for being anti-wellness because some residents simply wanted to go home and relax. We found success when we focused on what’s often seen as top priorities for all residents – free food. We now periodically choose a popular restaurant, take the residents’ orders for an appetizer, soup/ salad/flatbread, entrée and dessert, and allow them to pick it up at their leisure one day after work. No lecture or work-related associations, and more importantly, no one left out due to time constraints or clinical commitments.

This has been tremendously well-received and reminds me of a very common approach to cosmetic surgery consultations. From both the surgeon and patient perspectives, there are many things that a plastic surgeon can do technically to improve the appearance of a patient. There are also many things that the patient can tell their surgeon that they are unhappy with. It’s often not until we have the

patient focus on the three main things that can be corrected that surgeons can devise a strategy to ensure that the top priority is addressed and try to improve the others as well (given time and resources).

So what are your top three priorities when it comes to wellness? What would make a difference for you in improving your social, spiritual, emotional, familial, occupational, intellectual or even financial well-being? Not only would I love to hear this, but I think our leaders need to know this information to focus on the true priorities that can be addressed. This data will help us all to make a positive and significant impact on wellness and prevent burnout in our specialty as a whole. Please send your top three priorities and comments to richard.baynosa@unlv.edu. or PSN managing editor Paul Snyder at psnyder@plasticsurgery.org. I look forward to your feedback – and I’m excited to begin a continuing dialogue. PSN

Legislative Update Continued from page 14

WHOSE INTERESTS does your malpractice insurer have at heart?

Yet another medical liability insurer has transitioned from focusing on doctors to focusing on Wall Street. This leaves you with an important question to ask: Do you want an insurer that’s driven by investors? Or do you want an insurer that’s driven to serve you—one that’s already paid $120 million in awards to its members when they retire from the practice of medicine?

Join us and discover why delivering the best imaginable service and unrivaled rewards is at the core of who we are.

8077_ASPS_EKG_Dec2021_v1.indd 1

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to ensure that services insurers claim are “cosmetic in nature” are covered.

At press time, seven bills addressing congenital anomaly coverage are active in states including Florida, Illinois, Massachusetts, New York and Arkansas, the latter of which has a proposed rule currently under consideration. ASPS has been actively engaged in these state-level efforts, partnering with state association partners and co-signing three letters to state leaders to date.

The efforts of the New York State Society of Plastic Surgeons (NYSSPS) paved the way for legislation that stands as a model for states throughout the country.

The Give Kids a Chance – Carter’s Law mandates health insurance coverage for congenital anomalies and is the direct result of a NYSSPS campaign to expand coverage that was dubbed “1 in 38: The Campaign to Give Kids a Chance.”

Named for the statistic that in New York, one in 38 babies is born with a congenital anomaly, the campaign included a call for action to NYSSPS members and grassroots efforts urging the state’s Department of Financial Services to create new regulations that would also correct regulations governing insurance companies and their coverage of congenital anomalies.

Meanwhile, legislation in Illinois would amend the state’s insurance code to ensure that provisions requiring coverage for newborn infants include coverage for congenital defects – including treatment of craniofacial anomalies. The bill states that “the required coverage includes any services to functionally improve, repair or restore a body part involving the craniofacial area that is medically necessary to achieve normal function or appearance.”

In Arkansas, ASPS worked alongside the Southeastern Society of Plastic & Reconstructive Surgeons (SESPRS) to advocate in support of a regulation that would expand coverage for congenital anomalies in the state. In a joint letter to the Arkansas Department of Insurance, ASPS and SESPRS voiced support for the proposed rule designed to “address the problem of insurance denials for reconstructive surgery and necessary adjunctive care for children suffering from congenital or developmental deformities.”

ASPS remains committed to fighting for the expansion of congenital anomaly coverage and will continue to work closely with lawmakers, staff and coalition partners, as well as local, state and regional partners, to advance ELSA and state legislation to provide much-needed relief to families dealing with congenital anomalies. PSN

10/22/21 2:49 PM

April/May 2022

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.

Join ASPS and Save on PSTM22 in Boston!

APR IL 13-June 8

ASPS In-Service Exam For Surgeons

11-15

Southeastern Society of Plastic and Reconstructive Surgeons 65th Annual Scientific Meeting

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

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

20-24

The Aesthetic Meeting 2022

Canadian Society of Plastic Surgeons 75th Annual Meeting

• Subscriptions to premier plastic surgery publications such as PRS and PSN

San Diego Contact: (562) 799-2356 Web: surgery.org

Quebec City, Quebec, Canada Contact: (514) 843-5415 Web: plasticsurgery.ca

• Variety of educational resources on the ASPS Educational Network (ASPS EdNet)

20

17-18

Membership Benefits:

• Inclusion on Find A Surgeon featured on www.PlasticSurgery.org • Discounts on products and services to help grow your practice • CME tracking and credits (US/CAN only)

The Rhinoplasty Society Annual Meeting 2022

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

25-26

Eighth International Conference on Pediatrics

Bridging the GAPS

Ghent, Belgium Contact: +32 47 9070788 Web: gapsmeeting.com

15-Aug. 10

ASPS Life Long Learning: Aesthetic In-Service Exercise Online Contact: (800) 766-4955 Web: plasticsurgery.org/l3e Directly provided by ASPS

CALENDAR

London Contact: +44 1520 330005 Web: worldpediatricsconference.euroscicon.com

13-18

23-26

M AY 7

Royal Belgian Society For Plastic Surgery Spring Meeting Brussels, Belgium Contact: +32 47 9070788 Web: pro.rbsps.org

14

Women Plastic Surgeons Remix Webinar

PSTM22 Highlights:

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

World-renowned keynote speakers and hands-on Simulation Labs

Brussels, Belgium Contact: +32 47 9070788 Web: https://medimeet.be/product/catbbas-v/

JULY 9-21

The Aesthetic Cruise 2022

Europe Contact: (800) 364-2147 Web: meetings.theaestheticsociety.org

27-30

19-22

Four full days of programming designed for your entire practice

Fifth International Controversy Art and Technique in Breast and Body Contouring Aesthetic Surgery Meeting

California Society of Plastic Surgeons 72nd Annual Meeting La Jolla, Calif.

Contact: (978) 927-8330 Web: californiaplasticsurgeons.org

Toxins 2022: Basic Science & Clinical Aspects of Botulinum and Other Neurotoxins New Orleans Contact: (212) 500-4672 Web: neurotoxins.org/toxins-2022/

29-31

Ability to earn CME and Patient Safety Credits

Networking with peers from around the world, social events and much more!

J UN E 3-4

Ohio Valley Society of Plastic Surgeons 65th Annual Meeting Louisville Contact: (216) 375-5025 Web: ovsps.org

10-12

JOIN NOW PlasticSurgery.org/Join

April/May 2022

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

ACAPS/ASPS 8th Annual Plastic Surgery Boot Camp Tampa Contact: (847) 228-9900 Web: plasticsurgery.org Sponsored by ASPS, ACAPS

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 up-to-date information on a particular meeting, please visit the organization or corresponding meeting website – or contact the phone number provided.

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CLASSIFIEDS

OPPORTUNITIES

Is There a Shangri-la?

Solo practice for sale in Redding, Calif. It is a community of 100K surrounded by nature’s beauty where activities abound. You get tangible assets, such as equipment and supplies, and this can be financed by the owner. The practice thrives without any marketing in this underserved community. Hospital call is optional but if you enjoy all aspects of Plastic Surgery, there are opportunities salaried through the Mercy Medical Foundation. This is an excellent place to raise a family, to be involved in the community, and to establish a name and reputation for yourself. You will not waste your precious time in your car and have as much time as you like for your family and other interests. Serious candidates tired of the rat race, please email me at curtiswongmd@gmail.com for more details.

Plastic Surgeon For Clinic and Surgical Hospital in New Orleans The Center for Restorative Breast Surgery is actively seeking an exceptional Board Certified/ Board Eligible Plastic Surgeon to join our specialized group.

Contact encouraged by applicants with microsurgical experience and a focused interest in breast reconstruction. Competitive salary and generous benefit package included.

All interested candidates are encouraged to submit a cover letter along with their curriculum vitae to: The Center for Restorative Breast Surgery Attention: HR Department 1717 St. Charles Avenue New Orleans, LA 70130 Corianne.Green@scsh.com

Plastic Surgeon Massachusetts General Hospital Department of Surgery Division of Plastic and Reconstructive Surgery The Massachusetts General Hospital, an affiliate of Harvard Medical School, is conducting a search for a full-time academic plastic surgeon in the Division of Plastic and Reconstructive Surgery.

Candidates should be board eligible/certified in Plastic Surgery and Reconstructive Surgery.

Successful candidates should possess an MD or MD, PhD, excellent communication skills, and clinical expertise. Clinical interest should include Breast Reconstruction.

The incumbent will participate in all aspects of our program including clinical practice, education, and research. S/he will seek to further the teaching and research missions of the institution, and as such, must qualify for a Harvard Medical School appointment at the Assistant, Associate, or Full Professor level.

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Interested candidates should submit a letter of application and curriculum vitae to: William G. Austen, Jr, MD Chair, Search Committee Division Chief, Department of Surgery Massachusetts General Hospital 55 Fruit Street – WACC435 Boston, MA 02114 Abenigni@partners.org

https://www.breastcenter.com

FIND A PHYSICIAN CAREER TO LOVE IN PLASTIC SURGERY

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 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 to: manager@natural-lookingresults.com Greensboro Well established aesthetic surgery practice seeking BE/BC Plastic Surgeon to practice in Greensboro, NC. Ideal candidate would be 100% cosmetic focused with proficiency in face, breast and body.

Practice has fully accredited onsite surgical suite.

Candidates will receive a competitive compensation package, bonuses, benefits, and vacation.

Please submit resume and communication to: cosmeticsurgeryhrgreensboro@gmail.com

Busy Aesthetic Practice in Newport Beach is 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-square-foot 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 Rochester, N.Y. The Plastic Surgery Group of Rochester is seeking a BC/BE plastic surgeon to join our present team. Well-established 5 physician private practice in upstate NY with 3 offices and a mix of cosmetic and reconstructive cases. Procedures performed in office procedure rooms, on site ASC, and at flagship hospital of large and expanding Rochester Regional Health System. Familyfriendly community with short commute times, top-rated schools, low cost of living, access to the beautiful Finger Lakes and Lake Ontario. Highly competitive compensation with productivity bonuses and 2-3 year partnership track; surgery center with buy-in potential.

Email CV to: gail.edwards@rochesterregional.org Newport Beach Opportunity For $5,000 per month: Turn Key office, OR, first floor, reception.

Start July 1st in this “turn key” Newport Beach office, accredited OR, beautiful, first floor, the best. Contact 949-290-4795.

LOVE+ MEDICINE IS PRACTICED HERE. NOW, SO CAN YOU.

Join our physician-led, multi-specialty group practice of 900+ providers as Gundersen’s newest plastic surgeon on our main campus in La Crosse, Wis. You’ll be part of an established team of three plastic and reconstructive surgeons and two medical skin care specialists.  Newly remodeled space and equipment  Top-ranked. Physician-led health system  900+ providers across 80+ locations  Loan forgiveness, competitive compensation, generous retirement, CME opportunities and flexible schedules

FIND A CAREER TO LOVE LEARN MORE AT GUNDERSENHEALTH.ORG/ MEDCAREERS OR CONTACT BRENT WOOD AT BAWOOD@GUNDERSENHEALTH.ORG

EEO/AA/Veterans/Disabilities

34

April/May 2022

CLASSIFIEDS

Winston-Salem, NC Well-established, successful plastic surgery practice seeking BE/BC Plastic Surgeon to join our team. Cosmetically-focused practice with a strong reconstructive history offering a range of opportunities.

• Onsite AAAASF operating room • Med Spa • Family-friendly community and practice atmosphere • Easy access to mountains and beaches Please email CV to: apply@salemplasticsurgery.com Plastic Surgeon Opportunity in Upscale Palm Harbor, FL Well established, highly successful Plastic Surgery Practice with Med Spa, APRN expert injector, aestheticians, and laser services, seeks BE/ BC plastic surgeon. 10,000 sq ft facility with 2 multi-specialty OR’s fully accredited by AAAASF. Specializing in facial, cosmetic breast surgery, body contouring, and hair restoration. Loyal patient base/active email list of 6,000+. Turn-key office with dedicated team to help you succeed, including marketing, social media, nursing, and plastic surgeon to mentor, if desired. Offering attractive income guarantee and bonus structure, with fast-track partnership /ownership opportunity. Please send CV and cover letter to officemanager@lauferinstitute.com.

Tampa Bay, Florida Well established 100% aesthetic surgery practice with accredited Office Surgery Facility seeks Board Certified / eligible Plastic Surgeon.

Submit CV and inquires to BPS500@aol.com.

Premier Annapolis Plastic Surgery Practice Surgery Practice Seeks BE/BC Plastic Surgeon Well established Annapolis plastic surgery practice with over 35-year history seeks BE/BC plastic surgeon for partnership track. Practice includes AAAASF certified 2 OR surgery center as well as a thriving Medi Spa. Candidate should be energetic and motivated and have excellent interpersonal skills. Aesthetic fellowship/training is a plus but not required.

Please email CV or inquires to Amanda Freeland, Practice Administrator at: afreeland@plasticsurgeryspec.com.

Plastic Surgeon – Austin/San Antonio Aesthetic plastic surgery practice expanding and looking for a motivated, ambitious plastic surgeon to continue our growth. The practice is currently 100% aesthetic, however if the plastic surgeon is interested in reconstructive surgery it would be a great addition. The surgeon would spend their time in Austin and San Antonio.

• • • • •

Base salary Bonus opportunities based on productivity Benefits Partnership track available 100% cosmetic currently

Please email CV to: Johnny Franco at jfranco@morebeautifulyou.com.

ASPS/ASAPS B/C Plastic Surgeon retiring after 40+ years of private practice in Miami, Florida.

Nicely appointed 2,700 sq ft office, up to date AAAASF certified operating room, with new lease available.

Surgeries booked thru August 2022. Gross yearly income in excess $2 million. This practice is being offered with new concept of low down payment and 10-12 year terms. Call soon immediate sell anticipated. Inquiries to VickyPX123@gmail.com.

Midwest Solo Practice for Sale Busy cosmetic practice in a medium sized town in midwest. Great location for nature lovers and outdoors. Board certified in plastic surgery. Have all necessaries to start from day one.

AAAASF operating room for general anesthesia.

Skin care products and equipment, hydrafacial, rf microneedling, dermabrasion, fractional co2, and apogee lasers. Many other equipments.

Fully equipped office, computers and scanners in every room, digital emr, billing software, scheduling, and great trained employees.

Physician owns the free standing building with part rented to a private training facility and ample parking. Building sale negotiable. Email: plasticsurgerypracticesale964@gmail.com Poughkeepsie NY (Hudson Valley) Busy plastic surgery practice with sole practitioner is looking for a BC/BE plastic surgeon to join a 30 plus year old, 85% cosmetic, practice with a medispa. Located 90 minutes north of NYC in the beautiful Hudson Valley.

This is a fast track to owning the practice in 2-3 years position, with NO buy out required.

This is a perfect opportunity for a motivated, energetic physician to be mentored by the top plastic surgeon in the area that leads to owning your own business.

Please submit a cover letter with a current CV to: lookinggood@psohv.com Busy Private Practice in Houston, TX - Aesthetic & Reconstructive Surgery Opportunity for BC/BE Plastic Surgeon to join well-established practice with a strong reputation and high patient demand to perform aesthetic and reconstructive surgery of the face, breast, and body. Applicants with strong interest in performing breast reconstruction, cosmetic body con-

touring, and/or specializing in rhinoplasty/facial aesthetics strongly desired. The practice offers: • Team oriented environment with training/ mentorship alongside group of three prominent board-certified plastic surgeons • Ready-made patient base with large cosmetic caseload and heavy breast recon volume overflow for junior associate to get busy quickly • State-of-the-art facility with private physician offices, spacious clinic, multiple exam rooms and dedicated Med Spa area for lasers, injectables and non-surgical services • State-licensed and AAAHC accredited onsite ORs • Fully accredited AAAHC multi-speciality Ambulatory Surgery Center located one floor below, with direct access to four additional ORs • Two practice locations and new free-standing facility with ORs in process of being added • Complete administrative, billing, and marketing in-house support • Compensation • Competitive compensation models, with easily achievable 1M+ earning potential • Medical malpractice insurance • Comprehensive benefits package - Health/ Vision/Dental insurance & 401k plan • Short partnership track and Surgery Center shareholder opportunity Send CV and cover letter to: contact@memorialplasticsurgery.com.

Long Island Surgical Facility and Office For Sale

UNIQUE OPPORTUNITY TO LEAD THRIVING PLASTIC SURGERY PRACTICE WITH COMPETITIVE SALARY AND SUPERB MENTORSHIP Knoxville plastic surgeon David B. Reath, MD is partnering with H/K/B Cosmetic Surgery in Charlotte, the southeast’s premier plastic surgery group.

Updated Huntington New York plastic surgery office with AAAASF accredited surgical suite available for sale or rent. The condominium – approximately 2,800 square feet – includes 3 exam rooms and 4 consultation/ business offices. Surgical suite includes updated OR (approx. 180 sf), in wall O2 and vacuum, on roof generator and recovery room with separate exit. Ideal for one or two plastic surgeons.

Also available is adjacent space, approximately 1,100 square feet, which includes an overnight stay suite, 2 offices, 3 exam rooms, and reception area with a separate entrance. This space is amenable to ancillary services. This adjacent space is not necessary for use of the primary space but may be desired if there are 3 or more surgeons.

Availability arises as we are moving to larger space. Email James Romanelli, MD, at jr@jrcs.com or call 631-424-3600.

April/May 2022

We’re seeking an aesthetic fellowship-trained plastic surgeon to join our group and become the surgeon leader of Dr. Reath’s practice.

Dr. Reath has been one of the leading aesthetic surgery providers in Tennessee for the past 20 years. The office is fully staffed and includes a nurse injector and a medical aesthetician. There is a very large loyal patient base and an extremely busy medical spa practice. It is in a prime location in Knoxville.

The new surgeon will work alongside Dr. Reath until he retires. During this time, Dr. Reath will mentor the surgeon and work diligently to help establish their aesthetic practice. Dr. Kortesis and Dr. Bharti will also be very involved with the ongoing development of the business and the development of the surgeon.

Compensation is very competitive with a full complement of benefits. Candidates should easily be able to attain greater than 1.5MM in pay as their practices mature. There will be opportunities for academic pursuits, mentorship, teaching, and education if the candidate desires.

As we all know, starting into practice can be daunting on many levels, not the least of which can be financial. We are offering an opportunity to enter a busy, thriving practice with an established and faithful patient base. There is substantial transition time with superb mentoring and a strong compensation structure.

Interested candidates please contact: Chelsea@hkbsurgery.com.

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CLASSIFIEDS

Thriving Plastic Surgery Practice Amazing opportunity for someone to assume a thriving Plastic Surgery practice in Greenwood, SC. After building up a very successful practice over the past 30 years I have been forced to retire due to a personal health issue. The practice is the only one in Greenwood and the Lakelands area, representing a very special opportunity. Currently the practice is 80% cosmetic and 20% reconstructive. There are four months of booked cosmetic surgeries and consults on the schedule. The office has a AAAASF certified OR as well as an array of non-surgical modalities including Coolsculpting, fractionated CO2, Erbium, IPL lasers. There is an associated Skin Care clinic and waiting list for injectable patients.

Requirements: • MD/ DO • BE/BC • U.S. Citizen, H1-B, Green Card holders Benefits: • Nationally competitive financial package, 500-600k salary depending on experience • Full-time Academic Appointment • Minimal call coverage • Excellent Retirement Program • Health Insurance • Educational Benefits

Greenwood is a vibrant, growing mid-size town located in the Lakeland area of the Upstate of South Carolina. It offers a comfortable living experience with a low cost of living and a vast array of outdoor opportunities including boating, biking, hunting, fishing and hiking.

This represents a unique, turn-key opportunity for someone to assume control of a successful practice and build it in their own image.

Contact Lynn at ppsurgery@me.com or 864-223-0505.

St. Louis Brand New University Campus is Seeking Applicants in the Specialty of Plastic Surgery (Hand).

St. Louis has a rich cultural history including magnificent museums, opera houses, theaters, parks, and greenways, first rate Country Clubs (future site of The Presidents Cup), nationally ranked schools, International Blues and Film Festivals, professional sports, and an excellent cost of living.

• Moving Expenses Please email CV to jwt.dna@mindspring.com, or call J. W. Taylor at 1-800-933-1884.

Office Sharing Opportunity in Beautiful Portland, Oregon Amazing opportunity for late summer or early fall of 2022. Looking for a BC/BE Plastic Surgeon desiring a mostly hand practice (70+%) to share a medical office space with one plastic surgeon.

Option to take over the practice of a retiring Hand/Plastic surgeon, with NO buy-in. Office is in a professional medical office plaza with outpatient surgery center in building, and connected to a busy hospital. Office has two doctor’s offices with mountain views, multiple exam rooms, and two reception desks.

Outstanding opportunity for surgeon starting a new practice, or experienced surgeon looking for a new or second location.

Please submit Cover Letter and CV to mia.skourtis@providence.org

Plastic Surgeon Associate for Rapidly Expanding Plastic Surgery Practice-Beverly Hills Well-established plastic surgery practice in Beverly Hills is seeking a full-time plastic surgery associate to join our thriving practice. Stateof-the-art ambulatory center, modern facilities, professional team environment, and competitive compensation.

Eastern Pennsylvania Successful cosmetic/reconstructive practice is seeking BC/BE plastic surgeon to join our practice in Eastern Pennsylvania. Our practice includes four plastic surgeons, 1 dermatologist, I nurse practitioner, 3 physician assistants, one being an advanced patient injector and 2 licensed aestheticians.

Qualifications: The requirements listed below are representative of the knowledge, skill, and/or ability required for this position.

It is important that our next associate and partner candidate have substantial cosmetic focus during his or her residency. Compensation includes a base salary plus an incentive bonus based on productivity. In addition, we offer a comprehensive benefits package. The Company benefit package includes malpractice insurance, health, dental and vision insurance., vacation, conference allowance and organization dues. Consideration for partnership will be given after two years of employment.

• Board Certified or Board Eligible Plastic Surgeon.

• Excellent Communication and Surgical skills.

• Experience in Reconstructive and Cosmetic Procedures.

• Experience in General and Local Anesthesia Procedures.

• Excellent Bedside Manner to Build Strong Bonds with Patients.

• Looks to Exceed Patient Expectations Through Surgical Process.

Contact: careers@barrettplasticsurgery.com Washington DC-Chevy Chase Maryland Practice Looking for a BC/BE plastic surgeon to join our practice. We are a successful, well-established, busy plastic surgery practice that is balanced between cosmetic and reconstructive surgery.

We are looking for someone who is very motivated, a self-starter and interested in expanding our practice on a partner track. Preferably with microvascular competence and comfort with general cosmetic procedures. Micro fellowship not required. Please send resume and cover letter to patti@brunobrownplasticsurgery.com.

Our region offers a wide array of excellent schools and universities, and a vast metropolitan culture. The Lehigh Valley area (Allentown, Bethlehem, and Easton) offers a very reasonable cost of living and is located within 60 minutes to downtown Philadelphia and 90 minutes to New York City.

Please send cover letter and mstubbmann@asasurgery.com.

CV

Cosmetic Practice Seeks a BC Plastic Surgeon High traffic, multi-location cosmetic practice in Chicago and the surrounding suburbs seeks a BC plastic surgeon to join their respected team of surgeons.

This is an outstanding opportunity to join a practice now in its fifth decade of existence equipped with the latest technologies, a strong patient base, in-house operating rooms and a recognized, respected brand in the Chicago market

Microvascular Plastic Surgeon Opening in Portland, Oregon Unique opportunity to join an established full-scope reconstructive practice. You will be partnering with 4 other surgeons in a busy and fulfilling practice. We are seeking a BC/BE colleague who can integrate into our culture of collegiality and who can adapt to an organized model of care delivery.

Microsurgical training/experience a must.

100% Aesthetic Practice in DFW Metroplex Well-established plastic surgery practice focused exclusively on aesthetic surgery seeks junior associate to join busy growing team.

Compensation • Salary • Medical malpractice insurance • Productivity bonus • Health insurance • 401k plan • Potential future partnership opportunity Applicant • Board Certified/Board Eligible in Plastic Surgery • Passion for aesthetic surgery • Focus on patient outcomes and experience • Desire to work with a team • Love for technology About the Practice • Four fully accredited AAAASF operating rooms with two additional opening in Spring/Summer 2022 • Four locations, (Southlake, Plano, Dallas & Ft. Worth) • Three medical spas with nurse injectors, aestheticians and many laser platforms • Four Plastic Surgeons • Two Aesthetic Plastic Surgery Fellows • Four full-time anesthesia providers • Great team to help you be successful, including marketing, social media, nursing, and other plastic surgeons to mentor you Contact: All inquiries are confidential and can be submitted online via email to Sandy, V.P. of Business Development, at sandy@northtexasps.com. If you have any further questions, please feel free to reach out at 860-817-4344.

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to

• Full scope plastic & reconstructive surgery o Breast reconstruction (implant & autologous) o Functional breast reduction o Gender-affirming chest surgery o Facial Mohs reconstruction o Extremity, wounds, burn, and general reconstruction o Opportunities for Head & Neck reconstruction o Opportunities for TMR o Potential for expansion of transgender services (FFS, “bottom” surgery) o Mentorship and training of OHSU chief residents • Excellent work-life balance • Organized scheduling with surgical block time and protected time-off • On-call evenly divided across 5 partners, with no acute trauma, hand, or face calls • Seasoned clinical staff who support the growth & development of the department • Physician-directed EMR that actually improves efficiency and patient care • Leadership opportunities within a dynamic multi-specialty organization • Compensation model allows clinicians to focus on quality patient care, not RVUs or insurance appeals o Competitive salary and benefits package o Comprehensive medical and dental coverage o Industry-leading retirement programs o Shareholder track o Education leave & stipend o No direct management of practice overhead or billing • Located in Portland, Oregon, our location offers a dynamic combination of urban amenities surrounded by unparalleled outdoor activities. o Adventure awaits on the mountains, rivers, and coast o Nationally renowned food scene o Innumerable craft breweries and wineries o Vibrant arts and music scene o Professional and recreational sports, including the Blazers and Timbers Northwest Permanente, P.C. is a self-governed (physician-led), multi-specialty group of over 1500 physicians, surgeons, and clinicians, caring for over 630,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation’s pre-eminent health care systems, a benchmark for comprehensive, integrated and high-quality care with industry leading compensation.

To apply, please visit: nwpermanente.com. Please contact Shana Klemchuk, Senior Physician Recruiter, at Shana.T.Klemchuk@kp.org or 971-347-5826, with any questions. EOE

April/May 2022

CLASSIFIEDS

TRAINING

and beyond. Practice also includes a full service medical spa, which increases patient flow.

For more information and/or confidential consideration, contact Michael at 847-648-1400 or submit a cover letter and CV via email to chisurgeon@gmail.com.

Sarasota Plastic Surgery Center is Seeking BC/BE Plastic Surgeon Associate SPSC is a well-established 3 surgeon group practice that has been in existence for more than 35 years. SPSC is a 100% aesthetic surgery practice with a state licensed and Medicare-certified ambulatory surgery center, and a full service medical spa. This is a unique opportunity to join a thriving practice in a top plastic surgery market with a continuous flow of patients and excellent clinical, administrative and marketing teams.

SPSC’s high demand offers the opportunity to perform both reconstructive and cosmetic surgery of the face, breast and body; with plans to rapidly transition to an all cosmetic surgery practice.

Located on the gulf coast of Florida this premier location offers diverse cultural dining options, great entertainment, and excellent neighborhoods to raise a family.

Fellowship in aesthetic surgery is a requirement for joining our practice.

Forward CV and cover letter to: David Mobley, MD: david.mobleymd@yahoo.com, Scott Engel, MD: sengelmd@gmail.com Brian M. Derby, MD: bderbymd@gmail.com, or Devonne LaBonte, Administrator Sarasota Plastic Surgery Center 2255 S. Tamiami Trail Sarasota, FL 34239

Beaumont Integrated Reconstructive Microsurgery and Craniofacial/Skull Base Fellowship (CMF Micro) The Division of Plastic and Reconstructive Surgery at Beaumont Health offers a 1- year fellowship combining microsurgery & craniofacial and skull base 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), skull base exposure and reconstruction, 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.

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.

For Further information please contact Dr. Kongkrit Chaiyasate directly at kongkrit.chaiyasate@beaumont.org.

Oregon - Aesthetic Fellowship Opening July 2023 Aesthetic Society endorsed aesthetic Fellowship that includes a full spectrum of aesthetic surgery services within an established successful private practice setting. The experience entails broad, hands on 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. This Fellowship also has a strong mentorship component with monthly formal lectures/journal clubs. There will also be opportunities to enhance education and training via nationally organized meetings and local preceptorships.

Applicants to the Fellowship program must have completed a residency in a plastic surgery program accredited by the ACGME and be board

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

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

April/May 2022

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

Opportunity 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.

Harvard/Brigham & Women’s Hospital Complex Gender & Microsurgery Fellowship BWH Plastic Surgery is accepting applications for its gender surgery fellowship (start date July 2023). Experience is provided in all core procedures, including phalloplasty, metoidioplasty, vaginoplasty, non-gender microsurgical urogenital reconstruction and craniofacial feminization across four core faculty. Program leadership training is also available in a growing multidisciplinary program. The fellow will hold a faculty attending appointment as Clinical Instructor with opportunities for graduated independence.

Forward CV to: Dr. Devin O’Brien Coon 75 Francis St Boston, MA 02115 Email: mnoyes2@partners.org

MISCELLANEOUS Office Space Rental, San Francisco Shared office space to rent 4 days a week in historic 450 Sutter building near Union Square.

Great opportunity for plastic surgeon looking to expand or start their practice in the Bay Area. If interested, please contact Chelsie at the office of Dr. Delgado (415) 898-4161.

Classified Ad Policy

Ad Rates

CONTACT

Interview

For inquiries, contact niloo@drmovassaghi.com

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.

» » » » »

Plastic/Reconstructive Opportunity with Partnership Track Long Island & NYC

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. Health insurance and malpractice insurance are provided.

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.

■ 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

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

37

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.

A PENCHANT FOR WRITING – WITH A LEGEND’S ENCOURAGEMENT

W

hen Mine Kurtay, MD, Naples, Fla., decided to try her hand at writing books, she found encouragement from one of the most prominent voices in plastic surgery: Robert Goldwyn, MD, the esteemed PRS journal editor.

“Dr. Goldwyn, my dear colleague, once told me: ‘Mine, you’ve done good – you’ve put black on white.’

It was his very nice way of complimenting me,” Dr. Kurtay says. Her first name is pronounced “min-AE,” which became integral to the title of her memoir, Stories of Mine, her third book to date. The book was recently published in her native country of Turkey – and translated to Turkish – but the title became a point of contention with her Turkish editor. “He wanted to change it to Mine’s Stories; he didn’t see the difference with Stories of Mine. The book contains anecdotes that I’ve gathered throughout my life and as a plastic surgeon, and I preferred the ‘double meaning’ of Stories of Mine.”

Following her previous books, Luigi’s Birds and Too Much Loyalty, Stories of Mine comprises 200 pages and 90 short stories, the subject matter of which covers more than four decades of plastic surgery practice.

“All plastic surgeons have a lot of tales based on the funny things that happen every day and that can result from the misunderstanding between Dr. Kurtay’s latest book, Stories of Mine, was recently patients and doctors,” she tells published in her home country of Turkey.

PSN. “Writing comes with inspiration, and if you’re not in the mood, it doesn’t come to you,” she adds. “You have to be in the right mindset and suddenly, it flows. I didn’t have any trouble writing this book – the stories were there.”

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.

In this issue, we present ASPS member Anand Kumar, MD, Cleveland, who specializes in pediatric craniofacial surgery at Case Western Reserve University School of Medicine. A member of the Society’s Military Plastic Surgeons Steering and Resident Curriculum Development committees, PRS Global Open Editorial Board and Conflict of Interest Disclosure Review Group, as well as several past ASPS panels, Dr. Kumar was discharged from the U.S. Navy with the rank of commander. He served as staff pediatric surgeon and director of the Military Craniofacial Unit at Walter Reed Medical Center, Bethesda, Md., and served aboard the U.S. Naval Support Hospital Ship Comfort. Dr. Kumar tore himself away from a popular but disturbing podcast to answer the following questions for PSN: If I had to start my career over, I would... Consider law as a career. I’ve always advocated for giving patients the right to feel good and achieve their best possible life.

Medicine is a wonderful way to connect and advocate for underserved people – but so is the law.

The single-greatest contribution to plastic surgery was...

The development of the flap, of course. Every operation we do incorporates some type of flap, even orthognathic surgery.

The first website I check every morning is... My Apple stock page. I constantly scheme about the stock market, opportunities for investment and, most importantly, my financial exit strategy.

My all-time favorite movie is... A Few Good Men. This classic movie has it all: Navy dress blues, Navy summer Anand Kumar, MD whites, intrigue, murder, the fight for justice, honor, ethics, morals and standing up for the weak – and it’s incredibly entertaining. It has some of Jack Nicholson’s best lines, such as: “You can’t handle the truth.”

The last podcast I listened to was... “Dr. Death.” It’s a cautionary tale of medical training and the deadly consequences of accepting mediocrity, passing people through to avoid conflict and losing our way as doctors.

Dr. Kurtay considers writing to be a more forgiving endeavor than plastic surgery, because words can be corrected easily and with no penalty. “In the O.R., you depend on your skills and knowledge, the people assisting you and the patient’s healing capacity – and on the higher powers,” she says. “There have been times I thought I completed an excellent case, but the patient didn’t like it. Other times, I’ve thought I’d done the worst of all, but the patient was very happy.

The best part of next weekend will be... Spending the morning with Candace, my wife of 22 years – drinking coffee, discussing politics, the constant change in healthcare economics, what we are having for lunch, playing with Popeye, my one-eyed cat and his three-legged brother (Peter the cat), or calling my parents and sister to catch up. It’s the simple pleasures of life that never get old.

“But writing has its own uncertainty,” she says. “You never really know whether what you’ve written is good or not. That’s left to the reader, but some people are not easily satisfied. My advice for budding writers is: Do what makes you happy without being selfish about it. If you have the time, desire and means, and it doesn’t hinder anyone else, go for it. What other people think shouldn’t influence you, if you have that urge inside.”

I seriously collect... Port wines, Champagne and Davidoff cigars. I enjoy a proper aperitif and digestif to complement a formal meal – and ending with a Davidoff Special T cigar is the final touch.

Dr. Kurtay, who moved to Florida in 2000 after nearly three decades in Cleveland, left full-time practice in February – and she’s philosophical about the coming chapters in her life. “I don’t know what the future holds in retirement other than to write more, but I’ll never introduce myself as ‘retired’ when someone asks what I do,” she says. “I am and will always be a doctor. I wish that attitude upon my colleagues who are still young and working.” PSN

20 YEARS AGO IN PSN Supervision of certified registered nurse anesthetists (CRNAs) became a heated topic in the wake of a January 2002 report in The New York Times and a CMS rule that CRNAs must be supervised by a physician (either the operating doctor or an anesthesiologist). In some cases, doctors felt an increased burden in having to supervise when they felt they could be of better use elsewhere. ASPS supported the rights of its members to choose the type of anesthesia provider that best suited their practice needs, a matter discussed at length in the April 2002 issue of PSN: “We want to do what’s necessary to allow CRNAs to work in areas where they are needed – we feel that CRNAs are an important part of anesthesia care.”

– 1997 ASPS President Ronald Iverson, MD Danville, Calif. PSN

38

The best vacation I ever took was... To the Maldives recently with Candace, in celebration of our wedding anniversary and her birth. It was incredible! The people, the water, the food, the service and being close to India made it special.

During the shutdown, something outside of medicine that I worked on was... My physical readiness, running and improving my cardiovascular health. The pandemic highlighted just how important personal health is and how it affects your ability to be resilient to infection and stress.

The best thing a grateful patient ever gave me was...

A Marine Corp Kabar knife. During Operation Iraqi Freedom, I supported the 2nd Marine Division through operation Phantom Fury and the 2nd Battle of Falluja. My Marines gave me very personal tokens of their appreciation (Globe and Anchors, Kabars, etc.) in gratitude for healing them. It’s an honor to be a Navy physician and care for Dr. Kumar and his wife, Candace, during a stroll along the coast during their recent trip to the true American heroes.

Maldives in celebration of her birthday and their anniversary.

The biggest surprise I ever had in the O.R. was... During my time in the Navy in support of Operation Iraqi Freedom. I removed a piece of tibia from the patient’s maxillary sinus that came from another man in front of the column. It took me some time to process this.

War is an awful teacher. Its lessons are not lost on me.

The words I try to live by are... “There’s always room at the top; it’s just really crowded at the bottom!” per Henry Kawamoto, MD, circa 2002. I asked Dr. Kawamoto if I should do craniofacial surgery, knowing the limited number of jobs available. His answered said it all. The constant striving for excellence, “patient-first” advocacy and personal integrity that I witnessed during those early training years shaped much of my life’s doctrine. PSN April/May 2022

Educate your patients.

Elevate your practice. with ASPS Patient Education Brochures Exclusively available for ASPS members, our public education brochures arm your prospective patients with high-quality medical information that you can trust. With two full lines of printed brochures, plus e-brochure offerings, you can pick the style of brochure that works best for your practice. Find everything you need with ASPS.

eNLIGHTEN e-brochures also available!

ShopASPS.com April/May 2022

39

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1. 1.1 MemoryShape Post-Approval Cohort Study (formerly Contour Profile Gel Core Study) Final Clinical Study Report. Mentor Worldwide, LLC; 02 June 2015. 1.2 MemoryGel Core Gel Clinical Study Final Report.

Mentor Worldwide, LLC; April 2013. 1.3 Mentor MemoryShape Post-Approval Continued Access Study (formerly Contour Profile Gel Continued Access Study), Final Report. October 2014. 1.4 Mentor MemoryGel Breast Implant Large Post Approval Study Re-Op Phase Annual Report. 17 June 2016. 1.5 Adjunct Study Final Report for Mentor’s MemoryGel Silicone Gel-filled Breast Implants. 02 November 2012. 1.6 Mentor MemoryShape CPG Styles Study: A Study of the Safety of the Contour Profile Gel Breast Implants in Subjects who are Undergoing Primary Breast Augmentation, Primary Breast Reconstruction or Revision, Final Clinical Study Report. 20 October 2015. 2. Mentor Worldwide LLC. Mentor Worldwide Sales Data – 2019. 3. Based on patient survey at 10 years in the Mentor® MemoryGel® Breast Implant 10-Year Core Gel Clincial Study Final Report. Mentor Worldwide LLC. MemoryGel® Core Gel Clinical Study Final Report, April 2013. 4. Summary of the Safety and Effectiveness of Mentor’s MemoryGel® Silicone Gel-Filled Implants in Patients who are Undergoing Primary Breast Augmentation, Primary Breast Reconstruction, or Revision. 10-Year Core Gel Final Clinical Study Report. April 2013. 5. MemoryGel® Post Approval Study Seventh Annual Report, November 5, 2013. 6. Adjunct Study Final Report for Mentor’s MemoryGel® Silicone Gel-Filled Breast Implants, 02 November 2012. 7. Mentor Worldwide, LLC. MemoryShape™ Post-Approval Cohort Study (formerly Contour Profile Gel Core Study) Final Clinical Study Report. 02 June 2015. 8. Mentor Becker Expander/Breast Implant Clinical Trial 2013 Annual Report. 9. Adjunct Study Annual Report for Mentor’s Becker Adjustable Breast Implants: Year 18 (September 1992-November 2010) October 3, 2011. 10. CPG Styles Study: A Study of the Safety of the Contour Profile Gel Breast Implants in Subjects who are Undergoing Primary Breast Augmentation, Primary Breast Reconstruction, or Revision. 2015. 11. MemoryShape™ Post-Approval Continued Access Study (formerly Contour Profile Gel Continued Access Study). 2014. 12. Athena Study annual report (Sept 2018): A Study of the Safety and Effectiveness of the Mentor® Smooth and Textured Larger Size MemoryGel® Ultra High Profile (UHP-L) Breast Implants in Subjects who are Undergoing Primary Breast Reconstruction or Revision Reconstruction. 13. Glow Study annual report (Feb 2018): Memory Gel and Shape Combined Cohort Post Approval Study. 14. Head-to-head blinded in-person tabletop product comparison (MemoryGel Xtra vs. Inspira Responsive vs. Inspira Cohesive) with 452 respondents. Mentor Consumer Preference Market Research Report - July 2017.

IMPORTANT SAFETY INFORMATION The MENTOR® Collection of Breast Implants are indicated for breast augmentation - in women who are at least 22 years old for MENTOR® MemoryGel® Breast Implants or MENTOR® MemoryShape® Breast Implants, and at least 18 years old for MENTOR® Saline Breast Implants.Breast implant surgery should not be performed in women: With active infection anywhere in their body; With existing cancer or pre-cancer of their breast who have not received adequate treatment for those conditions; Who are currently pregnant or nursing. Safety and effectiveness have not been established in patients with autoimmune diseases (for example lupus and scleroderma), a weakened immune system, conditions that interfere with wound healing and blood clotting, or reduced blood supply to breast tissue. Patients with a diagnosis of depression, or other mental health disorders, should wait until resolution or stabilization of these conditions prior to undergoing breast implantation surgery. There are risks associated with breast implant surgery. You should be aware that breast implants are not lifetime devices and breast implantation may not be a one-time surgery. You may need additional unplanned surgeries on your breasts because of complications or unacceptable cosmetic outcomes. Many of the changes to your breast following implantation are irreversible (cannot be undone) and breast implants may affect your ability to breastfeed, either by reducing or eliminating milk production. Breast implants are not lifetime devices and breast implantation may not be a one-time surgery. The most common complications for breast augmentation with MemoryGel® Implants include any reoperation, capsular contracture, nipple sensation changes, and implant removal with or without replacement. The most common complications with MemoryShape® Implants for breast augmentation include reoperation for any reason, implant removal with or without replacement, and ptosis. A lower risk of complication is rupture. The health consequences of a ruptured silicone gel breast implant have not been fully established. MRI screenings are recommended three years after initial implant surgery and then every two years after to detect silent rupture. Detailed information regarding the risks and benefits associated with MENTOR® Breast Implants is provided in several educational brochures. For MemoryGel® Implants: Important Information for Augmentation Patients about MENTOR® MemoryGel® Breast Implants.

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.

Mentor Worldwide, LLC | Irvine, CA 92618 USA © Mentor Worldwide, LLC 2020 136012-200401