Aesthetic Training in Plastic Surgery Residency

A 10-Year Analysis of Resident Aesthetic Surgery Clinic: Abdominoplasty Performed by Residents Is Safe and Leads to Comparable Outcomes to Attending Surgeons

INTRODUCTION

Resident-led aesthetic clinics have been introduced in plastic surgery training programs to enhance residents' experience in cosmetic procedures. Although these clinics provide valuable hands-on training, concerns regarding the safety of resident-led surgeries, such as abdominoplasty, remain. This study aims to evaluate the safety of abdominoplasty performed by residents compared to those performed by attending surgeons.

METHODS

A retrospective cohort study was conducted for abdominoplasty cases performed at a single academic center between 2012 and 2022. Cases were categorized based on whether the primary surgeon was a resident or an attending physician. Patient demographics, operative details, and complications (both acute and long-term) were collected and statistically analyzed. Outcomes were compared using comparative statistics and regression analysis.

RESULTS

A total of 89 abdominoplasty cases were reviewed, with 49 led by attending physicians and 40 by residents under supervision. There was no statistically significant difference in overall complication rates between the 2 groups (P > 0.05). Resident-led cases had a longer operative time (P < 0.0001) and more frequent concurrent liposuction (P < 0.001). Despite these differences, acute complications, such as seroma and hematoma, and long-term complications, such as hypertrophic scarring and skin necrosis, were comparable between groups, supporting the noninferiority of resident-led procedures.

CONCLUSIONS

The outcomes of abdominoplasties performed by residents in a supervised clinic were comparable to those conducted by attending surgeons, affirming the safety of resident-led aesthetic clinics. These findings support the integration of resident clinics into plastic surgery training, where they offer significant educational benefits and maintain high standards of patient care. Further multicenter studies are recommended to corroborate these findings and assess additional outcome measures, such as patient satisfaction.

Aesthetic Specialization: A Comparative Study across Medical and Surgical Specialties

BACKGROUND

Postresidency fellowship training has become increasingly popular as a career option. Specifically, the subspecialty of aesthetic surgery has grown tremendously over the past 2 decades within several fields, including plastic and reconstructive surgery (PRS), otolaryngology, dermatology, and ophthalmology. However, the popularity of aesthetic specialization through fellowship remains unknown. The present study aims to analyze trends in aesthetic specialization across these specialties and compare its popularity to other fellowships.

METHODS

A retrospective review of data from the San Francisco Match, National Resident Matching Program, American Society for Dermatologic Surgery, and the Accreditation Council for Graduate Medical Education was performed. Data on graduating residents and applicants to fellowship were collected. Analysis of variance and t tests were used to compare differences between groups.

RESULTS

Significant disparities were observed in applicants and matched applicants to aesthetic fellowships among the 4 residencies ( P < 0.001). Aesthetic fellowship was the most popular option after otolaryngology residency (12.5% to 27%, depending on the year) and the second most popular choice after PRS (8% to 17%) and dermatology (2% to 5%). A comparison between PRS and otolaryngology demonstrated a significantly higher percentage of the latter choosing aesthetic fellowship over time ( P < 0.001). However, no significant difference in applicants to aesthetic fellowship was found between dermatology and ophthalmology ( t test, P = 0.060).

CONCLUSIONS

The number of applicants to aesthetic fellowship has increased over time across all eligible residencies with the more surgery-heavy specialties (otolaryngology and PRS) having the highest percentage of applicants. Differences in aesthetic training between fields was also observed, which may reflect underlying variations in training and residency exposure.

Lasers, Light, and Energy-Based Devices in Plastic Surgery: A 3-Year Review of a Resident Cosmetic Clinic Experience

Background

The increasing utilization of laser and light-based technologies in plastic surgery has heightened the need for comprehensive training programs within residency programs, allowing trainees to remain competitive in the cosmetic medicine field.

Objectives

This review intends to describe our trainees' experience with lasers in their last 2 years of training while participating in their resident cosmetic clinic.

Methods

This retrospective chart review examines laser procedures conducted from 2021 to 2023 within the Resident Cosmetic Clinic at the study institution. Data were gathered from internal records and patient charts, focusing on demographics, procedure types, complication rates, and training structures.

Results

This study analyzed 162 resident cosmetic laser, light-based device, and radiofrequency cases between 2021 and 2023. There were 90 patients with an average age of 46.8 years with the majority being females (95.6%). Intense pulsed light was the most frequently used modality used in 46.01% of procedures. The overall complication rate was 6.17%.

Conclusions

The findings suggest that resident laser clinics, under proper supervision, provide a safe and effective training ground for future plastic surgeons. This study underscores the need for standardized and comprehensive education to enhance resident knowledge and skills in laser and other energy-based devices.

Level of Evidence 3 Therapeutic

Complications of Chemical Peels, Lasers, and Energy-Based Device Procedures Performed by Core Cosmetic Physicians: A Retrospective Analysis

BACKGROUND

There has been a proliferation of physicians of different levels of experience and training offering nonsurgical cosmetic procedures. Rising demand, compounded by increasing utilization of new and existing technologies by numerous physician specialties, compels discussion of adequate standardized training and patient safety.

METHODS

A retrospective chart review of patients who presented to our single site dermatology clinic for managment of complications following chemical peel, laser or energy-based device treatments performed by core cosmetic physicians between the years of 2013 and 2024 was conducted. Core cosmetic physicians included plastic surgery, facial surgery/otolaryngology, oculoplastic surgery, and dermatology. Charts were reviewed for documentation of the type of complication, procedure causing the complication, and physician credentials, and referral source.

RESULTS

Twenty-five patients were identified as having complications from chemical peeling, laser treatment or energy-based devices. Devices implicated included CO2 laser (fractional or fully ablative), chemical peels, 1064 nm long-pulsed Nd:YAG laser, 1320 nm Nd:YAG laser, intense pulsed light, 595 nm pulsed dye laser, Q-switched Nd:YAG laser, radiofrequency with and without microneedling, and 1550 nm erbium-doped fiber laser. Complications included hypertrophic scarring, atrophic scarring, post-inflammatory erythema, post-inflammatory hyperpigmentation, and post-inflammatory hypopigmentation.

CONCLUSIONS

Even in experienced hands, complications can arise. It is imperative that all physicians offering cosmetic treatments are equipped to recognize clinical endpoints, identify and manage complications, or make a timely referral to decrease the risk of a permanent and potentially devastating esthetic outcome for patients.

Exploring Trends in Immediate Postresidency Career Paths: A Multi-year Analysis of Plastic Surgery Resident Graduates Across the United States

Background

Plastic surgery is one of the most diverse specialties in medicine. Because of the competitiveness of plastic surgery residency, applicants are entering the field with increased experience and more developed interests in specific specialties. Programs and prospective applicants may find it beneficial to know trends in the career paths of recent graduates.

Objectives

To identify trends in postresidency career paths for plastic surgery graduates.

Methods

Data from all integrated plastic surgery residency programs were analyzed from 2013 to 2022. Eighty-eight residency programs were analyzed for review. Residency websites were the primary source of data. Postresidency career paths were categorized into subspecialty fellowships, academic practice, or private practice. Secondary data included program rank, size of the program, associated fellowship program, associated independent program, and program location.

Results

Seventy-three programs met the inclusion criteria. Private practice was the most common immediate postgraduation path. Microvascular and aesthetic fellowships demonstrated maximum growth in the last 10 years, followed by hand fellowships. Programs ranked in the top 25 by Doximity reputation were significantly associated with graduates going into craniofacial (P = .05) and microvascular fellowship (P = .021), and immediate academic practice (P = .011). Lower-ranked programs were correlated with higher levels of graduates entering directly into private/community hospital practice (ρ = 0.327).

Conclusions

Life after residency is a necessary consideration for training physicians. Understanding trends in postresidency career paths could help programs and prospective applicants make more informed decisions on what programs may offer the best opportunities to pursue their desired career path.

Level of Evidence 5

A SWOT Analysis of Hot Topics in Plastic Surgery Resident Education: Consensus From the ACAPS 10th Annual Winter Meeting

Background

With the aim of facilitating a critical self-reflection on how to align plastic surgery education with making excellent plastic surgeons, a rotating small-group session followed by live interactive audience polling was used to perform a SWOT (strengths, weaknesses, opportunities, and threats) analysis at the 10th Annual American Council of Academic Plastic Surgeons Winter Meeting.

Methods

The final day of the conference included a 3-hour session of rotating small groups followed by live interactive audience polls discussing the following six relevant educational topics: the Plastic Surgery Common Application and resident selection, aesthetic surgery education, leadership development and business education, embedded fellowships and focused training, mentorship, and faculty retention.

Results

A total of 60 individuals participated in the activity. A SWOT analysis was successfully performed for each educational topic, and a minimum of four opportunities were identified per topic to help guide future endeavors. Examples of opportunities include releasing recommendations for the implementation of holistic review; developing formal guidelines for aesthetic surgery education in residency via collaboration between ACAPS, American Society of Plastic Surgeons, and The Aesthetic Society; creating extended focused elective rotations; integrating business education into formal curricula for all training levels; enforcing transparency regarding position expectations and offerings including salary, call schedule, and current challenges; and more.

Conclusion

The results of this study will help guide future initiatives by the ACAPS to improve resident education and academic retention.

Interest of Oral and Maxillofacial Surgeons Towards Specialised Training in Facial Aesthetic and Plastic Surgery in India - An Evaluative Study

Introduction

The Dental Council of India has included facial plastic surgery in the scope of practice of Oral and Maxillofacial Surgeons (OMFSs) in India. However, the knowledge and interests of these specialists towards facial plastic surgery are unexplored.

Materials and Methods

A descriptive cross-sectional study consisting of a structured questionnaire tool with six domains and 46 questions was circulated amongst registered OMFSs in India. The study consisted of 950 participants. The data obtained from this questionnaire were coded and entered into Statistical Package for Social Sciences (SPSS) and a descriptive analysis was conducted.

Results

The study yielded that only 33% of the participants were completely aware of facial fillers and 30.5% were aware of Botox procedure. However, there was complete awareness of blepharoplasty in 42%, cheiloplasty/palatoplasty in 65.8%, laser facial resurfacing in 23.7% and facial rejuvenation in 23.5% of the participants.

Discussion

It was found that a high number of OMFSs felt that their exposure to plastic surgery during their post-graduation years was not sufficient.

Aesthetic training concept during plastic surgery residency - Opportunity or risk?

Background

Aesthetic surgery training renders to be challenging to acquire sufficient hands-on experience during residency. To resolve this problem, the "Munich Model" was established in our clinic: Senior residents perform aesthetic surgeries, supervised by an experienced plastic surgeon while patients benefit from reduced surgery costs. With this model, we hypothesize no significant differences in the postoperative outcome between procedures performed by residents and plastic surgeons.

Methods

Between August 2012 and December 2017, 481 aesthetic surgeries were included in this retrospective single-center study, of which 283 were performed by residents and 198 by plastic surgeons. Procedures included mastopexy, abdominoplasty, extremity lift, breast reduction, breast augmentation, facial surgery, aesthetic liposuction and lipedema liposuction. Postoperative outcomes were compared regarding surgery time, time of drain removal, inpatient length of stay, duration of wound healing, perioperative blood loss and occurrence of major (surgical revision needed) and minor complications (no surgery needed).

Results

We found no significant differences in aesthetic surgical procedures between residents and board-certified plastic surgeons in the outcome measures of surgery duration, time of drain removal, inpatient length of stay, perioperative blood loss and complication rate, including major and minor complications. Only the inpatient stay was prolonged in aesthetic liposuctions performed by residents.

Conclusion

This study demonstrates comparatively that supervised aesthetic surgeries at a university hospital utilizing the "Munich Model" widely meet the specialist surgeons' standards.

Evaluation of a Plastic and Reconstructive Surgery Resident Non-surgical Cosmetic Clinic Experience

INTRODUCTION

An important component of plastic surgery residency training is independent cosmetic patient management. A resident cosmetic clinic was created at Oregon Health & Science University in 2007 to expand this experience. The cosmetic clinic has traditionally been most successful in offering nonsurgical facial rejuvenation with neuromodulators and soft tissue fillers. This study focuses on the demographics of the patient population and the treatments provided over a 5-year period and compares this experience to those of the same program's attending cosmetic clinics.

METHODS

A retrospective chart review of all patients seen at Oregon Health & Science University's Plastic and Reconstructive Surgery Resident Cosmetic Clinic between January 1, 2017, and December 31, 2021 was performed. Patient demographics, type of injectable received (neuromodulator versus soft tissue filler), location of injection, and additional cosmetic procedures were evaluated.

RESULTS

Two hundred patients met the study criteria, which included 114 seen in the resident clinic (RC), 31 seen in attending clinic (AC), and 55 patients seen in both. A primary analysis compared the two groups seen in the resident and attending only clinics. The average age of patients seen in the RC was younger, 45 versus 51.5 (P ≤ 0.05). There was a trend toward more patients in the RC being involved in healthcare as compared to those patients seen in the AC, but this difference was not found to be statistically significant. The median number of neuromodulator visits in the RC was 2 (1, 4) versus 1 (1, 2) in the AC (P ≤ 0.05) The most common location for neuromodulator injections in both clinics was the corrugators.

CONCLUSIONS

Patients in the resident cosmetic clinic were younger females, most receiving neuromodulator injections. No statistically significant differences were identified in patient population, injections received, and location of injections between the two clinics, indicating a similar trainee skill set and patient care plan between the two clinics.

Development of Competencies in Oral and Maxillofacial Surgery Training

The goal of graduate surgical education is to ensure that the graduate is competent to practice in his or her chosen specialty. Traditionally, surgical learning has been based on an apprenticeship model; that is, the long-term observation and assessment of the trainee over a prolonged period of time. Patient expectations, work hour restrictions, and expectations of increased faculty oversight have led to decreased resident autonomy and independence. Graduates completing surgical training with less surgical autonomy may have lower clinical competence, which may affect patient safety, patient outcomes, and career satisfaction. This will require the modification of current assessment and training methods.

A Systematic Review on the Implementation and Educational Value of Resident Aesthetic Clinics

BACKGROUND

Resident aesthetic clinics (RACs) provide plastic surgery residents with hands-on aesthetic surgery training. Although RACs have demonstrated successful surgical outcomes without compromising patient care, few studies have evaluated the efficacy or educational value of RACs to increase resident confidence and competence in procedures. In addition, clinic structures vary widely among institutions, with each clinic offering a unique patient volume, caseload, and degree of resident autonomy that impacts the clinic's educational value. This systematic review identifies existing RAC practices, compares clinic structures, and proposes a curriculum framework to maximize educational value for residents.

METHODS

Following PRISMA guidelines, we performed a systematic review of plastic surgery residency training program RACs. We queried PubMed, Embase, and Web of Science from January 2000 to April 2020. Eligible articles were original articles that discussed RAC structure and educational value. Data abstracted included details on clinic structure (eg, volume, location, cost, clinic operations) and trainee-perceived educational value (eg, resident satisfaction, resident confidence in procedures).

RESULTS

Of 1199 identified publications, 10 met the inclusion criteria: 6 single-site studies and 4 national survey studies. Among the single-site studies, annual volumes ranged from 22 to 68 patients/year and 35 to 81 cases/year. Resident aesthetic clinics were all staffed by full-time academic faculty (100%); one-third also were staffed by adjunct faculty and 17% also by community plastic surgeons. Resident involvement varied by hours in clinic and degree of autonomy. The survey studies found that RACs increase resident confidence and competence in performing aesthetic procedures and identified critical challenges to RAC implementation (eg, financial viability, continuity of care) that limited RAC educational value. Based on this review's findings, we propose a 6-step RAC curriculum framework for training programs seeking to establish an RAC and maximize the clinic's educational value.

CONCLUSIONS

Resident aesthetic clinics are increasingly important for providing plastic surgery residents with aesthetic training. Patient and case volume, degree of resident autonomy, and clinic attending physicians are critical determinants of the educational value of RACs. We hope our findings can aid plastic surgery training programs in better organizing educational and sustainable RACs.

A Systematic Review of Aesthetic Surgery Training Within Plastic Surgery Training Programs in the USA: An In-Depth Analysis and Practical Reference

BACKGROUND

The importance of aesthetic surgery exposure for plastic and reconstructive trainees has been recently validated by the expansion of case requirements for aesthetic procedures from 50 to 150, as well as resident-driven desire for increased cosmetic exposure throughout training. We aim to systematically review the literature at a national level to report on overall trends in aesthetic surgery training within PRS residencies.

METHODS

A literature search of PubMed, Embase, and Scopus identified all English articles published in the USA between 2000 and 2020, using a combination of "aesthetic surgery", "cosmetic surgery", "plastic surgery", "residency and internship", "education", and "training."

RESULTS

Our initial search resulted in 415 articles. After review of inclusion and exclusion criteria, in addition to cross-referencing, 41 studies remained, including 15 studies discussing resident and/or program director surveys, eight studies discussing teaching methods, sixteen studies discussing dedicated resident clinics, four studies discussing cosmetic/aesthetic fellowships, three studies discussing cosmetic practice patterns, and eleven studies discussing patient outcomes.

CONCLUSION

Current literature demonstrates that there are gaps in aesthetic surgery training for PRS residents in the USA, including facial and neck surgeries and non-surgical interventions. Resident clinics have clear benefits for resident education, without sacrificing patient outcomes. Residency programs should consider the development of a resident cosmetic clinic and/or dedicated cosmetic center to increase surgical exposure and increase trainee comfort in providing this subset of procedures. Published literature is limited in consistency of methods of evaluation, and further in-depth analysis of case volume and diversity at training programs within the USA and internationally is indicated.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Consumer Awareness and Comfort with Resident-run Cosmetic Clinics: A Crowdsourcing Study

Background:

Resident cosmetic clinics (RCCs) are the training modality of choice among both residents and faculty and are a mainstay at most residency programs.^1–4 Despite this, knowledge of RCCs among plastic surgery consumers remains untested. We hypothesize that the public would be aware of and receptive to RCCs.

Methods:

Participants with prior cosmetic procedures or interest in future cosmetic procedures were recruited using Amazon Mechanical Turk and asked to complete a survey in September 2020. First, prior awareness of RCCs was assessed. After a brief description of RCCs, perceptions of safety and preferences for care were assessed.

Results:

After screening for quality, 815 responses were included. Forty-five percent of consumers were aware of RCCs. Seventy-six percent of consumers believed that RCCs were just as safe as attending clinics and 65% were comfortable receiving care from fourth-year residents or higher. Belief in RCC safety was associated with 4.8 times higher odds of feeling comfortable receiving care at an RCC [95% confidence interval (3.3–7.1), P < 0.001]. When given a hypothetical choice between residents and attendings in two scenarios, 46% of consumers chose residents for abdominoplasty and 60% chose residents for Botox injections. Belief in RCC safety was associated with choosing a resident or being indifferent in both scenarios.

Conclusions:

Consumer preference regarding RCCs has largely been untested. This study shows that belief in RCC safety influences consumers’ perceived comfort with receiving care at an RCC. This knowledge can help guide RCC practice and maximize learning opportunities for surgeons-in-training.