Plastic Surgery News, September 2021 by PlasticSurgeryNews

September 2021

ERODING SCOPE As more non-plastic surgeons – and even non-practitioners – offer cosmetic work, ASPS members discuss the challenge of educating the public on the meaning of credentials. Page 21

COVID-19 vaccine mandates take effect for healthcare workers Page 7

ASPS member saves guitarist’s hand after rollover accident Page 8

Preparing for retirement Page 25

Designed for

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.

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.

September 2021

ADVERTORIAL

Reducing sticker shock can help patients move forward. It’s a familiar scene. After hearing your recommendation for a procedure, your patient may be excited to imagine how they’ll look and feel. Then comes the cost conversation; the sticker shock sets in, and your patient hesitates. How do you turn the consultation around? The answer is simple. By offering convenient financing, you can help more patients see how the procedure they want can fit into their monthly budget. With a financing solution like the CareCredit health, wellness and beauty credit card, you can be prepared to help patients move forward with your full recommendation. CareCredit offers promotional financing that can help patients overcome cost concerns by giving them a way to pay over time for procedures and skin care products.* Keep reading to find out how CareCredit can help your practice.

Remember where patients start their journey. Patients do their homework before they schedule a consultation. They take their time to research procedures and cost before committing to care; on average, the decision to purchase cosmetic surgery takes 188 days.1 When they visit your practice, they may already have some idea of how much the procedure they want will cost. Even after all this preparation, patients may experience sticker shock when they hear your full recommendation. Around 32% of cosmetic surgery patients reported having declined cosmetic purchases due to cost.1 With promotional financing options available on purchases of $200 or more, CareCredit can help more patients achieve their desired outcome.*

Show patients their estimated monthly payments. The opportunity to pay over time with promotional financing may help more patients feel confident moving forward with the procedure you recommend now versus later. With the CareCredit Payment Calculator, patients can quickly and easily see what their estimated monthly payments could be based on financing options you accept. When your patients see how they can spread the cost out over time, they may accept your full recommendation instead of a partial plan. The average out-of-pocket spend for a patient opening a CareCredit account in a cosmetic surgery practice is $5,125.2 When you break down the total outof-pocket cost into convenient monthly payments, it can help increase both conversions from consultation to scheduled appointment and the average ticket sale.

Applying for the CareCredit credit card is fast, simple and easy.

Know what to say during the cost conversation. To help your team feel more comfortable during cost conversations, CareCredit offers free resources, including the Preparing for Financial Discussions guide. It features tips to help your team feel comfortable discussing cost and ways to incorporate financing during key conversations with patients. This guide can help your team to respond to patient concerns at different touchpoints, including before the consultation and during cost conversations, as well as how to address patients not ready to move forward. Patients may call or visit your practice multiple times during their journey to purchasing a cosmetic procedure. In fact, 39% of cosmetic surgery patients visited a provider two or more times before choosing them for their procedure.1 By ensuring your team is prepared to talk about financing with every patient, you can help more patients move from contemplating the procedure to scheduling.

90% of cardholders say they are likely

or very likely to use their CareCredit credit card again.3 Start accepting the CareCredit credit card today. Visit carecredit.com/psn or call 866-247-3049.

Already enrolled? Visit carecredit.com/providercenter to access exclusive tools and resources, including the Preparing for Financial Discussions guide.

ASPS members receive reduced processing rates.

Patients can see if they prequalify with no impact to their credit score, so they can apply with confidence and be prepared to accept your full recommendation. Learn more at carecredit.com/prequalify *Subject to credit approval. Minimum monthly payments required. See carecredit.com for details. 1 CareCredit Path to Purchase Research – Cosmetic, 2018. 2 CareCredit average 2020 1st ticket sale in cosmetic practices that accept CareCredit. 3 Cardholder Engagement Study Q3 2020. This insert was independently produced by CareCredit. Plastic Surgery News had no part in its production. The views expressed here do not necessarily reflect those of the editor, editorial board, or the publisher, and in no way imply endorsement by the American Society of Plastic Surgeons (ASPS).

September 2021

IN THIS ISSUE FEATURES 07 Federal agencies, states and hospitals announce COVID-19 vaccine mandates

Plastic Surgery News

Mandatory vaccinations for healthcare workers are announced as delta variant cases climb across the country.

08 Complex surgery saves truck driver’s hand and function

L. Scott Levin, MD, helped John Foisy play guitar again after a rollover accident – but says he could’ve done more.

09 A commitment to education and training the next generation

ASPS PRESIDENT

Foad Nahai, MD, reflects on his career and accomplishments after winning the ASPS Special Achievement Award.

16 YPS Perspective: Residents prepare for Plastic Surgery The Meeting 2021

20 Examining decision aids for hand surgery patients Mélissa Roy, MDCM, MSc, discusses her research being supported by the Combined Pilot Research Grant.

21 COVER: An unending battle

24 Leading by example, fostering inspiration

ASSOCIATE MEDICAL EDITORS

Summer E. Hanson, MD, PhD sehanson@mdanderson.org B. Aviva Preminger, MD, MPH premingermd@gmail.com ADVERTISING EDITOR

Scot B. Glasberg, MD scotbg@gmail.com Michael Costelloe mcostelloe@plasticsurgery.org STAFF VP OF COMMUNICATIONS

Mike Stokes mstokes@plasticsurgery.org

ASPS past President Debra Johnson, MD, shares insights to her career after winning the ASPS President’s Award.

25 It’s never too soon to prepare for retirement

CHIEF MEDICAL EDITOR

EXECUTIVE VICE PRESIDENT

As more non-plastic surgeons perform cosmetic work, ASPS members discuss dangers to patients and the specialty.

Joseph Losee, MD joseph.losee@chp.edu Bruce Mast, MD bruce.mast@surgery.ufl.edu

Getting to know the winners of the PSTM21 travel scholarships and a preview of the Senior Residents Conference.

September 2021 Vol. 32 No. 6 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.

MANAGING EDITOR

Paul Snyder psnyder@plasticsurgery.org SENIOR NEWS EDITOR

In the first of a three-part series, retired plastic surgeon Enrique Fernandez, MD, discusses retirement preparation.

Jim Leonardo jleonardo@plasticsurgery.org ASSOCIATE EDITOR

Kendra Y. Mims kmims@plasticsurgery.org CONTRIBUTING EDITORS

Ashley Amalfi, MD; Anu Bajaj, MD; Sami Khan, MD; Jeffrey Kozlow, MD; Neal Reisman, MD, JD CONTRIBUTING WRITERS

Erika Adler; Catherine French; Jun Magat; Gina McClure; Tyler Neese

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

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:

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

14 Legislative Update 15 Letter to the Editor 29 Calendar 31 Classifieds 34 The Last Stitch

ASPS Membership Department Plastic Surgery News 444 E. Algonquin Road Arlington Heights, IL 60005 Periodicals postage paid at Arlington Heights, IL, and at additional mailing offices. USPS# 508-890. The views expressed in articles, editorials, letters and other publications published by PSN are those of the authors and do not necessarily reflect the opinions of ASPS. Acceptance of advertisements for PSN is at the sole discretion of ASPS. ASPS does not guarantee, warrant or endorse any product, program or service advertised.

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

September 2021

SUNDAY | 10.31.21

Atlanta, Ga.

Join this year’s Close The Loop 5K campaign The Plastic Surgery Foundation and its Breast Reconstruction Awareness campaign have created a fun and easy way for you to help us raise awareness and reach new supporters. We’ve launched the 2021 Close The Loop 5K campaign and ask that you be one of the first to register and help spread the word! Participate in person Oct. 31 or virtually, anytime between now and Oct. 31. Register as an individual, as a team member, or as a fundraiser only, through the No Sweat Challenge. Here’s what you can do: • Join the 5K • Invite at least three others to join the campaign • Raise at least $100 for the campaign PARTICIPATE IN 5K ONSITE OR ONLINE! 7:30 a.m. ET | Oct. 31, 2021 Atlanta, Ga.

September 2021

PRESIDENT’S MESSAGE

Get involved in the PSRN and help define what we do every day By Gayle Gordillo, MD The PSF President

here’s no single factor or metric that defines who each of us is as a plastic surgeon. Nevertheless, the results that we have for our patients is something that not only serves to bolster our individual reputations, but the specialty as a whole. The more information we can provide about the work we do and the more we can show demonstrable results, the more we build trust not only from patients, but also from the regulatory agencies, the house of medicine and the public at large. It wasn’t long ago that, citing safety concerns, the FDA put a 14-year moratorium in place on silicone gel-filled breast implants. Anyone who tuned into the FDA hearings on breast-implant safety just two years ago watched as concerns about BIA-ALCL and breast implant illness (BII) flared at the federal level. The possibility of government limiting the devices many of us use or the procedures many of us do might be a little bit closer than some of us would like. The key to preserving the work we do relies on patient safety and the ability to provide as much information as possible about the devices we use and procedures we do. When the FDA lifted its restrictions on silicone implants in 2006, the Society and its members shared a plethora of information with the agency. Similarly, in 2019 testimony from The PSF past-President Andrea Pusic, MD, MHS, and ASPS immediate-past President Lynn Jeffers, MD, MBA, described the National Breast Implant Registry (NBIR) and highlighted the importance of clinical registries in providing data. This testimony proved crucial in ensuring that any regulatory decisions made would be done so with the best available evidence. Since 2002, ASPS and The PSF have

been collecting that evidence through the Plastic Surgery Research Network (PSRN), which helps plastic surgeons identify safe, effective treatments for patients and promote evidence-based medicine in the specialty. Over the past two decades, the program has evolved and expanded to five total registries that actively collect data on plastic surgery procedures, devices, rare diseases and outcomes. The suite of registries in PSRN comprises individual case collection and outcomes (TOPS); fat-grafting cases and outcomes (GRAFT); BIA-ALCL cases (PROFILE); the Qualified Clinical Data Registry (QCDR) to assist members with CMS quality assurance compliance; and the NBIR.

Significant contributions Overall, we have almost 2,000 unique sites participating in The PSF’s PSRN program, and the caseload has grown by leaps and bounds in the past six years. Since 2017, more than 200,000 distinct cases have been entered into the PSRN databases. In addition to being a useful tool for one’s own practice, data entry into TOPS, GRAFT and NBIR can be submitted to the ABPS to satisfy the Practice Improvement Component of Continuous Certification. TOPS is the largest aggregation of plastic surgery data and comprises more than 1.5 million plastic surgery procedures and outcomes, tracking patients over time and assisting plastic surgeons with clinical decision-making and practice improvement by identifying clinical strengths and areas needing improvement on an individual level with national benchmarking. GRAFT collects data at the time of the procedure and follow-up visits to track outcomes of fat grafting performed for all aesthetic and reconstructive surgical procedures. The collected data provides insight into the safety and efficacy of these procedures and helps establish best-practice guidelines. The PROFILE registry captures data to

describe patient demographic characteristics and other medical history; implant procedure information; characteristics of the implant; clinical presentation; pathologic findings; clinical course; treatment; and treatment outcomes of patients with primary BIA-ALCL. ASPS-QCDR is a CMS-approved repository of physician performance measures for federal quality-reporting that provides national and peer benchmark information to allow clinicians to evaluate the quality of their care against national CMS results and to develop quality-improvement plans to correct gaps in care and improve patient outcomes. In the three years since its launch, more than 38,000 cases have been entered into NBIR, which serves as the centralized data repository for collecting information on all breast implant devices placed by surgeons in the United States. As strong as that number is, we want it to grow to produce as complete of a picture as possible on the breast implants we put into our patients. If you haven’t yet registered, please do so at thepsf.org/nbir. Plastic surgeons who enter data into the NBIR will be able to compare their practice performance and outcomes to the registry aggregate. The new NBIR Device Tracking app allows users to submit a case to the registry while simultaneously registering a device with manufacturers Allergan, Mentor and Sientra – all in less than three minutes of your time. Something that is particularly important to The PSF is that the majority of registry users are not from academic centers. I know it’s sometimes easy to connect The PSF and data collection with academic institutions as an “ivory tower”-type of endeavor. The fact, however, is that 74 percent of our contributing sites are located in solo and private group practices. This is a tremendous accomplishment and speaks to the collective power of an inclusive effort across our membership. The significance of the contributions from our members in private practice cannot be overstated. All of this work is done not only with the input and support of our members, but also

with our partners in industry and at the FDA, which wants more real-world, patient-generated data when it makes its decisions. “We believe well-designed registries can provide high-quality, real-world data that benefits all stakeholders.” says Danica Marinac-Dabic, MD, PhD, MMSc, FISPE, associate director in FDA’s Office of Clinical Evidence and Analysis. “Data yielded by registries such as PROFILE and the NBIR can inform clinical decision-making and support FDA regulatory decisions by providing evidence of device safety and effectiveness in larger, more diverse populations. When linked to other data sources, registries can also provide valuable data on patient perspectives and preferences. There are many opportunities for leveraging registries to evaluate the safety and effectiveness of medical devices, including conducting clinical studies that require an Investigational Devices Exemption. FDA is committed to working with stakeholders to establish ways to utilize real world data sources to support product development and provide new insights into medical device safety and effectiveness over the total product lifecycle.” There’s a lot to be excited about as we look to the future of our registry program, as these are not static entities. The PSF is developing a robust set of patient-reported outcomes (PRO) programs. The PSF leadership recently approved funding to deploy an NBIR PRO, which will focus on BII, using Dr. Pusic’s BII severity scale. We’re working on a pilot that will allow that PRO to be sent directly to patients via text. Our soon-to-be-launched MATRIX registry to track implantable meshes will have a PRO component, as well. Although the data we collect every day helps fortify a symbiotic relationship with government and industry, it’s important to remember what’s at the heart of every last bit of data – patient safety. We are the ones who can collect this information, and as with every procedure we perform, we owe it to our patients to get it right. PSN

EDITOR’S MESSAGE

Taking a moment to reflect on the importance of rest By B. Aviva Preminger, MD, MPH PSN Associate Medical Editor

“Almost everything will work again if you unplug it for a few minutes, including you.” – Anne Lamott

he road to becoming a plastic surgeon – as we all know – is not easy. Establishing and maintaining a practice demands dedication, hard work and a seemingly unlimited supply of time. Surgery is all about repetition, so showing up and being present is part of the job. Medicine, in general, is all about care. Our patients depend on us, and once we operate, that patient is our responsibility. We need to put our hands on our patients and be present. Nothing made this more apparent to me than the COVID-19 pandemic, and how it seemed as though almost every non-surgeon I know was able to work remotely. As surgeons, there seems to be an unspoken understanding that vacations – or rest time in general – is taboo and could possibly even be a sign of weakness. Once we graduate

residency and start practicing, this sentiment is compounded by the loss of financial revenue incurred during vacation time, as well as the need to find colleagues whom you can trust to cover you when you leave. Furthermore, the issues (and mail!) that pile up while you are away sometimes leave you wondering if the break – no matter how long – was even worth it at all. I have a solo private practice and I know too well the reality of these concerns. I grew up with a unique appreciation of the value in taking time to rest. My family is Orthodox Jewish, and every Friday from sundown until the stars came out on Saturday night, there was dedicated time for rest. Work was not permitted. This break was built-in to my regular schedule, and I took it for granted. When I became a resident, that dedicated rest time began to disappear. I could no longer control or restrict my work hours. As an attending, call requirements and patient and practice-management demands made it increasingly impossible to carve-out rest time. The demands of motherhood – to be certain, my favorite of all my “jobs” – made any residual notions of rest disappear entirely.

Only recently have I begun to revisit and appreciate the value of real rest time and recognize how privileged I was to grow up with some sense of having that time protected. In The Sabbath, Abraham Joshua Heschel, one of the leading Jewish theologians and Jewish philosophers of the 20th century, writes: “To gain control of the world of space is certainly one of our tasks. The danger begins when, in gaining power in the realm of space, we forfeit all aspirations in the realm of time. There is a realm of time where the goal is not to have but to be, not to own but to give, not to control but to share, not to subdue but to be in accord.” I recently took two weeks off – the first time I’ve ever done so in my professional career. Amazingly enough, I found that I was far less missed than I expected and that most things remained the same or waited for me while I was gone. Do you know what changed, though? Me. As Sen. Joseph Lieberman writes in The Gift of Rest, “The difference between work we do the rest of the week and rest we do on the Sabbath lies in the object toward which each is directed. With our labor during the week, we seek to change and improve the world. With our rest, we seek to change and

improve ourselves… and truly feel how much we have to be grateful for.” Rest without work is meaningless and work without rest often results in fatigue and a loss of appreciation for the privilege of what we do. Together, however, they create balance and a reciprocal sense of appreciation for both work and rest. In other words, you need the two to have a mutually reinforcing relationship to improve your own well-being. The pandemic may have changed everybody’s perception of work, whether you’re in the medical profession or not. Nevertheless, plugging away at odd hours – even in the comfort of your own home – is not always a recipe for great personal health. Wellness and burnout remain potent topics in our profession and ASPS has several resources for plastic surgeons who might feel as though they’re careening toward burnout. Everyone’s situation is different, but I spent the better part of my career simply believing I could not afford two weeks to concentrate on my own well-being. I hope that this message encourages my colleagues to take some dedicated time to rest and recover so that they may return to the care of their patients and their craft with a renewed sense of wonder and dedication. They’re counting on us. PSN September 2021

States, agencies, hospitals mandate vaccination for healthcare workers By Jim Leonardo & Paul Snyder

ealthcare workers in California, New York and Washington, D.C., will be required to receive the COVID-19 vaccination – and other states are expected to follow suit – as cases across the country continue to rise again as the delta variant of the virus spreads. California officials in August announced the state would reverse acceptance of voluntary testing for unvaccinated healthcare workers and instead require that the workers be vaccinated. The “first in the nation” California order requires paid and unpaid workers in healthcare facilities to be fully vaccinated by Sept. 30. The order applies to those who provide services or work in hospitals, nursing facilities, psychiatric hospitals, clinics and doctors’ offices. It also includes dialysis centers and residential substance-abuse treatment centers and at least a half-dozen other facilities. New York officials, meanwhile, announced that the state will require the vaccination of all patient-facing healthcare professionals by Labor Day, Sept. 6. In Washington, D.C., healthcare workers will be required to have their first dose of the vaccine by Sept. 30. At the federal level, HHS also announced in August that it will require all of its front-facing healthcare employees to get vaccinated against COVID-19, a policy that will apply to more than 25,000 officials under the HHS’ sprawling umbrella, including staff at the Indian Health Services and National Institutes of Health who operate health and clinical research facilities or could come into contact with patients. The U.S. Public Health Service Commissioned Corps, which consists of more than 6,000 healthcare workers who respond to public health crises around the country, will also be included under the mandate. HHS was the second federal department to announce a mandate, following the VA’s announcement of its own vaccination mandate in July. “Vaccines are the best tool we have to protect peo-

FALL 2021

●

A Supplement to Plastic Surgery

Page 16

A patient’s guide to understa

procedures because of the influx of patients dealing with the delta variant of COVID-19. Nevertheless, an increasing number of independent healthcare facilities, hospitals and health systems nationwide are requiring their employees to be vaccinated. American Hospital Association spokesperson Colin Mulligan reported that nearly 1,500 hospitals in the United States now require staffers to get a COVID-19 vaccine. The AMA in July also voiced its support of vaccine mandates for healthcare workers across the country. ASPS past President David Song, MD, MBA, says the mandates in Washington, D.C. – or anywhere else – should be expected. “Given what we know about both the safety and efficacy of the COVID-19 vaccines, it is a natural progression to mandate those who care for others to be vaccinated given the special role we play in other people’s lives,” he says. “As

plastic surgeons, it behooves us to all be vaccinated for the safety of our patients, colleagues, family and friends.” Although the Society hasn’t officially taken a stance on vaccine mandates, ASPS President Joseph Losee, MD, notes the FDA has already announced complete and full approval of the Pfizer COVID-19 vaccination. “I’m hopeful that states, private and public institutions will begin to require vaccinations,” he says. PSN For additional information on running a practice during COVID-19 restrictions and for guidance and recommendations, go to plasticsurgery.org/covid19.

New issue of Breast Reconstruction available now

PLUS: Survivor has women sis Fighting Pretty after diagno

News

ple from COVID-19, prevent the spread of the delta variant and save lives,” HHS Secretary Xavier Becerra said in an August statement. ASPS/PSF Vice President of Membership Steven Williams, MD, Dublin, Calif., says California’s mandate is in accordance with the responsibility of medical professionals to put patient needs first. “As the pandemic continues and new variants develop, it becomes increasingly important that we use what tools we have to protect everyone,” he says. “It’s important to remember that each person who contracts COVID-19 makes the disease stronger and more versatile. I expect more states will follow California’s lead.” ASPS/PSF Vice President of Development Scot Glasberg, MD, New York, says the New York order shouldn’t come as a surprise, and notes that most New York plastic surgeons are or will be vaccinated because of their special relationship with their patients and the “elective” nature of their business. Elective procedures could again face delays across the nation with the rise of the delta variant. Texas Gov. Greg Abbott in August asked the state’s hospital systems to delay elective work to help the hospitals’ strained capacity as a result of the influx of COVID-19 patients. Texas, however, has not put forth a vaccination mandate for healthcare workers. As of press time, Texas was the only state that had a governor publicly call for a delay in elective procedures, but PSN counted hospitals in 16 states that proposed or announced delays in elective

nding treatment options

Traveling for reconstruction Page 24

Understanding your options Page 29

WHEN YOU SEE US

Amplifying the narratives for thrivers of color Page 6

he 2021 edition of Breast Reconstruction, PSN’s-award-winning annual supplement, is now available to members not only as a complimentary inclusion with this month’s issue, but extra copies will be available onsite in Atlanta at Plastic Surgery The Meeting 2021 and also available to purchase in bulk for your office or practice at ShopASPS.org. Featuring profiles of breast cancer survivors, plastic surgeons and various organizations committed to helping patients learn more about their reconstruction options after mastectomy, this patient-facing publication provides stories of hope, courage and triumph – as well as practical education about reconstruction options, safety advice and pertinent consultation questions and pointers from ASPS members around the country. With Breast Reconstruction Awareness Day coming on Oct. 20, get your copies now to help further the Society’s mission of educating, engaging and empowering women to make the decision that’s best for them following a diagnosis with breast cancer. PSN

8/23/21 5:32 PM indd 1

Breast Reconstruction_Fall21_EDIT.

September 2021

Complex hand, microvascular surgery lets trucker play guitar again By Paul Snyder

y any measure, John Foisy is a fortunate man. In September 2019, while driving his truck to make a delivery in Atlanta, he was cut off by another driver, which caused Foisy to roll his truck. The impact of the roll on Foisy’s left arm – which had been dangling out the driver side window at the time of the accident – cost him his palm, nerves, blood vessels and arteries in the arm and severed almost everything down to the bone. Two years later, the only thing missing from that arm is a pinky finger. Foisy, an avid guitar player, is able to play his instrument again and much of that’s due to the work of ASPS member and ACS Board of Regents Chair L. Scott Levin, MD, FACS. Although Dr. Levin is proud of the result and particularly pleased that Foisy can again play guitar, he also sees a missed opportunity in the result. “As plastic surgeons, our capabilities have come a long way,” Dr. Levin says. “When you consider the advances in microvascular surgery, peripheral nerve surgery, the surgical management of pain and vascular composite allografts, we’ve created a world of possibilities for patients. My criticism of this is that we have many venues and medical meetings where we could share this with other specialties in surgery and medicine – but we only seem to talk to each other.” Immediately after the accident, emergency surgery at a Virginia hospital helped stop the bleeding and doctors were able to set Foisy’s broken fingers – although his pinky finger had to be amputated. However, his healing wasn’t progressing as hoped and doctors told Foisy that he would be lucky to be able to turn a doorknob again, let alone play a guitar. About a month after the accident, Foisy went to Penn Orthoplastic Limb Salvage Center, where Dr. Levin set to

John Foisy delivers a performance at the Penn Orthoplastic Limb Salvage Center in May for the team that saved his left hand after a rollover trucking accident nearly destroyed it. After the accident, doctors told him he might never play guitar again – but the team led by ASPS member L. Scott Levin, MD, worked diligently to restore that function.

work on a series of procedures involving limb salvage, microvascular surgery and hand surgery to address the significant loss of skin, subcutaneous tissue, muscle and nerves in Foisy’s hand. Dr. Levin used flaps from Foisy’s upper arm to reconnect the blood supply to his hand. A guitar player himself, Dr. Levin was sympathetic to Foisy’s desire to play again and actually instructed Foisy to bring his guitar with him so that he could understand the patient’s playing technique and get a better idea of how to conduct the microvascular and complex hand procedures to enable the greatest amount of range for Foisy’s left hand. Dr. Levin’s work resurfaced Foisy’s palm and opened his thumb index web space using a lateral arm free flap, which

THE RHINOPLASTY SYMPOSIUM LIVE IN ATLANTA THURSDAY | OCT. 28, 2021 Chair: Rod Rohrich, MD Co-Chair: Jason Roostaeian, MD Register Now: PlasticSurgeryTheMeeting.com/TRS

allowed the team to do reconstructive work on his nerves. All the while, Foisy was a committed patient in physical therapy, enduring sessions three times a week over eight months to gain movement in his fingers, hand and wrist. The entire time, he was reteaching himself how to play the guitar. The outcome was successful – Foisy returned to Penn in May to play an intimate performance at the clinic for Dr. Levin and the other team members who helped in his recovery – but despite restoring form and function in his patient, Dr. Levin still says the outcome could have been better, had he been able to see Foisy sooner. “He would have recovered more quickly – months sooner – and I would have been able to do more,” he says. “By the

time he came here, his hand was already deformed with soft-tissue contractures that limited his motion.” Dr. Levin insists the late referral came because many doctors in the medical field still don’t know the breadth of work that plastic surgeons can perform. Dr. Levin says he has colleagues across the country who can perform the kind of complex work that he does, but so many in the medical profession simply don’t know such options exist. “We can talk about the perceptions of plastic surgery and how it immediately gets associated with aesthetic work and making people beautiful,” he says. “That’s not a knock – I’m all for aesthetic surgery and believe that as plastic surgeons, we have to strive for perfection with every patient we see. Aesthetic work is a hallmark of our specialty. But when we look at the innovations we’ve made, there seems to be the continuing problem of just showing them to one another. There are endocrinologists, vascular surgeons and even cardiologists who don’t understand what we do, and they need to know that because we can do more in these situations.” Foisy’s story was recently featured in the Philadelphia Inquirer, and although Dr. Levin notes he does have patients referred to him from around the country and world, plastic surgeons need to continue to improve a dialogue with other specialties so the innovations and advancements made by the specialty are realized to their full potential. “Without a concerted effort on that front, we’re only holding ourselves back,” he says. PSN

PSN earns more national acclaim

ore space was cleared for the PSN award shelf in July when the 2021 Apex Awards for Publication Excellence were announced. Continuing its history of providing members with award-winning content, the Apex Awards honored PSN in the “Feature Writing” category for Kendra Y. Mims-Applewhite’s July/August 2020 PSN cover story, “Where do we go from here?,” which shared the experiences that some of the Society’s Black members endured in training and practice. The PSN team also earned top honors for the 2020 edition of the Breast Reconstruction supplement in the “Print Media – Special Purpose” category. This is the third straight year that the Breast Reconstruction supplement has garnered national award recognition. PSN

September 2021

ASPS Special Achievement Award

Taking from mentors, giving back to trainees and the specialty

oad Nahai, MD, is a prime example of taking “the road less traveled” en route to a distinguished career in the specialty. After spending his early years in Tehran, Iran, Dr. Nahai left the country in 1957 to attend boarding school in Canterbury, England, and he remained in the United Kingdom for medical training. He arrived in the United States in 1970, and after two years at Johns Hopkins, he completed general and plastic surgery residencies and a Fellowship at Emory University, Atlanta. Dr. Nahai’s colleagues say that his accomplishments – and the way he’s achieved the various successes throughout his career – made him an ideal recipient of the ASPS Special Achievement Award, which he received during Plastic Surgery The Meeting 2020. “Dr. Nahai epitomizes everything the award was created for,” says ASPS past President Jeffrey Janis, MD. “The award reads ‘For an outstanding physician who has brought credit and distinction to plastic surgery through clinical practice and application, community and civic accomplishments, organization and executive performance, or teaching and research.’ One would think the award was created personally for Dr. Nahai – with a picture of him next to it. It’s hard to think of anyone more deserving of the ASPS Special Achievement Award than him.” ASPS Trustee James Grotting, MD, who bestowed the award to Dr. Nahai, agrees. “I can think of no one who’s been more of an international ambassador for plastic surgery, developing friendships and relationships with plastic surgeons all over the globe,” Dr. Grotting said during the awards ceremony. “Dr. Nahai brought the world of plastic surgery closer together through the bridges he’s built between our specialty and other disciplines. He’s a champion of diversity in the specialty, and innovator and educator par excellence.”

An unexpected honor Dr. Nahai says he was touched that his colleagues chose him for the award, but it was unexpected. “Receiving this award was surprising, special and important to me because while in my early days I was very much involved in ASPS and The PSF, but later in my career my leadership and editorship of the Aesthetic Surgery Journal were all related to a sister society,” he tells PSN. “It speaks very highly and says so much about ASPS and the Board of Trustees that they’d honor me this way.” Dr. Nahai earned his Bachelor of Medicine and Surgery degree at the University of Bristol (United Kingdom), and he competed a medical and surgical internship at United Bristol Hospitals prior to emigrating to the United States. In addition to serving as the Aesthetic Surgery Journal editor, Dr. Nahai was the first Maurice J. Jurkiewicz chair in plastic surgery and professor of surgery at Emory University, and he’s served as president of the Aesthetic Society, American Association for the Accreditation of Ambulatory Surgical Facilities and International Society of Plastic Surgery, as well as chairman of the Plastic Surgery Research Council. Over the course of his career, Dr. Nahai has edited or co-edited 12 textbooks and published more than 250 peer-reviewed articles on aesthetic and reconstructive surgery. His adaptability and belief in himself began after he somewhat reluctantly left a comfortable life in Iran built by his father, an insurance executive, and found himself at St. Edmunds School, United Kingdom, at age 12. “Once I got over the initial shock and disSeptember 2021

ruptive change of leaving a reasonably well-off family to go to a boarding school in England, I loved it – and I don’t regret one minute of it,” he says. “I learned self-discipline, what commitment means and that if I start something I’m going to finish it. I learned that failure is not fatal, although to this day I do have fear of failure. I learned to persevere – and that the good that happens to me is a consequence of my own behavior and choices, and if anything unfavorable happens, that’s equally a result of my own behavior and choices.”

Acknowledging his commitment Dr. Nahai says he’d prefer to be known as a mentor, educator and leader as much as any-

Dr. Nahai shows off his ASPS Special Achievement Award during PSTM20.

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thing else, qualities for which he feels were highlighted at Plastic Surgery The Meeting. “I believe I’ve been recognized for my commitment to education and to training the next generation of plastic surgeons,” he says. “I’d also like to think I’ve been able to do this not just by teaching them, but also by example – by my deeds as well as my spoken or written words. “The second reason for the award may be the modest contributions I’ve made to the evolution and advancement of reconstructive surgery through general research, anatomical research and innovation, dating back to my early days as resident at Emory,” Dr. Nahai adds. “I had worked with leaders such as

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By Jim Leonardo

CPT CORNER

Demystifying the ‘complexity’ of coding debridement of complex wounds “CPT Corner” provides general information, available at the time of publication, regarding various coding, billing and claims issues of interest to plastic surgeons. ASPS is not responsible for any action taken in reliance on the information contained in this column. By Sami Khan, MD, & Jeffrey Kozlow, MD

ound care is an integral part of most plastic surgery practices. A working knowledge of proper wound debridement coding is paramount to accurate reporting of procedures, which subsequently can help prevent insurance denials and ensure timely reimbursement for work performed. In this month’s column, we will review some of the coding guidelines for wound debridement as confusion still remains around proper utilization of specific debridement CPT codes in various clinical situations. There are three main groups of CPT codes that are utilized when reporting surgical procedures associated with wound care: 1. 1104x for debridement including subcutaneous tissue, muscle or bone 2. 1500x for surgical preparation of wound by excision prior to skin substitute, graft or flap reconstruction 3. 1101x for debridement specifically of open fractures Additional codes for debridement of infected skin (11000-11001); necrotizing soft-tissue infections of the genitalia and perineum (11004); abdominal wall (11005); or prosthetic material in the abdominal wall (+11008); may also be more-appropriate codes in defined specific situations, but they are not specifically the focus of this article. The 1104x family of codes contains three stand-alone codes in addition to three add-on codes, each of which are associated specifically with one of the primary codes. Codes 1104211046 are intended for management of acute wounds that are infected or have significant necrotic tissues that require debridement and control of the wound before reconstruction is even being considered. In addition, the 1104x family of codes is used for the surgical management of wounds that are expected to heal by secondary intention without future grafts or flaps. The choice of a specific 1104x code is based on two factors: tissue level/depth of debridement of the wound and size of the wound. Note that the anatomic location of the wound does not influence which code is chosen. Report excisional debridement codes based on the deepest layer of significant, nonviable tissue removed. If the entire wound surface is debrided, the measurement of the wound should be taken after the debridement procedure; however, if only a portion of a wound surface is debrided, report the measurement of the area that was actually debrided. For multiple wounds, add the surface area of those wounds that are at the same depth, but don’t combine wounds from different depths. Each primary code, as well as each additional unit of add-on code, is measured in 20 cm2 units. For example, if a 95 cm2 wound of the right forearm is debrided including skin and necrotic muscle, the procedure would be coded as follows: 11043 + 11046 x 4 units. It’s also critical to note that these codes have a Medically Unnecessary Edit (MUE) that limits the number of times a code may be reported by a surgeon in a single setting. These MUE are followed by Medicare and most private insurers. It is also important to note that most Medicare Administrative Contractors have a policy

TABLE I II MUSCLE AND/OR FASCIA OR BONE DEBRIDEMENT OF SUBCUTANEOUS TABLE TISSUE, TABLE DEBRIDEMENT OF SUBCUTANEOUS TISSUE, DEBRIDEMENT OF SUBCUTANEOUS TABLE TISSUE,I MUSCLE MUSCLE AND/OR AND/OR FASCIA FASCIA OR OR BONE BONE CODE TABLE IDESCRIPTOR CODE DESCRIPTOR DEBRIDEMENT OF SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA OR BONE CODE DEBRIDEMENT OF SUBCUTANEOUS TISSUE,DESCRIPTOR MUSCLEand AND/OR OR BONE Debridement, subcutaneous tissue (includes epidermis dermis,FASCIA if performed); 11042 Debridement, subcutaneous tissue (includes epidermis and dermis, ifif performed); CODE DESCRIPTOR first 20 sq. cm. or less Debridement, subcutaneous tissue (includes epidermis and dermis, performed); 11042 CODE DESCRIPTOR 11042 first or first 20 20 sq. sq. cm. cm.subcutaneous or less less Debridement, tissue (includes (includes epidermis epidermis and and dermis, dermis, if performed); performed); Debridement, subcutaneous tissue 11042 Debridement, subcutaneous tissue (includes epidermis and and dermis, dermis, ififif performed); performed); +11042 11045 Debridement, (includes epidermis first 20 sq. cm.subcutaneous or less each additional 20 sq. cm., ortissue part thereof (List separately in dermis, additioniftoperformed); code for primary procedure) Debridement, subcutaneous tissue (includes epidermis and ++ 11045 first 20 sq. cm. or less 11045 each 20 part (List separately in addition code each additional additionalsubcutaneous 20 sq. sq. cm., cm., or ortissue part thereof thereof (List separately indermis, additionifto to code for for primary primary procedure) procedure) Debridement, (includes epidermis and performed); Debridement, muscle and/or fascia (includes epidermis, dermis and subcutaneous tissue, +11043 11045 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); Debridement, muscle and/or fascia (includes epidermis, dermis and subcutaneous tissue, each additional 20 sq. cm., or part thereof (List separately in addition to code for primary procedure) +11043 11045 if performed); first 20 and/or sq. cm. or less Debridement, (includes and subcutaneous tissue,procedure) each additionalmuscle 20 sq. cm., or fascia part thereof (Listepidermis, separatelydermis in addition to code for primary 11043 ifif performed); first sq. or performed);muscle first 20 20and/or sq. cm. cm.fascia or less less(includes epidermis, dermis and subcutaneous tissue, Debridement, Debridement, muscle and/or fascia (includes epidermis, dermis and subcutaneous tissue, 11043 Debridement, muscle and/or fascia (includes epidermis, epidermis, dermis dermis and and subcutaneous subcutaneous tissue, tissue, Debridement, and/or (includes performed);muscle first 20 sq. cm.fascia or less +11043 11046 ififif performed); each additional 20less sq. cm., or part thereofdermis (List separately in additiontissue, to code for Debridement, and/or (includes epidermis, and subcutaneous performed);muscle first 20 sq. cm.fascia or ++ 11046 if performed); each additional 20 sq. cm., or part thereof (List separately in addition to primary procedure) 11046 if performed); each additional 20 sq. cm., or epidermis, part thereofdermis (List separately in additiontissue, to code code for for Debridement, muscle and/or fascia (includes and subcutaneous primary procedure) Debridement, muscle and/or fascia (includes epidermis, dermis and subcutaneous tissue, primary procedure) + 11046 if performed);bone each (includes additionalepidermis, 20 sq. cm.,dermis, or partsubcutaneous thereof (List separately in addition tofascia, code for Debridement, tissue, muscle and/ or if +11044 11046 if performed); each(includes additionalepidermis, 20 sq. cm.,dermis, or part thereof (List separately in additionortofascia, code for Debridement, bone primary procedure) performed); first 20 sq. cm. orepidermis, less Debridement, bone (includes dermis, subcutaneous subcutaneous tissue, tissue, muscle muscle and/ and/ or fascia, ifif 11044 primary procedure) 11044 performed); first 20 sq. cm. or less performed); first 20 (includes sq. cm. orepidermis, less Debridement, bone dermis, subcutaneous subcutaneous tissue, tissue, muscle muscle and/ and/ or or fascia, fascia, if Debridement, bone (includes epidermis, dermis, 11044 Debridement, bone (includes epidermis, dermis, subcutaneous subcutaneous tissue, tissue, muscle muscle and/ and/ or or fascia, fascia, ififif Debridement, bone (includes epidermis, performed); first 20 sq. cm. or less 11044 + 11047 performed); additional 20epidermis, sq. cm., ordermis, part thereof (List separately in addition Debridement,each bone (includes dermis, subcutaneous tissue, muscle and/toorcode fascia, if performed); first 20 sq. cm. or less ++ 11047 performed); each additional 20 sq. part (List in to code for primary procedure) 11047 performed); each sq. cm., cm., or ordermis, part thereof thereof (List separately separately in addition addition Debridement, boneadditional (includes20epidermis, subcutaneous tissue, muscle and/toorcode fascia, if for Debridement, boneadditional (includes20epidermis, subcutaneous tissue, muscle and/toorcode fascia, if for primary primary procedure) procedure) + 11047 performed); each sq. cm., ordermis, part thereof (List separately in addition + 11047 performed); each additional 20 sq. cm., or part thereof (List separately in addition to code for primary procedure) for primary procedure) TABLE II TABLE II MUES FOR DEBRIDEMENT OF SUBCUTANEOUS TISSUE, TABLE II MUSCLE AND/OR FASCIA OR BONE CODES MUES FOR DEBRIDEMENT OF SUBCUTANEOUS TISSUE, MUSCLE MUES FOR DEBRIDEMENT OF SUBCUTANEOUS TISSUE, MUSCLE AND/OR AND/OR FASCIA FASCIA OR OR BONE BONE CODES CODES TABLE II CODE DESCRIPTOR MUE TABLE II MUSCLE CODE DESCRIPTOR MUE MUES FOR DEBRIDEMENT OF SUBCUTANEOUS TISSUE, AND/OR FASCIA OR BONE CODES CODE DESCRIPTOR MUE MUES FOR DEBRIDEMENT SUBCUTANEOUS MUSCLE 11042 Debridement,OF subq; first 20 sq. cm. or TISSUE, less 1 AND/OR FASCIA OR BONE CODES 11042 Debridement, first 20 sq. cm. or less 1MUE CODE DESCRIPTORsubq; 11042 Debridement, subq; first 20 sq. cm. or less 1 DESCRIPTORsubq; each additional 20 sq. cm. MUE +CODE 11045 Debridement, 12 (e.g., up to 260 cm22 can be reported) ++11042 11045 Debridement, subq; each additional 20 sq. cm. 12 up to 260 cm 2 can be reported) first 20 sq. cm. or less 112 (e.g., 11045 Debridement, subq; each additional 20 sq. cm. 11042 subq; first 20 sq.fascia; cm. or 1 (e.g., up to 260 cm can be reported) Debridement, muscle and/or firstless 20 sq cm 112 (e.g., up to 260 cm2 can be reported) Debridement, muscle and/or fascia; 20 sq +11043 11045 subq; each additional 20 sq. cm. or less Debridement, muscleeach and/or fascia; first first 20cm. sq cm cm 2 112 +11043 11045 Debridement, subq; additional 20 sq. 11043 1 (e.g., up to 260 cm can be reported) or less or less Debridement, muscle and/or and/or fascia fascia;;first 20addisq cm Debridement, muscle each 1 (e.g., up to 220 cm2 can be reported) Debridement, muscle and/or and/or fascia;; first 20 sq cm +11043 11046 10 Debridement, or less20 sq cmmuscle 2 1 (e.g., tional Debridement, muscle and/or fascia fascia ; each each addiaddi++11043 11046 10 or less20 can be be reported) reported) 11046 10 (e.g., up up to to 220 220 cm cm2 can tional sq cm tional 20 sq cmmuscle and/or fascia ; each addiDebridement, 2 11044 Debridement, bone; first 20 sq. cm. or less 1 can be reported) +11044 11046 10 (e.g., up to 220 cm Debridement, muscle and/or fascia ; each addi2 Debridement, 110 tional 20 sq cmbone; +11044 11046 Debridement, bone; first first 20 20 sq. sq. cm. cm. or or less less 1 (e.g., up to 220 cm can be reported) tional 20 sq cmbone; + 11047 Debridement, each additional 20 sq. cm. 10 (e.g., up to 220 cm22 can be reported) ++11044 11047 Debridement, bone; each additional 20 sq. cm. 10 (e.g., up to 220 cm first 20 sq. cm. or less 1 2can be reported) 11047 Debridement, bone; bone; each additional 20 less sq. cm. 11044 Debridement, first 20 sq. cm. or 110 (e.g., up to 220 cm can be reported) 2 + 11047 Debridement, bone; each additional 20 sq. cm. 10 (e.g., up to 220 cm can be reported) + 11047 Debridement, bone; each additional 20 sq. cm. 10 (e.g., up to 220 cm2 can be reported) TABLE III TABLE III ACTIVE WOUND CARE MANAGEMENT CPT CODING TABLE III ACTIVE MANAGEMENT CPT ACTIVE WOUND WOUND CARE CARE MANAGEMENT CPT CODING CODING TABLE III CODE DESCRIPTOR TABLE III CODE DESCRIPTOR ACTIVE WOUND CARE MANAGEMENT CPT CODING CODE DESCRIPTOR ACTIVE CARE MANAGEMENT CPT CODING Debridement (e.g.,WOUND high pressure waterjet with/without suction, sharp selective debridement with scisDebridement (e.g., high pressure waterjet with/without suction, debridement with CODE DESCRIPTOR sors, scalpel and forceps), open wound, (e.g., fibrin, devitalized epidermis and/or dermis, exudate, deDebridement (e.g., high pressure waterjet with/without suction, sharp sharp selective selective debridement with scisscisCODE DESCRIPTOR 97597 sors, scalpel and forceps), open wound, (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, including topical wound assessment, use selective of a and/or whirlpool, whenexudate, performed sors, biofilm), scalpel and forceps), openapplication(s), wound, (e.g., fibrin, devitalized epidermis dermis, de97597 Debridement (e.g., high pressure waterjet with/without suction, sharp debridement with scis97597 bris, biofilm), including topical application(s), wound assessment, use aa whirlpool, when performed Debridement (e.g., high pressure waterjet with/without suction, epidermis sharp selective debridement with and for ongoing per session, totaldevitalized wound(s) surface first 20 sq. cm. or lessscisbris, instruction(s) biofilm), including topical application(s), wound assessment, use of ofarea; whirlpool, when performed sors, scalpel and forceps), opencare, wound, (e.g., fibrin, and/or dermis, exudate, deand for per total wound(s) area; first sq. cm. or 97597 sors, scalpel and forceps), opencare, wound, (e.g., wound fibrin, epidermis dermis, exudate, and instruction(s) instruction(s) for ongoing ongoing care, per session, session, totaldevitalized wound(s) surface surface first 20 20 sq. cm. or less lessdebris, biofilm), including topical application(s), assessment, use selective ofarea; a and/or whirlpool, when performed 97597 Debridement (e.g., hightopical pressure waterjet with/without suction, sharp debridement with bris, biofilm), (e.g., including application(s), wound assessment, use selective ofarea; a whirlpool, when performed Debridement high pressure waterjet with/without suction, sharp debridement with and instruction(s) for ongoing care, per session, total wound(s) surface first 20 sq. cm. or less scissors, scalpel(e.g., and forceps), open wound, (e.g.,total fibrin, devitalized epidermis and/or dermis, exudate, Debridement pressure with/without suction, sharp selective debridement with and instruction(s) forhigh ongoing care,waterjet per session, wound(s) surface area; first 20 sq. cm. or less scissors, scalpel and forceps), open wound, (e.g., fibrin, devitalized epidermis and/or dermis, exudate, +97598 debris, including topical application(s), assessment, use of a whirlpool, whenwith perscissors,biofilm), scalpel and forceps), open wound,with/without (e.g.,wound fibrin, suction, devitalized epidermis and/or dermis, exudate, Debridement (e.g., high pressure waterjet sharp selective debridement +97598 debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when perDebridement (e.g., high pressure waterjet with/without suction, sharp selective debridement with formed and instruction(s) for ongoing care, (e.g., per session, total wound(s) area; dermis, each additional +97598 debris, biofilm), including topical application(s), wound assessment, usesurface of a whirlpool, when perscissors, scalpel and forceps), open wound, fibrin, devitalized epidermis and/or exudate, formed and for care, session, total surface area; additional scissors, scalpel and forceps), open wound, (e.g., fibrin, epidermis and/or dermis, exudate, 20 sq. cm., orinstruction(s) part thereof (Listongoing separately addition to devitalized code for primary formed and instruction(s) for ongoing care,inper per session, total wound(s) wound(s) area; each each additional +97598 debris, biofilm), including topical application(s), wound assessment, usesurface ofprocedure) a whirlpool, when per20 or part thereof (List separately in addition to code for +97598 debris, biofilm), including application(s), wound usesurface ofprocedure) a whirlpool, when per20 sq. sq. cm., cm., orinstruction(s) part thereoftopical (Listongoing separately addition to assessment, code for primary primary procedure) formed and for care,inper session, totaldebridement, wound(s) area; each additional Removal of devitalized tissue from wound(s), non-selective without anesthesia (e.g., formed and instruction(s) for ongoing care,inper session, totaldebridement, wound(s) surface area; each additional Removal of devitalized tissue from wound(s), non-selective without anesthesia (e.g., 20 sq. cm., or part thereof (List separately addition to code for primary procedure) 97602 wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), Removal devitalized tissue wound(s), non-selective without anesthesiawound (e.g., 20 sq. cm.,ofor part thereof (Listfrom separately in larval addition to codedebridement, for primary procedure) 97602 wet-to-moist dressings, enzymatic, abrasion, therapy), including application(s), wound assessment, and instruction(s) for ongoing care, per sessiondebridement, 97602 wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical topical application(s), Removal of devitalized tissue from wound(s), non-selective without anesthesiawound (e.g., assessment, and instruction(s) for care, per session Removal of devitalized tissue from wound(s), non-selective without anesthesiawound (e.g., assessment, and instruction(s) for ongoing ongoing care, per sessiondebridement, 97602 wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), 97602 wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session assessment, and instruction(s) for ongoing care, per session TABLE IV CPT CODES FOR TABLE SURGICAL TABLE IV IV PREPARATION CPT PREPARATION CPT CODES CODES FOR FOR SURGICAL SURGICAL PREPARATION TABLE IV CODE DESCRIPTOR TABLE IV CODE DESCRIPTOR CPT CODES FOR SURGICAL PREPARATION CODE DESCRIPTOR CPT CODES FOR SURGICAL Surgical preparation or creation of recipient site PREPARATION by excision of open wounds, burn eschar or scar Surgical preparation or creation of recipient site by of open burn eschar or scar CODE DESCRIPTOR 15002 (including subcutaneous tissues), or incisional of scar trunk, arms, legs; Surgical preparation or creation of recipient siterelease by excision excision ofcontracture, open wounds, wounds, burn eschar orfirst scar100 CODE DESCRIPTOR 15002 (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq. cm. orpreparation 1% of body of infants and children 15002 (including subcutaneous tissues), incisional of scarofcontracture, trunk, arms, legs;orfirst Surgical or area creation ofor recipient siterelease by excision open wounds, burn eschar scar100 sq. 1% of of and Surgical preparation orarea creation oforrecipient siterelease by excision ofcontracture, open wounds, burn eschar orfirst scar100 sq. cm. cm. or or 1% of body body area of infants infants and children children 15002 (including subcutaneous tissues), incisional of scar trunk, arms, legs; Each additional 100 sq. cm., or parts orrelease each additional 1% of body areaarms, of infants 15002 (including subcutaneous tissues), or thereof, incisional of scar contracture, trunk, legs;and first 100 +15003 Each additional sq. cm., or parts each 1% sq. cm. orList 1% of100 body area of infants and children children. separately in addition codechildren foror procedure Eachcm. additional 100 sq.area cm., orinfants partstothereof, thereof, orprimary each additional additional 1% of of body body area area of of infants infants and and +15003 sq. or 1% of body of and +15003 children. List separately in addition to code for primary procedure children. List separately in addition tothereof, code fororprimary procedure Each additional 100 sq. cm., or parts each additional 1% of body area of infants and Surgical preparation or creation of recipient site by excision of open wounds, +15003 Each additional 100 sq. cm., or parts orprimary each additional 1% of body area of infants and Surgical preparation or creation of recipient site by excision of open wounds, children. List or separately in addition tothereof, code for procedure +15003 burn eschar, scar (including subcutaneous tissues), or incisional release of scar contracture, face, Surgical preparation or creation of recipient site by excision of open wounds, children. List or separately in addition to code fortissues), primaryorprocedure 15004 burn scar subcutaneous incisional release of scar scalp, eyelids, neck, ears, orbit, genitalia, hands, and/or multiple first 100 sq.face, cm. or burn eschar, eschar, ormouth, scar (including (including subcutaneous tissues), orfeet incisional release ofdigits; scar contracture, contracture, face, 15004 Surgical preparation or creation of recipient site by excision of open wounds, 15004 scalp, eyelids, mouth, neck, ears, orbit, genitalia, hands, feet and/or multiple digits; first cm. Surgical preparation or creation of recipient site by excision of open wounds, 1% of body area of infants and children scalp, eyelids, mouth, neck, ears, orbit, genitalia, hands, feet and/or multiple digits; first 100 100 sq. sq.face, cm. or or burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, 1% of body area of infants and children 15004 burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, 1% ofeyelids, body area of infants and children scalp, mouth, neck, ears, orbit, genitalia, hands, feet and/or multiple digits; first 100 sq. cm. or 15004 +15005 Each additional 100 sq.neck, cm., ears, or part thereof, or each additional 1% ofmultiple body area of infants scalp, eyelids, mouth, orbit, genitalia, hands, feet and/or digits; first 100and sq. children cm. or +15005 Each 100 or thereof, 1% ofadditional body area of sq. infants and children +15005 Eachof additional sq. cm., cm.,and or part part thereof, or or each each additional additional 1% 1% of of body body area area of of infants infants and and children children 1% body area100 of infants children +15005 Each additional 100 sq. cm., or part thereof, or each additional 1% of body area of infants and children +15005 Each additional 100 sq. cm., or partTABLE thereof,Vor each additional 1% of body area of infants and children TABLE VV MUES FOR SURGICAL PREPARATION CODES TABLE MUES FOR SURGICAL PREPARATION CODES MUES FOR SURGICAL PREPARATION CODES TABLE V CODE DESCRIPTOR MUE TABLE V CODE DESCRIPTOR MUE MUES FOR SURGICAL PREPARATION CODES CODE DESCRIPTOR MUE MUES trunk, FOR SURGICAL PREPARATION CODES Surgical preparation; arms, legs; first 100 sq. 15002 1MUE Surgical preparation; trunk, arms, legs; first 100 sq. CODE DESCRIPTOR cm. or 1% of body area of infants and children Surgical preparation; trunk, arms, legs; first 100 sq. 15002 1 CODE DESCRIPTOR MUE 15002 1 cm. of of and cm. or or 1% 1% of body body area area of infants infants and children children Surgical preparation; trunk, arms, legs; first 100 sq. Each additional 100 sq. cm.,arms, or parts thereof, or sq. 15002 1 Surgical preparation; trunk, legs; first 100 60 (e.g. up to 6,000 cm22 or 60% in infants/ Each 100 sq. cm., or thereof, or cm. oradditional 1% of body area of infants and children 15002 1 (e.g. +15003 each additional 1% of area ofand infants and Eachor 100area sq.body cm., or parts parts thereof, or 60 to 6,000 cm cm. 1% of body of infants children children may reported) or 60% 60% in in infants/ infants/ 60 (e.g. up up tobe 6,000 cm2 or +15003 each additional 1% of body area of infants and children +15003 each additional 100 1% of area of infants children may be reported) Each sq.body cm., or parts thereof,and or 2 children may be reported) children or 60% in infants/ 60 (e.g. up to 6,000 cm Each additional 100 sq. cm., or parts thereof, or children +15003 each additional 1% offace, bodyscalp, areaeyelids, of infants and 60 (e.g. up 6,000 cm2 or 60% in infants/ Surgical preparation; mouth, children mayto be reported) +15003 each additional 1% offace, bodyscalp, areaeyelids, of infants and Surgical preparation; mouth, children children may be reported) neck, ears, orbit, genitalia, hands, feet and/or Surgical preparation; face, scalp, eyelids, mouth, children 15004 1 neck, orbit, genitalia, feet multiple digits; 100 sq.hands, cm. oreyelids, 1% and/or of mouth, body area 1 neck, ears, ears, orbit,first genitalia, hands, feet and/or 15004 Surgical preparation; face, scalp, 15004 1 multiple digits; first 100 sq. cm. or 1% of body area Surgical preparation; face, scalp, eyelids, mouth, of infants and children multiple digits; first 100 sq.hands, cm. orfeet 1% and/or of body area neck, ears, orbit, genitalia, of infants and children 15004 1 neck, ears, orbit, genitalia, hands, feet and/or of infants and children multiple digits; first 100 sq. cm. or 1% of body area 1 15004 Each additional 100 100 sq. cm., or part thereof, or area multiple digits; first sq. cm. or 1% of body 19 (e.g. Up to 1,900 cm22 or 19% in infants/ Each additional 100 cm., or of infants and children +15005 each additional 1% of area of thereof, infants Each 100 sq. sq.body cm., or or part part thereof,and or 19 to 1,900 cm of infants and children children may reported) 19 (e.g. (e.g. Up Up tobe 1,900 cm2 or or 19% 19% in in infants/ infants/ +15005 each additional 1% of body area of infants and children +15005 each additional 100 1% of area of thereof, infants and children may be reported) Each sq.body cm., or part or 2 children may be reported) children 19 (e.g. Up to 1,900 cm or 19% in infants/ Each additional 100 sq. cm., or part thereof, or children +15005 each additional 1% of body area of infants and 19 (e.g. Up 1,900 cm2 or 19% in infants/ children mayto be reported) +15005 the reporting each additional 1% of body area ofor infantsof andnecrotic to disallow of 11043/+11046 tissue, jet therapy or other children children may water be reported) childrenwith a place of service 11044/+11047 billed non-operative means, it’s more appropriate

TABLEto VI report the appropriate active wound care other than an inpatient hospital, outpatient TABLE VI CPT CODES FOR DEBRIDEMENT SPECIFICALLY OF OPEN TABLE VI hospital or ASC.CPT management codesFRACTURES 97597-97602. The addSPECIFICALLY OF CPT CODES CODES FOR FOR DEBRIDEMENT DEBRIDEMENT SPECIFICALLY OF OPEN OPEN FRACTURES FRACTURES TABLE VI ForCODE chronic, outpatient wound care that’s on code +97598 does have an MUE of 8 units DESCRIPTOR TABLE VI CODE DESCRIPTOR CPT CODES FOR DEBRIDEMENT SPECIFICALLY OF OPEN FRACTURES CODEwith limited DESCRIPTOR provided sharp debridement that canat the also beof reported. CPT CODES FOR DEBRIDEMENT SPECIFICALLY OFsite OPEN Debridement including removal of foreign material anFRACTURES open fracture and/or an open 11010 CODE 11010 CODE 11010 11010 11011 11010 11011 11011 11011 11012

Debridement including removal of material atat the open DESCRIPTOR dislocation (e.g., excisional debridement); and subcutaneous Debridement including removal of foreign foreignskin material the site site of of an antissues open fracture fracture and/or and/or an an open open DESCRIPTOR dislocation (e.g., excisional debridement); skin and subcutaneous tissues dislocation (e.g., excisional debridement); skin and subcutaneous tissues Debridement including including removal removal of of foreign foreign material material at at the the site site of of an an open open fracture fracture and/or and/or an an open open Debridement Debridement including removal of foreign foreign skin material at the the site of of an antissues open fracture fracture and/or and/or an an open open Debridement including removal of material at open dislocation (e.g., excisional debridement); and subcutaneous dislocation (e.g., excisional debridement); subcutaneous muscle fascia,and/or and muscle Debridement including removal of foreignskin, material at the site site tissue, of antissues open fracture an open dislocation (e.g., excisional debridement); skin and subcutaneous dislocation (e.g., excisional debridement); skin, subcutaneous tissue, muscle fascia, and muscle dislocation (e.g., excisional debridement); subcutaneous tissue, muscle fascia,and/or and muscle Debridement including removal of foreign skin, material at the site site of an open fracture an open Debridement Debridement including including removal removal of of foreign foreign material material at at the the site of of an an open open fracture fracture and/or and/or an an open open

Surgical preparation The 1500x family of codes, often referred to as the surgical prep codes, contains two standalone codes and two add-on codes, which are each associated specifically with one of the primary codes. These codes are only reported when significant additional work to prepare the recipient site is necessary prior to a reconstructive graft or flap. In contrast, the excisional debridement codes are used when you are acutely managing necrotic tissue to get control of the wound. These codes are also reported if significant excisional preparation of a wound is required when using negative-pressure therapy for the management of wound. In addition, the 1500x code family is also used for the surgical excision of burns in preparation for grafting. However, there are other codes related to the management of burns (e.g., debridement, dressing changes) that may also be reported, but those are beyond the scope of this article. The choice of a specific 1500x code is based on two factors: anatomic location of the wound and size of the wound. These codes are utilized for surgical preparation of a wound, burn or scar/scar contracture for reconstructive purposes. Typically, the depth of debridement includes subcutaneous tissue. The stand-alone codes 15002 and 15004 are each based on the first 100 cm2 area of the wound, or in an infant the first 1 percent body-surface area. If the wound is larger than 100 cm2, or in an infant 1 percent body-surface area, then the add-on codes 15003 or 15005 are utilized in addition to the primary code. 15003 and 15005 each describe an additional 100 cm2 area of the wound, or in an infant an additional 1 percent body surface area. If the wound is larger than 200 cm2, then more than one additional unit of the add-on code may be utilized (i.e., if the wound is 350 cm2, then the procedure would be coded as 15002 + 15003 x 3 units). For multiple wounds, add the surface area of all wounds from all anatomic sites that are grouped together into the same code descriptor. Besides the size of the debrided wound, the anatomic location of the wound also determines which of the surgical prep codes is correctly used. For wounds of the trunk, arms or legs, 15002/15003 are utilized. For wounds on the face, scalp, eyelids, mouth, neck, ears, orbit, genitalia, hands, feet and/or multiple digits, 15004/15005 are utilized. The add-on codes do have MUE as well that may limit reporting, although they are actually quite large and would rarely not allow for full reporting of the work performed. It’s important to discuss the misinterpretation that can occasionally occur based on the skin replacement surgery and skin substitute introductory language in the CPT book – that one should “Use 15002-15005 for initial wound recipient site preparation…” The use of the word “initial” was intended to represent the excisional debridement of the wound compared to dressing changes or other post-op care. It was not intended to limit the reporting of the 1500x family of codes when multiple excisional preparations may be required for appropriate patient care, such as may be required in burns requiring serial excisional or in wounds managed with serial excisional preparation and negative pressure dressing placements. We are unaware of any of the surgical societies or payers who have interpreted this language otherwise and limited the use of the 1500x codes on different days for the same area assuming all other clinical documentation is appropriate.

Debridement The 1101x family of codes contains three separate stand-alone codes. These codes are September 2021

children

specifically to be utilized when debridement of a wound associated with an open fracture or dislocation is performed. All three of these codes also include the removal of debris or foreign bodies; therefore, foreign body removal is considered bundled with these codes and should not be billed separately. These codes are based on the depth of tissue debridement. The deepest tissue level that’s debrided determines the specific code that’s reported. Note, the size of the wound does not matter for these three CPT codes, just the tissue depth.

Global period All three debridement codes families have zero-day global periods. This is important, as often both acute and chronic wound-care require serial debridement procedures prior to ensuring a clean wound that can then be allowed to heal secondarily or that can then be reconstructed with a skin graft or flap. Thus, each debridement procedure can be billed separately, but it’s important to remember some payers may want/require that the -58 modifier for staged or related procedure or service by the same physician should be appended to each subsequent debridement procedure, in order to indicate that they were part of a surgical plan. Additional evaluation and management codes may be reported as well in the postoperative period assuming no reconstructive procedure that has a 90-day global (e.g., skin grafts, flaps) is also performed.

Additional codes There are three other specific clinical entities that have unique CPT debridement codes. Debridement of necrotizing wound infections of the perineum and abdomen are coded using 1100x (11001-11006). If the necrotizing infection involves the head/neck or thorax or extremities, then the appropriate CPT code 1500x is utilized based on the anatomic location of the debridement procedure. The debridement of burns, if no concomitant skin grafting is performed, is billed using the family of codes 160xx (16000-16030). The surgical excision of decubitus pressure ulcers have their own specific family of CPT codes, 159xx. Case One: An 80-year-old patient from a nursing home presents with multiple chronic wounds of the lower extremities. Due to multiple comorbidities, the surgical plan is to debride all non-viable tissue, dress the wounds and allow them to heal secondarily. Sharp excisional debridement of a right medial calf wound, including necrotic skin and subcutaneous fat measuring 25 cm2, and a right lateral calf wound including necrotic skin and subcutaneous fat measuring 25 cm2, is performed. A right posterior calf wound is sharply debrided of necrotic muscle. This wound measures 45 cm2. All three wounds are dressed with wet to dry saline dressings. Editor’s note: In the July/August 2021 edition of CPT Corner (“A primer on expanding your understanding of muscle flap codes”), an error was noted in Case #1. Specifically, if an excisional debridement is performed at the same operative setting as a muscle flap (e.g., CPT 15734), the excisional debridement would be considered a surgical preparation procedure and best reported with the 1500x family of codes which better describe the necessary work to prepare the recipient site prior to a reconstructive graft or flap. In the initial printing, we errantly suggested that the debridement would be reported with the 1104x family, however, these codes are used for the acute management of a necrotic wound and would not typically be reported with flap codes. In addition, current Pair-To-Pair edits recognized by most payers will disallow the concurrent submission of 1104X with any flap code. We regret the error and the online version of CPT Corner will contain the updated recommendations.

September 2021

children may be reported)

TABLE VI CPT CODES FOR DEBRIDEMENT SPECIFICALLY OF OPEN FRACTURES CODE

DESCRIPTOR

11010

Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (e.g., excisional debridement); skin and subcutaneous tissues

11011

Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (e.g., excisional debridement); skin, subcutaneous tissue, muscle fascia, and muscle

11012

Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (e.g., excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone

Coding: For multiple wounds in the same anatomic area, add the surface area of those wounds that are at the same depth, but do not combine wounds from different depths.

the entire nasal subunit for reconstructions. The defect is then reconstructed with a bilobed flap.

Depth of debridement: subcutaneous fat 11042, 11045 x 2 units

Coding: 15004: Surgical wound preparation for reconstruction, in this patient this includes non-viable tissue and the additional soft tissue to allow for reconstruction of the entire subunit.

Right posterior calf wound: 45 cm2

14060: Bi-lobe flap

Depth of debridement: muscle 11043, 11046 x 2 units

One of the areas of confusion is: When is it appropriate to use a separate debridement code in conjunction with a reconstructive CPT code? In the clinical vignette above, an appreciable amount of non-viable tissue is removed in order to facilitate the reconstructive procedure and avoid wound healing complications. In addition to the removal of the non-viable wound edges/tissue, the nasal tip subunit was completely resected in order to facilitate the reconstructive procedure also justifying the use of the surgical preparation/debridement CPT code. Both of these portions of the surgical preparation of the wound are evidenced by the appreciable increase in size of the final wound. Not every Mohs reconstructive procedure may warrant the addition of a surgical preparation or debridement CPT code, especially if minimal or no tissue is removed, or if the Mohs defect is simply irrigated in order to remove debris from the Mohs procedure. There must be significant additional work in order to justify the use of the 1500x codes.

Right medial and lateral calf wounds: 25 + 25 cm2 = 50 cm2

Case Two: A 25-year-old male patient presents to the E.R. after falling while hiking. He has a complex traumatic wound of the left ankle with skin/soft tissue loss. There’s an associated underlying nondisplaced fibula fracture. Within the wound is a small amount of dirt. The orthopedic consultant plans to manage the nondisplaced fibula fracture nonoperatively with casting. He asks you to place a splint at the end of the debridement. Due to the contaminated nature of the wound, you take the patient to the O.R. for washout and debridement of the wound. You debride the wound measuring 18 cm2 including nonviable skin and a small amount of fascia. You also pulse irrigate the wound to remove the dirt and remove a few small foreign bodies/rocks. The patient is brought back to the O.R. after 48 hours for a “second look” debridement, at which time the nonviable skin edges including dermis are excised and the wound now measures 24 cm2 after debridement. Coding: First operation: 11011 Second operation: 11010-58 Because of the associated fracture within the area of the wound, the 1101x codes are used for these debridement procedures. The depth of tissue of the debridement determines the code utilized, but the total area does affect the code utilized. Because the second operation is a planned, staged surgery, the -58 modifier is appended to CPT 11010. The debridement codes have a zero-day global, so the need for the modifier may be payer dependent. Case Three: A 7-year-old male is brought to the pediatric emergency after suffering a dog bite to face. On evaluation, he’s noted to have a 3 cm. laceration of the left cheek. The laceration is noted to have contused wound edges that are irregular due to the dog bite. In the E.R., the left cheek laceration is debrided of the contused, jagged skin including epidermis and dermis. The laceration is irrigated and a complex repair measuring 3.2 cm is performed. Coding: 13132: Complex repair cheek 2.67.5 cm When utilizing a complex repair code, the debridement is bundled into the repair code and not separately reportable. Case Four: An 80-year-old male undergoes Mohs resection of a basal cell carcinoma of the nasal tip. He presents 72 hours after the Mohs procedure for reconstruction. He has a 0.6 x 0.6 cm wound of the nasal tip with macerated skin edges and a necrotic base. In addition to a surgical excision of the non-viable tissue, the defect is enlarged to 1.5x1.5 cm to encompass

Proper documentation Appropriate, descriptive documentation of the details of the debridement procedure is important to ensure appropriate reimbursement in a timely fashion and minimize insurance denials. Operative notes should include the following: 1. Treatment diagnoses and other medical conditions that are pertinent to the wound being debrided. 2. Describe the wound: size, depth and specific tissues involved. 3. Presence of infection. 4. Presence of nonviable, devitalized or necrotic tissue. 5. Method of debridement: The inclusion of the word “excisional” implies sharp debridement. It’s helpful to document the specific sharp instruments utilized to debride tissue. 6. Description of all types of tissue removed (i.e., skin, subcutaneous fat, fascia/muscle, bone). This is important for appropriately justifying which 1104x or 1101x code that is billed. 7. If serial or staged debridement procedures or reconstructive procedures are planned. Remember to use modifier -58, as some payers may require it. 8. The final wound dimensions, after debridement, including total surface area in cm2. This is also important for choosing the appropriate add codes units for 1104x and 1500x. Understanding the differences and the nuances of the different families of debridement codes can lead to a simplification of billing and coding of complex wound management. PSN

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ON LEGAL GROUNDS

Examining some of the legal risks tied to destination surgery “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

he COVID-19 pandemic prompted a marked increase in self-reflection and evaluation, with increased public interest in aesthetic awareness and plastic surgery consultations as a result. There also appears to be an increase in destination surgery, which carries its own set of inherent risks and complications. The perceived “value” of plastic surgery is in the eye of the patient, and although many advertisements and promotions are designed to take advantage of lower costs, patients should be made aware of the risks – which include not only the usual (infection, complications), but also failed expectations and significant additional costs to fix or correct what occurred. Case One: Siobhan R. travels south of the border to have a suction lipectomy and tummy tuck in an aesthetic clinic that advertised in her local paper and online. The ad claims that surgeons and staff were trained in the United States, practice in a modern facility and provide services at half the

cost that would be expected at home. She travels with a friend, has the surgery and returns to her Texas home two days later. She then starts to experience swelling, fever and other signs of illness. Her abdominal incision opens and drains, prompting a visit to her local E.R. There she’s told her insurance will not cover her complaint, as it arose from a cosmetic procedure. The plastic surgeon on call reluctantly consults and discusses the proposed plan for a hospital admission and its inherent costs and fees. With no obvious alternative to consider, Siobhan agrees. Three surgeries and a huge bill later, she heals – but with terrible abdominal scars and contour issues. Although she hired an attorney, there’s no possibility of a claim against the foreign care providers. The attorney then pursues the American plastic surgeon who cared for her as he “should have done more to lessen her damage.”

Discussion There are many liability issues when care is provided abroad. The physician surgeon who will perform the procedure should be evaluated by a prospective patient as they’re researching care in their own home city. Look at the providers’ experience, training and work environment. Do they have hospital privileges should a complication develop? Is the medical environment sterile and kept up to appropriate regulated standards? Is the experience a “factory” that just repeats care rather than individualizes appropriate care for each prospective patient? Is the surgeon’s medical license intact – can that even be checked? What about the rest of the nursing

and anesthesia staff? The same quality issues should be considered. What medical clearance is performed? Although the safety and health of the patient is paramount, many patients travel abroad for surgery and receive no medical clearance or approval for the care to be provided. How safe might it be to travel after surgery with a blood clot, or given the natural physical challenges of air travel? Receiving fillers and products abroad also deserves scrutiny. Foreign countries don’t have the same standard as the FDA. Some products injected during destination surgery are illegal in the United States, or simply not approved for safety reasons. There are many stories available on celebrities who had foreign material injected into their bodies, with negative results. What about consultation time to agree on the best and most appropriate choice of procedures – if any? Patients typically seek consultation based on their perception of what they might “need” – an opinion that is often enhanced by what they read on the internet. Travel restrictions and lack of repeat consultations creates further issues in procedure choices that are supposed to best-benefit the prospective patient. Insurance coverage is often denied if a complication arises, due to its origin in a cosmetic surgery procedure. Imagine the negaContinued on page 30

AN ETHICAL MATTER

The rise of domestic medical tourism – and the ethical questions raised By Anu Bajaj, MD

Editor’s Note: The PSN Ethics Column has been updated to include insights from past Ethics Committee Chairs, including Anu Bajaj, MD, who served as the committee’s 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.

ecently, I have heard numerous discussions regarding medical tourism – the topic generates a lot of chatter on the ASPS Discussion Board in particular. We’re all familiar with the stories of patients traveling to have a particular procedure, only to return home with complications (my colleague Neal Reisman, MD, JD, discusses this from a legal standpoint above). Most of us assume that these procedures are performed in low-budget locales abroad – however, some work is performed by our own colleagues in other states. In the past, patients traveled if they could afford a well-known plastic surgeon or had a unique problem that required a specific area of expertise. During residency, I recall caring for many patients who had undergone lowcost plastic surgery out of the country. We rarely would see complications from patients who stayed in the United States. However, the acceleration of social media platforms, telemedicine and other connectivity factors have made borders seem increasingly irrelevant, and many patients are learning more about plastic surgery from different parts of the country – often opting to travel to have work done away from home.

These patients are staying within the United States, and many are seeing legitimate, board-certified plastic surgeons. This isn’t necessarily new, but what is different – and happening more frequently – is that patients choose to travel because they can find inexpensive surgery elsewhere in the United States. Although they can afford a domestic trip for a low-cost procedure, these patients might not have the financial resources to stay for adequate post-op care. And, perhaps the operating surgeon isn’t as concerned about providing post-op care. This raises some important questions. What happens if the patient returns home and has a complication? As a surgeon who’s treating a traveling patient, what’s your obligation with regards to post-op care? What’s the patient’s financial obligation to a local physician who may choose to help him/her out? If you’re the operating surgeon, what happens if the patient can’t afford to return to see you if virtual visits aren’t enough? Is a local physician obligated to treat your complication? These questions don’t always have good answers. I’ve heard stories from multiple colleagues about a patient traveling domestically for surgery done by a board-certified plastic surgeon. The patient returns home, develops a severe infection resulting in sepsis and ICU admission, which then requires multiple additional procedures by a local plastic surgeon. An added twist to this scenario is when the treating plastic surgeon reaches out to the operating plastic surgeon who fails to respond despite numerous attempts at contact. The principles of professionalism in the Code of Ethics – and the law – can offer some guidance in these situations. Section 1: Article V in the Code of Ethics states, “Members may choose whom to serve. In emergency situations,

however, Members should render service to the best of their ability. Having undertaken the care of a patient, a Member may not neglect the patient; and until the patient has been discharged, a Member may discontinue services only after giving adequate notice.” From a legal standpoint, a patient may terminate the physician-patient relationship at any point, but a physician cannot. The law regarding this issue is based “on the more dependent status of the patient in the relationship with the physician.” Furthermore, “Abandonment in the medical setting means the ending of needed care without either making or allowing for reasonable arrangements for that care to continue.” In other words, the patient-physician relationship is a fiduciary relationship in which the physician is obligated to provide postoperative care for the patient. Reasonable arrangements could include providing the patient with adequate notice that you’ll no longer be able to provide care; providing alternative providers to the patient; and providing the records during the transition of care. Other societies and associations, including the AMA and the ACS, have tried to address the issues related to medical tourism. Under the guiding principles of the ACS, it states: “The surgeon will ensure that the surgical patient receives appropriate continuity of care. An ethical surgeon should not perform elective surgery at a distance from the usual location where he or she operates without personal determination of the diagnosis and of the adequacy of preoperative preparation. Postoperative care should be rendered by the operating surgeon unless it is delegated to another physician who is equivalently qualified to continue this essential aspect of total surgical care… It is recognized that for many operations performed in an ambulatory setting, the pattern of the patient’s postoperative visits to the surgeon may vary considerably; it is, however, the responsibility of the operating surgeon to establish

communication to maintain proper continuity of care. Similar circumstances may apply when patients travel great distances for elective surgery.” Similarly, the ABPS states that a physician may be investigated if that physician “Fails to establish an appropriate physician/patient relationship during the perioperative period.” Based on these principles, as physicians and surgeons, when we agree to perform a surgical procedure on a patient, that agreement also includes the post-op care. At the very least, if one of our patients experiences a complication in a distant location, we’re obligated to share records and communicate with the treating surgeon. The other issue is: Who will pay for this often-costly care? Again, the surgical fee customarily includes post-op care. However, in these circumstances, the surgeon treating the complication is usually not the surgeon who performed the surgery. Patients frequently become disgruntled and do not wish to pay the surgeon who’s literally saving his or her life – the operating surgeon is completely out of the picture, and the patient has a new face upon which to vent his or her dissatisfaction. This scenario makes many surgeons reluctant to assume care of a patient who had surgery at a distant location if this care is of a non-emergent nature. Under these circumstances, as physicians, we “should do the right thing” – take care of the patient. Ultimately, I do believe that we bear a responsibility to manage our own complications. If we are unable to do so, we should be cooperative with the treating physician(s). We should consider that if we knowingly operate on patients who have traveled a great distance to see us, a thorough discussion of the post-op care should be a part of the informed-consent process – and the patient should have a clear understanding of what’s expected in terms of follow-up and the management of potential complications. PSN September 2021

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LEGISLATIVE UPDATE

Future Leaders Forum yields insights, predictions from residents, Fellows By Tyler Neese

gainst the backdrop of the ongoing COVID-19 pandemic, the annual ASPS Advocacy Summit was held, for the first time, in a virtual format. From May 19-26, 97 physicians participated in a week of action focused on legislative and regulatory issues impacting the practice. The week included Congressional meetings, speakers from Capitol Hill and beyond, as well as physician panels. One of the highlights of this year’s event was the Future Leaders Forum on May 23. Offered this year for the first time, the forum was conceived by the Advocacy Summit Planning Committee, which felt the virtual format offered a great opportunity to convene a larger number of physicians for dedicated resident/Fellow programming.

The event brought together 35 attendees from across the country – a record number of residents and Fellows for the summit – and provided these physicians with an opportunity to learn more about advocacy and help define future plastic surgery issues.

Speakers and programming The forum’s keynote speaker, Rep. Kim Schrier, MD (D-Wash.), discussed the importance of advancement and engagement in all levels of policymaking – legislative, regulatory, health system and organized medicine. The quintessential physician advocate, Rep. Schrier shared her journey from medicine to lawmaking and stressed the importance of maintaining a firm foot in the practice of medicine in order to be an effective advocate. In an panel discussion titled, “Advice

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

from the Future: A Conversation with ASPS Presidents on Advocacy and Leadership,” attendees heard from past ASPS Presidents Scot Glasberg, MD; Lynn Jeffers, MD, MBA; and Robert X. Murphy Jr., MD, MS, CPE. The panelists discussed how deep involvement in ASPS advocacy efforts can make a significant impact on the specialty, as well as how active engagement in the Society’s advocacy efforts can provide an opportunity for meaningful input into and involvement in the policymaking and direction of the organization. The leaders also stressed how advocacy is an important component of a physician’s job – whether advocating within the hospital or for patients – and shared how involvement within the Society’s advocacy efforts is a great springboard for rising physicians into leadership roles within organized plastic surgery. Attendees also heard directly from their peers when PlastyPAC Resident Ambassadors David Hill, MD, and Benjamin Schultz, MD, delivered a presentation discussing the importance of advocacy and its role in surgeons’ professional responsibility to the specialty. Drs. Hill and Schultz shared recommendations for getting directly involved in advocacy via ASPS Fly-In events, physician grassroots, committee participation and the Society’s other advocacy activities, and they encouraged their colleagues to do so as soon as possible in their medical careers. ASPS Director of Advocacy and Government Relations Patrick Hermes closed the event by hosting a roundtable discussion focused on identifying future opportunities and needs for the practice. Specifically, attendees were asked to identify potentialities related to healthcare delivery systems, payment sources and new horizons in plastic surgery over the next two decades, as well as being asked to “make an intellectual down payment on a strategy to control the specialty’s destiny.”

Key takeaways • ASPS suggested more specific, restrictive language for a Maine bill regarding dental scope of practice and the administration of botulinum toxin and dental fillers, which was amended prior to passage and now implements that language. • The Society collaborated with the Northeastern Society of Plastic Surgeons (NESPS) to share comments on four different Massachusetts bills that would expand coverage for children with congenital anomalies. • ASPS and the Northwestern Society of Plastic Surgeons (NWSPS) opposed a bill that would have expanded the scope of optometrists in Oregon and provided more control to the state’s Board of Optometry. The bill failed to pass. • ASPS worked against legislation that would have created an “advanced esthetician” category in three states: • with the Louisiana Society of Plastic Surgeons, where the societies were successful in killing the bill; • with the Mountain West Society of Plastic Surgeons (MWSPS) in opposition to Nevada legislation that was ultimately successful but was amended to include some ASPS-proposed limitations; • with the NWSPS to improve an Oregon bill – which ultimately passed – to lessen the capabilities of the state’s aesthetics board. • The Washington Office of the Insurance Commissioner issued a notice that it is considering adopting new rules regarding health insurance discrimination and gender affirming treatment. It invited interested parties to participate in the decision to adopt the new rule prior to its formulation, and as such, Society staff contacted the office to determine how it can contribute. • ASPS commented against amendments to a proposed rule that would continue to allow naturopaths in Oregon to participate in the practice of medicine. • The Rhode Island state Legislature adjourned for the year, but not before ASPS and NESPS were successful in stopping a bill that would create burdensome maintenance of certification requirements. • ASPS shared concerns about the title change effort by the American Academy of Physician Assistants -- in which they are “re-branding” as “physician associates” -- with the National Conference of State Legislatures and National Governors Association. ASPS also signed a joint specialty statement in opposition to the change.

The Future Leaders Forum was designed to help ASPS maintain its forward-looking vision, serving as both a brain trust of the practice’s future leaders for the purpose of informing and shaping the Society’s long-term strategic objectives, as well an opportunity to engage residents and Fellows and allow them to take ownership and an active role in the future of the practice. As such, the event concluded with a 75-minute breakout session, in

which attendees shared input and perspective on the future of plastic surgery. This session produced a number of key takeaways that provide valuable insights into the future trajectory of the practice, as well as the focus and priorities of young physicians.

Practice setting Responses to the question “Do you anticipate spending most of your career in private practice, as an employed physician, or as an academician?” were mixed. However, regardless of which setting they favored, a common thread among the physicians was that income goals and personal preference for surgical opportunity and case availability are significant determinants in choosing a practice setting. Among the physicians who favored employed practice, consistent reimbursement was noted as an attractive benefit. For example, one doctor shared that he’s joining a private health system that’s on an RVU system, which ensures that he will be reimbursed at the RVU rate regardless of what insurance carrier the patient has. Attendees also emphasized that in employed practice, employer contracts determine the physician’s job responsibilities and they see the negotiation of that contract as a critical point in determining their professional experience. For example, a health system contract could stipulate that the physician is not required to perform research. One attendee shared that while he wishes to pursue practicing in the academic setting due to an interest in reconstructive cases, he expects to also work in a cosmetic practice to supplement his income. This combination also provides a balance of benefits from all systems and the ability to gain experience in different settings. Not becoming pigeonholed into performing, for example, solely reconstruction and/or cosmetic surgeries was also a consideration. Many in attendance felt that private practice provided autonomy and scheduling flexibility that’s often lacking in the health system setting. For these physicians, the prospect of owning a small business was also appealing, as was avoiding RVU-based reimbursement; set prices; and research requirements (which many felt are often not respected with the requisite amount of dedicated research time). The ability to be more selective about which cases to take was also appealing to the physicians who favored private practice. However, Continued on page 30

Thank you, PlastyPAC contributors

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 July help play a key part in the specialty’s success on Capitol Hill. California Josef Hadeed, MD Debra Johnson, MDI Zeshaan Maan, MDn H Amy Wandel, MD Florida Rajendra Sawh-Martinez, H MD, MHS Kansas s Timothy King, MD, PhD Kansas W. Thomas Lawrence, MD Louisiana Holly Wall, MDI

Massachusetts Theodore Calianos, MDI Michigan Ellen Janetzke, MDI Jeffrey Kozlow, MD Aamir Siddiqui, MD Mississippi s Marc Walker, MD Missouri Justin Sacks, MD, MBAu Nebraska s Sean Figy, MD

New Jersey s Charles Pierce, DO, MPH I Evan Sorokin, MD

Tennessee H Daniel Hatef, MD u Ellis Tavin, MD

New York Jeffrey Ascherman, MD Glenn Becker, MDu Alan Matarasso, MDI

Texas C. Bob Basu, MD, MBA, MPHI Sebastian Brooke, MDu

North Carolina Lynn Damitz, MDI Ohio Spencer Anderson, MDn R. Michael Johnson, MDI

Virginia Michael Olding, MDu Washington David Stephens, MDI Cristiane Ueno, MD

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

September 2021

LETTER TO THE EDITOR

Another viewpoint on financial management PSN welcomes “Letters to the Editor” from readers who would like to share comments, questions or critiques on our coverage or issues affecting the Society or specialty at large. Please contact PSN Managing Editor Paul Snyder at psnyder@plasticsurgery.org. Letters may be edited for space and clarity, and any submissions printed in PSN are done so only with the permission of the author.

1. Save your money. Don’t worry about the specific investment vehicles, just save it. Remember that rate of contribution to a retirement fund is far more important than rate of return. 2. Eliminate debt. This includes student debt (and I realize some of this is almost astronomical), credit card debt and mortgage debt. If you’re buying a home and need a 30-year mortgage, you’re buying more home than you can afford. 3. Never buy a new car. It’s much more financially prudent to buy a “new” used car, as automobiles are a depreciating asset. Unless someone else is paying for it, never lease your car. 4. If you’re not married, you don’t need life insurance. If you don’t have children, you need a minimal policy. When you do need life insurance, purchase a 20-30year term policy. Whole-life insurance is an expensive and inefficient way to protect your loved ones should you die.

n the June 2021 edition of PSN, Jordan Frey, MD, wrote a piece titled “10 Steps for Financial Freedom for Young Surgeons.” Although several of his points have relevance, I found there were not enough straightforward, salient steps that will truly help any surgeon, at any age, find some degree of financial independence. Rather than go through Dr. Frey’s article item by item, let me clarify some of his points and give readers a simple approach to achieving the financial freedom that anyone would want.

5. Before you buy life insurance, get as much disability insurance as you can buy. Before age 50, the chances of being disabled outweigh the chances of dying. This is true even if your employer is providing some form of disability insurance as part of your contract benefits. When buying your own policy, make sure it’s occupation-specific (you cannot work as a plastic surgeon; but maybe you can be a radiologist if you break your wrist). When paying for your own disability policy, use pre-tax dollars. 6. Sometimes you have to spend money to make money. Being your own financial advisor makes as much sense as being your own physician. You need to find someone who will deliver dispassionate

financial advice with fiduciary responsibility at a reasonable price. This may take a bit of detective work. On the other hand, don’t be a passive participant. Get involved. Read The Wall Street Journal, White Coat Investor and The Millionaire Next Door. Be able to speak the language. 7. When it comes to investing, diversify, diversify, diversify. When you are done, diversify some more. No eggs in one basket. 8. If you’re going to invest in real estate, understand that most real estate managers (essentially “caretakers” of your property) are going to charge 10 percent of the rental. Plus, you are responsible for any repairs, replacements, insurance, etc. Will Rodgers said 100 years ago to “invest in land, because they just are not making any more of it,” but understand both the front-end and back-end costs. 9. Don’t buy a vacation home. It’s the dumbest thing you can do with your money. 10. Bulls make money, bears make money, pigs make none. This is the oldest axiom of the stock market. If you don’t know what a bull or a bear is, you have a lot of reading to do. This is just one man’s opinion and it has worked very well for me. There should never be anyone more interested in your financial well-being than you. Remember, the wealthiest people in the world have learned to have their money make money.

SHARE update set for Atlanta

ith its first year in the books, a wide-ranging update on The PSF’s Surgeons in Humanitarian Alliance for Reconstructive, Research and Education (SHARE) program will take place Nov. 1 during Plastic Surgery The Meeting 2021 in Atlanta. Joyce McIntyre, MD, who is clinical chair of the SHARE program, says that in addition to sharing data about the program’s effectiveness in the past year, members of the first class of global learners from Africa will also be taking part via teleconference to discuss cases, research in progress and their accomplishments over the past year. “Anyone with an interest in global surgery is welcome to attend,” Dr. McIntyre says. In addition to gaining support for their research, the first year of the global learners’ two-year commitment to the program focused on particular cases with subject-matter experts providing insights and interactive discussion. Dr. McIntyre says the year ahead will have more of an interdisciplinary focus and will draw heavily from the ASPS Leadership Curriculum. “We’re really going to be able to take advantage of some of the best educational resources that ASPS has available,” she says. If you’re interested in participating in the program as a volunteer, further information and applications are available online at ThePSF.org/SHARE for domestic and international members. PSN

– Carl H. Manstein, MD, MBA Meadowbrook, Pa. PSN

Top ASPS social media posts for Summer 2021

September 2021

YOUNG P L A S T I C

S U R G E O N S

PERSPECTIVE WRITTEN BY AND FOR YOUNG PLASTIC SURGEONS

Meet the recipients of travel scholarships to PSTM21 in Atlanta

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

Nine plastic surgery residents won travel scholarships to Plastic Surgery The Meeting 2021 in Atlanta, and for the first time ever, an international resident was named one of the recipients. The nine winners shared a little bit about themselves ahead of this year’s meeting. Robertino Basso, MD Hospital Italiano of Buenos Aires PGY-3

David Chi, MD, PhD Washington University in St. Louis PGY-4

What are you considering for a career in plastic surgery (specialty area/type of practice)? Microsurgery

What are you considering for a career in plastic surgery (specialty area/type of practice)? Reconstructive microsurgery, academic surgery and aesthetic practice.

Who is the plastic surgeon you aspire to emulate and why? The PSF past President Peter Neligan, MD. He has worked hard throughout his entire career, authored many books, chapters and peer-reviewed papers, and his books have been an inspiration and a frequent reference guide throughout my career. He is a leader in reconstructive microsurgery and always encourages young plastic surgeons.

Who is the plastic surgeon you aspire to emulate and why? Joseph Murray, MD, and Susan Mackinnon, MD, for their persistence in developing revolutionary advances – and maintaining an excellent standard of character.

What are you most looking forward to at PSTM21? I hope to meet plastic surgeons and residents from all over the world and learn from the leaders. It will be an enriching experience.

What are you most looking forward to at PSTM21? Learning from the expert surgeons and seeing old friends from the interview trail.

What’s your favorite hobby/activity to enjoy away from the O.R.? I enjoy playing paddle tennis and reading books.

What’s your favorite hobby/activity to enjoy away from the O.R.? Infant care, weightlifting, pickup basketball and reading.

Sarah Hart, MD University of Michigan PGY-5

Hannah Langdell, MD Duke University PGY-3

What are you considering for a career in plastic surgery (specialty area/type of practice)? I am interested in aesthetic surgery as well as general reconstruction.

What are you considering for a career in plastic surgery (specialty area/type of practice)? An academic career in either hand or microsurgery.

Who is the plastic surgeon you aspire to emulate and why? Erika Sears, MD, is one of my attending surgeons at the University of Michigan who is a fabulous role model. She is a surgeon, a researcher, a mother, a wife and a teacher. She is dedicated to providing her patients the best care, committed to training the residents and an advocate for overall wellness.

Who is the plastic surgeon you aspire to emulate and why? One of my mentors at Duke is Suhail Mithani, MD, a hand and microvascular surgeon. I hope to emulate his creativity, passion for teaching and eagerness to accept difficult cases and collaborate with many different specialties.

What are you most looking forward to at PSTM21? Attending all different types of talks, meeting new colleagues at the Women Plastic Surgeons Luncheon and Young Plastic Surgeons Networking Reception, spending time with my co-residents in Atlanta learning new plastic surgery techniques – and competing in the annual Residents Bowl.

What are you most looking forward to at PSTM21? The opportunity to attend all of the sessions in person after many Zoom conferences over the past year and a half! I’m excited to meet the other members of my ASPS committees and interview faculty for a Duke Plastic Surgery educational podcast, “The Resident Review.”

What’s your favorite hobby/activity to enjoy away from the O.R.? Running, high-intensity interval training and Peloton. I also enjoy reading thrillers and historical fiction novels – and exploring new restaurants with my husband.

What’s your favorite hobby/activity to enjoy away from the O.R.? Cycling, hiking and playing tennis.

Benjamin Massenburg, MD University of Washington PGY-5

Elizabeth Moroni, MD, MHA University of Pittsburgh Research year between PGY-3 and PGY-5

What are you considering for a career in plastic surgery (specialty area/type of practice)? Academic craniofacial surgery.

What are you considering for a career in plastic surgery (specialty area/type of practice)? After residency, I plan to pursue Fellowship training in reconstructive microsurgery. I also hope to utilize my master’s degree in health administration to serve in leadership/administrative roles.

Who is the plastic surgeon you aspire to emulate and why? Richard Hopper, MD. He is simultaneously an incredible leader who earns respect from everyone he meets, a gifted surgeon able to develop and perform novel surgical techniques for difficult problems in subcranial surgery or segmental midfacial distraction, as well as an empathetic human who deeply cares for his patients, staff, faculty and residents as colleagues and friends.

Who is the plastic surgeon you aspire to emulate and why? I have had so many inspiring mentors throughout medical school and residency, but I’d have to say ASPS President-elect J. Peter Rubin, MD, MBA. I admire his ability to balance clinical practice, leadership and research.

What are you most looking forward to at PSTM21? The camaraderie of PSTM21 and being able to share experiences, pitfalls, tips and research with national and international colleagues.

What are you most looking forward to at PSTM21? After a year spent attending meetings remotely, I am excited to reconnect with colleagues and learn from leaders in the field in person again!

What’s your favorite hobby/activity to enjoy away from the O.R.? Surfing is my first love, but I also enjoy mountain biking, snowboarding or any other activity that keeps me outdoors.

What’s your favorite hobby/activity to enjoy away from the O.R.? Running, hiking, paddleboarding, kayaking and biking.

Christina Rudolph, MD Albany Medical Center PGY-3

Charalampos Siotos, MD Rush University Medical Center Research year between PGY-3 and PGY-5

What are you considering for a career in plastic surgery (specialty area/type of practice)? I am particularly interested in pediatric plastic surgery, microsurgery and complex reconstructive surgery. I would like to continue to work in an academic setting, where I can serve as a mentor to aspiring medical students and residents.

What are you considering for a career in plastic surgery (specialty area/type of practice)? Microsurgery is one of the fields that I find very interesting. However, there are still many areas to explore before I dedicate my career in one subspecialty.

Who is the plastic surgeon you aspire to emulate and why? Courtney Carpenter, MD, who is the director of the Cleft-Craniofacial Center at Albany Medical Center. She leads by example as a surgeon and as a mother by actively working to empower her patients, their families and her residents. She actively works to improve the health literacy of her patients and their families. As an attending and my program’s wellness coordinator, she provides strong female mentorship and advocates for resident psychosocial wellbeing.

Who is the plastic surgeon you aspire to emulate and why? Joseph Murray, MD. As part of the team that performed the first renal transplant, Dr. Murray is often cited as a skilled, imaginative surgeon. His work paved the road for modern, life-changing organ and composite tissue transplantation.

What are you most looking forward to at PSTM21? Learning how to be involved in my local and national community as a resident through exposure to the various committees. Specifically, I am interested in being further exposed to the leadership development, wellness, advocacy and women plastic surgeon committees. I am also looking forward to learning from plastic surgery experts. What’s your favorite hobby/activity to enjoy away from the O.R.? Exploring Albany’s locally owned restaurants and going on walks in Washington Park with my friends. I love spending time outside and watching movies with Kali, my German Shepherd.

Rosaline Zhang, MD, MSTR University of Wisconsin PGY-3 What are you considering for a career in plastic surgery (specialty area/type of practice)? Hand and/or microsurgery.

What are you most looking forward to at PSTM21? PSTM is a great opportunity for young residents like myself to become familiar with innovative techniques and cutting-edge technologies in our field and also interact with experts from all over the world. What’s your favorite hobby/activity to enjoy away from the O.R.? One of my most favorite activities is painting. Alone or with friends, painting relaxes me and is a great channel for my non-surgical creativity.

Who is the plastic surgeon you aspire to emulate and why? I have been blessed with many mentors, including Scott Bartlett, MD, Jesse Taylor, MD, and Michael Bentz, MD, who are role models for their dedication to teaching residents, innovative research, global surgery and exceptional patient care. What are you most looking forward to at PSTM21? Inspiration for future research endeavors and meeting and networking with women leaders in plastic surgery. What’s your favorite hobby/activity to enjoy away from the O.R.? Running, baking, reading and travel.

September 2021

Senior Residents Conference: Time to focus on your future By Paris Butler, MD, MPH; Sara Dickie, MD; John Stranix, MD; & Ann Palzer

Targeted education As you head toward the completion of your residency, you’ll likely have questions about topics not routinely covered in training. We’ve done our best to put together seven hours of pertinent information, broken into small, palatable segments most relevant to the seasoned resident. The day starts with tips on building the practice you want in any setting: academic, employed or private.

Senior Residents Conference participants during Plastic Surgery The Meeting 2019 in San Diego. We will explore the current landscape for plastic surgeons and discuss what most firsttime contracts include – and what you should be thinking about going into a contract negotiation. Listen to real-life stories from in-practice surgeons who deal with getting started in practice and how to remain agile when faced with unexpected challenges, including how to handle the unhappy patient. Speakers will be upfront and honest about their experiences. Navigating the job market means setting priorities, identifying where you want to practice and making time to engage in an active search. Should you consider pursuing a career in rural/underserved plastic surgery? Is it a good idea to get a job where you trained? Our experienced faculty will provide their insight about the realities and rewards of these career choices. You will hear straightforward advice on how to network, interview and land a job. The morning concludes with the lively “Wild World of Private Practice” panel discussion. Panelists will talk candidly about mistakes they’ve made, things they wish they’d known when they were a senior resident and the barriers that exist in this market for new to practice surgeons. After the lunch break,

three accomplished plastic surgeons will converse about their experiences and offer advice for starting a family while being a plastic surgeon. Ample time will be available during the program for you to pose questions and get forthright answers from all faculty panelists. Once you’re in practice, becoming board-certified is the next logical step. The afternoon session includes a presentation with tips for oral board collection followed by important information from ABPS Chair and ASPS past President David Song, MD, MBA. The afternoon will include talks that address the effective and ethical use of social media, how to interpret profit and loss statements and how to account for RVUs in cosmetic surgery. The program concludes with the valuable “Hiring a Candidate for an Academic Position” panel, an exciting opportunity for you to learn what distinguished academic chairs look for when they review a resume. It’s your chance to ask them direct questions about entering the world of academic practice. Lastly, we recognize that your career should be a marathon and not a sprint. For that reason, an on-demand lecture on staying

Abstract presentation An integral part of both SRC and PSTM is the opportunity to present your research during the Resident Scientific Sessions on Friday, Oct. 29. Abstract submissions were accepted through April 30, and the best paper selections and resident author names will be announced in an issue of PSN later this year.

Registration For senior residents planning to attend Thursday’s SRC, registration is required ($475). Members of the Residents & Fellows Forum save $100 ($375). The fee is necessary to cover the educational sessions, meals and Resident Reception on Thursday. On behalf of this year’s co-chairs, we look forward to seeing you in Atlanta. For more information, to register or to remain current with deadlines and developments, go to plasticsurgerythemeeting.com and click on the “Residents” tab. YPS

Resident Highlights at #PSTM21 Gain a better understanding of what to expect and all you need to know to prepare for life after residency. Learn about the financial, legal and ethical issues of establishing and running a practice. Thursday, Oct. 28

Friday, Oct. 29

Senior Residents Conference and Resident Reception

Top Resident Abstract Presentations

Register today at www.plasticsurgerythemeeting.com/residents or call ASPS Member Services at 800-766-4955 for more information. 2021 Residents Program Supporters:

September 2021

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

ew speakers and an ever-evolving program will highlight the Senior Residents Conference (SRC), slated for Oct. 28 during Plastic Surgery The Meeting 2021 in Atlanta. We invite you to spend a full day networking with your resident colleagues and current leaders in plastic surgery. The SRC is a joint effort between ASPS, the Young Plastic Surgeons Steering Committee and the American Council of Academic Plastic Surgeons. The co-chairs of this year’s event are Paris Butler, MD, MPH; Sara Dickie, MD; and John Stranix, MD. The resident program serves as the unofficial launch of Plastic Surgery The Meeting, the annual scientific meeting of ASPS/PSF/ ASMS/TRS, which is the specialty’s largest meeting in the world. We’re excited to return to an in-person event in our host city of Atlanta and encourage you to join us for the resident-focused conference. This year’s meeting brings together the best and brightest in our specialty, and we want you to experience the energetic educational and entertaining offerings that are available.

healthy, ergonomics and injury avoidance is included in your registration fee. On Thursday evening, plan to attend the annual Resident Reception at the Omni Atlanta Hotel at the CNN Center from 6-7 p.m. (EST). The event offers another prime opportunity to mingle with other residents over cocktails and appetizers, and network with leaders of the specialty who quite possibly could be your future employer. We thank Allergan Aesthetics, an AbbVie company, for sponsoring the SRC and we’re grateful for their generous support of our resident education programs.

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.

September 2021

Experience.

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

ALLODERM SELECT™ RTM has a distinct basement membrane (upper) and dermal surface (lower). When applied as an implant, it is recommended that the dermal side be placed against the most vascular tissue. Soak the tissue for a minimum of 2 minutes using a sterile basin and room temperature sterile saline or room temperature sterile lactated Ringer’s solution to cover the tissue. If any hair is visible, remove using aseptic technique before implantation. ALLODERM SELECT™ RTM should be hydrated and moist when the package is opened. DO NOT use if this product is dry. Use of this product is limited to specific health professionals (e.g., physicians, dentists, and/or podiatrists). Certain considerations should be made to reduce the risk of adverse events when performing surgical procedures using a tissue graft. Please see the Instructions for Use (IFU) for more information on patient/product selection and surgical procedures involving tissue implantation before using ALLODERM SELECT™ RTM.

ALLODERM SELECT™ RTM is available by prescription only. For more information, please see the Instructions for Use (IFU) for ALLODERM SELECT™ RTM available at www.allergan.com/AlloDermIFU or call 1.800.678.1605. To report an adverse reaction, please call Allergan at 1.800.433.8871.

To learn more, visit AlloDerm.com/HCP 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. Data on file, Allergan. 2018; Number of AlloDerm™ RTM Units Sold. 2. Wainwright DJ. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns. 1995;21(4):243-248. 3. Data on file, Allergan Aesthetics; May 2021; Plastic Surgery Aesthetic Monthly Tracker. 4. Data on file, Allergan Aesthetics; Search Performed on PubMed in June 2021.

September 2021

Combined Pilot Research Grant

Examining the role of decision aids for hand surgery patients 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 Mélissa Roy, MDCM, MSc Title: Craniofacial Fellow, Division of Plastic Surgery, Seattle Children’s Hospital Award: Combined Pilot Research Grant Project: Development and Testing of a Decision Aid for Patients With Dupuytren’s PSN: What do you aim to accomplish by studying decision aids for Dupuytren’s patients? Dr. Roy: The goal was to establish the foundation for the development of contemporary decision-aid tools that would guide hand surgery patients in their treatment selection. Decision aids have been shown to help patients reach decisions that are high quality or informed and consistent with personal values. We aimed to better-support quality decisions in hand surgery with an innovative patient-centered tool: a video decision-aid of the available management options for Dupuytren’s disease. To do so, we developed our decision aid following the International Patient Decision Aid Standards (IPDAS), then assessed its acceptability among patients and measured its feasibility and effect size. The ultimate objective was to increase patients’ involvement, comprehension and empowerment in their care. PSN: How far are you in your research and what have you learned thus far? Dr. Roy: We’ve deployed the video deci-

Clockwise from top: Dr. Roy (right) in scrubs at the Duke Flap Course in 2019; with her mentor, Steven McCabe, MD, at the American Association for Surgery of the Hand annual meeting in 2017; and relaxing in Toronto’s High Park with her husband, Brooke, and family members Luna (left) and Balto. sion-aid into the clinical setting, and the data collection and analysis have been completed. As part of the final manuscript review, it’s very exciting to reflect on the project and its main conclusions. The development of a decision aid was a creative and formative process that took place within an existing framework of well-defined and exhaustive standards. During this crucial step, we learned that continuous improvement and amendments were to be expected to have a useful (and accepted) product. We’ve learned that the decision aid was effective in decreasing patients’ decisional conflict and improving their decisional self-efficacy. We hope these findings will influence the daily practice of hand surgeons, clinicians and beyond in terms of communicating medical information to patients in the process of shared decision-making. Decision aids and support tools can make a difference in patients’ clinical care experience.

PSN: What do you see as this project’s practical applicability? Dr. Roy: The practical application will be to provide patients with additional tools to support quality and evidence-based decisions in a context of overwhelming complex medical information often from varied sources, and with patients having diverse personal values. The video decision-aid is one specific tool addressing the decision of how to “best” manage a patient’s Dupuytren’s. We do recognize the clinical nuances that are involved in making such a decision or recommending a particular option; however, the overarching goal of enhancing clinical practice with decision aids remains to ensure patient participation and comprehension in their care, allowing them to take ownership. Although decision aids don’t replace clinical encounters, they can become clinically integrated tools to support effective communication.

VIRTUAL MIGRAINE SURGERY SYMPOSIUM SATURDAY | OCT. 16, 2021 PROGRAM CHAIRS: Bahman Guyuron, MD and Jeﬀrey Janis, MD

PSN: Has anything unexpected surfaced? Dr. Roy: Extensive data collection regarding patients’ sociodemographic information (including their health literacy), decision-aid acceptability, decision self-efficacy and decisional conflict levels took place. Analysis of the gathered data demonstrates excellent acceptability of the tool which was noted to provide very clear and well-structured information. Interestingly, despite developing our video decision-aid with international standards and ensuring comprehensive review of options (description and illustrations, risks and benefits, expected outcomes and recovery, and more), numerous patients suggested presenting additionally detailed information. Similarly, many commented on the importance of their surgeon’s opinion and recommendations, despite being made familiar with all clinically acceptable options. This reliance on medical expertise was very present and is a reminder that decision aids don’t replace clinical exchanges or recommendations – but they can help contextualize options within a clear and succinct framework. PSN: What might be behind this change? Dr. Roy: Although we can provide tools for patients to make informed and quality decisions about their health, there was likely a vast amount of information with which they were less-familiar beforehand. In approximately one-third of surgical patients as per our previous studies, patients have limited health literacy and therefore cannot fully understand and act upon the health information provided. This lack of familiarity combined with the responsibility of being involved in the decision may reveal to be occasionally overwhelming for some. Expert reassurance and guidance toward making an informed decision can be required. PSN: Who are your mentors and key collaborators on this project? Dr. Roy: I’ve had the privilege of completing my plastic and reconstructive surgery residency at the University of Toronto. Chaired by Christopher Forrest, MD, the division is incredibly supportive of research endeavors and has undoubtedly contributed to my development in working through a surgeon-scientist career path. Within the division, Steven McCabe, MD, MSc, has been an exceptional mentor by encouraging me to think outside the box and take initiative. He has continuously supported me throughout my graduate degree, clinical duties and beyond. Another shout-out goes to my MSc committee members and co-authors for the project, as they’ve been constant figures of encouragements and support: Christine Novak, PhD; Herb von Schroeder, MD; David Urbach, MD, MSc; Karen Okrainec, MD, MSc; and Paul Binhammer, MD, MSc. PSN: What did you want to be when you were growing up? Dr. Roy: I was always encouraged to pursue my dreams and passions with unconditional love and support from my family. I had a Continued on page 27

September 2021

The ‘doctor’ will see you now...

Non-plastic surgeons and non-medical practitioners alike are ramping up efforts to perform cosmetic procedures. Leaning on vague language to tout credentials and a public drawn to low prices, patient safety remains in the crosshairs.

By Paul Snyder

September 2021

SPS member Liza Wu, MD, Philadelphia, knows how easy it can be for patients to decide upon a non-plastic surgeon for a cosmetic procedure – because she knows doctors who do the same thing. She doesn’t have to look any further than her own family. “About 10 years ago, my mother wanted a laser treatment for hyperpigmentation on her face,” she recalls. “I was home visiting and she’s telling me about how she went to a doctor to get laser work for the dark spots on her face, but it didn’t help at all.” Puzzled, Dr. Wu asked her mother who she saw for the treatment. She casually replied that it was an OB/GYN. “My mom’s a physician, a family practitioner,” Dr. Wu says. “I’m looking at her, saying, ‘Why would you do that?’ She just said her friend had recommended him and she trusted him. That’s it. It was just shocking to me that a doctor would do that – never mind a doctor whose daughter is a plastic surgeon – but a recommendation from a friend can be enough. They just assume the doctor knows what they’re doing.”

“No one should be allowed to just call th because they are doing ‘plastic surgery.’ Th good name and credit for all the work we’v surgeons. It’s a competitive field and we need our brand, which is earned through years and

An ineffective treatment is one thing, but similar assumptions on the parts of patients have led to a number of complications, which often end up in the hands of plastic surgeons for revision. Yet despite the discomfort and dissatisfaction with results from the original practitioner, lessons aren’t always learned. “We deal with it all the time,” says ASPS/ PSF Vice President of Health Policy and Advocacy Gregory Greco, DO. “The patients were treated at such-and-such place and now we have to solve the problem. What’s odd is that the patients still go back to the place – because it’s cheaper.” The fact that non-plastic surgeons continue to perform plastic surgery procedures is neither a new nor surprising story, as several ASPS members point to the financial enticements of taking on cosmetic procedures. Still, with the increase in weekend courses that focus on particular procedures (from fillers to fat reduction techniques to offerings such as the education program held earlier this year by general surgeons – and originally endorsed by the ACS – on oncoplastic surgery that advertised lessons on reductions and mastopexies for symmetry on the contralateral breast), the once-anecdotal mentions of dentists doing rhinoplasties, OB/GYNs doing breast surgery and dermatologists doing facelifts are growing in number. Legislative moves at state and federal levels designed to remove supervisory protections for nurse practitioners and physician assistants are steering more patients to non-plastic surgeons for cosmetic work – and despite advocacy efforts by ASPS, even the terminology surrounding “board-certified plastic surgeon” is becoming a play on words within physical and digital advertising. This, of course, all runs parallel to the steady flow of stories about complications and deaths arising from patients who sought procedures in settings ranging from basements to apartments and fly-by-night clinics, and from individuals who have no medical credentials at all. “We’re no longer in competition with just physicians,” Dr. Greco says. “It’s almost be-

come an issue of physician vs. non-physician practitioner now. The pendulum has swung so far that when a complication comes in, we are almost oddly relieved with the knowledge that at least the patient was treated by a physician provider.” Unfortunately, these providers are not always entirely truthful with their credentials, which leads to harming unsuspecting patients. “I recently dealt with a patient who came to me for a secondary facelift revision,” says ASPS past President Jeffrey Janis, MD. “We sat down and discussed what had happened, which revealed that the doctor who performed her original procedure was an ophthalmologist. She was distraught and kicking herself – she felt duped, because more and more of these doctors are advertising themselves in such a way that would make a patient think they’re a plastic surgeon. Time and again, it’s the plastic surgeons who are called-in to get these patients out of their jams, but because of these experiences, the term ‘plastic surgeon’ gets even more and more confusing from a public perception standpoint.”

Legislative gateways On the advocacy side, there’s rarely a shortage of legislative or regulatory movement at the state or federal level to open the doors for more plastic surgery work by non-plastic surgeons. One look at the Society’s advocacy efforts during this year alone shows efforts designed to curb scope-expansion attempts for dentists in Georgia and Maine; for nurse practitioners in Florida, Louisiana, Mississippi, Tennessee, Virginia; for optometrists in Alabama, Mississippi and Oregon; for PAs in Utah; and for naturopaths in Maryland and Oregon. As part of the new Medicare omnibus bill proposed at the federal level, Medicare could make direct payment to PAs for professional services furnished at the start of January 2022. Medicare currently can only make payment to the PA’s employer or independent contractor, so as it stands, PAs cannot bill and be paid by

the Medicare program directly for their professional services; they also do not have the option to reassign payment for their services, or to incorporate with other PAs to bill the program for PA services. The argument lodged by PAs against the current situation is that it hinders them from fully participating in emerging models of healthcare delivery, but Dr. Greco sees a consequence of allowing this expansion. “If this goes through, it just opens things up at the state level to roll back supervisory requirements and enable scope creep,” he says. Although ASPS has not taken a position on that provision of the omnibus bill, the Society has been keeping tabs on recent moves by PAs to increase their own scope of practice. In May, the American Association of Physician Assistants (AAPA) House of Delegates passed a resolution affirming “physician associate” as the official title for the PA profession (as opposed to the longstanding “physician assistant” title), a move ASPS opposes. Due to the gap in training and expertise between medical doctors and ancillary providers, most states have historically required that PAs be closely supervised by physicians – including chart review, co-location of physicians wherever physician assistants practice and a limited scope for PAs. In most cases, a written collaborative agreement with a physician that can outline the procedures a PA is allowed to perform is required. Supervision is determined at the practice level in 31 states, and by the state medical board or within state law in 19 states. However, in recent years, more statehouses have taken up legislation that eases these supervisory rules and provides more independence for PAs to provide healthcare services. The Society is reaching out to PA-related organizations, including the Physician Assistant Education Association, which represents PA educational programs; and the National Commission for Certification of Physician’s Assistants, which certifies PAs. Both groups expressed reservations about the title change and are responsible for knowing and validating exactly the appropriate role for PAs. September 2021

hemselves a plastic surgeon hose people are taking our ve put in to become plastic to be proactive in protecting d years of training.” – Brian Drolet, MD Word play Again, however, PAs are just one group eager to take on the work that doesn’t have the same amount of training as a plastic surgeon. As chief of hand and upper extremity surgery at Vanderbilt University in Nashville, ASPS member Brian Drolet, MD, does not perform cosmetic procedures, but sees the greater public safety concern in expanding scope without proper training. “I think plastic surgery has the only true claim to cosmetic surgery because we’re the only specialty that has required cosmetic surgery experience during our accredited residency training,” he says. “Our research has found that many providers doing cosmetic surgery are practicing far outside the scope of their accredited training backgrounds – like an oral surgeon performing abdominoplasty. Meanwhile, the only specialty that has any cosmetic surgery training requirement is plastic surgery. So, this comes back to the issue of public safety. People should be able to trust the brand of plastic surgery because they know we have thorough training experiences that include cosmetic surgery. “No one should be allowed to just call themselves a plastic surgeon because they are doing ‘plastic surgery,’ ” Dr. Drolet adds. “Those people are taking our good name and credit for all the work we’ve put in to become plastic surgeons. It’s a competitive field and we need to be proactive in protecting our brand, which is earned through years and years of training.” Although there has been and continues to be active work by the Plastic Surgery Education Campaign and ABPS to highlight the importance of finding a board-certified plastic surgeon when pursuing a procedure – not to mention notable legislative victories in states such as California where the state medical board deemed that certification from the American Board of Cosmetic Surgery (ABCS) was not equivalent to the standards of ABPS – Dr. Janis notes the years spent focused on the words “board-certified plastic surgeon” also September 2021

gave the competition the ammunition needed to exploit loopholes. “A lot of practitioners are conflating certification in cosmetic surgery with ‘board-certified plastic surgeon,’ ” he tells PSN. “Although it’s been legislated at the state level, it’s not being policed enough and there are some who would leverage that in their terminology. If they say they’re board-certified and perform plastic surgery procedures, is that lying? No. But is it entirely truthful? It’s certainly a bit disingenuous. “People will take that and parlay it into a twist on words,” Dr. Janis adds. “You can market yourself as ‘double board-certified,’ but when you look, it might be in OB/ GYN and the American Board of Cosmetic Surgery (ABCS). For the average consumer who’s seeing all these doctors tout that they’re ‘board-certified,’ well, ‘double board-certified’ sounds even more impressive. It doesn’t matter that the certification comes from a specialty with no standardized training in cosmetic or reconstructive plastic surgery or a non-ABMS recognized program.” Although it’s more of a mouthful, Dr. Janis suggests that education should perhaps turn to terminology that underscores the fact that ASPS members are ABPS-certified, as a way to address the vagaries around “board-certified” terminology. ABPS Executive Director Keith Brandt, MD, says the board is aware of these concerns and continues to discuss the problem. From an enforcement perspective, however, he notes that with the exception of legislation, there isn’t a solid route to influence non-plastic surgeons on the use of the term “board-certified.” “We are reviewing websites we know about and asking the uncertified to remove the term ‘board-certified,’ but it’s tougher with ABCSand even ABMS-certified physicians who are certified in another specialty,” he says. “There needs to be more education so that the general public understands the difference in ABPS certification. ABPS plastic surgeons

continuously verify their certification through continuous education. We stay up-to-date and learn the new issues. We continue to learn how to avoid complications. ABCS offers one exam and they’re done. Their training doesn’t even come close.” After years of debate about whether to let members use the ABPS emblem on their websites, the board developed a specialized “board-certified” emblem that ABPS-certified plastic surgeons can use. The problem, Dr. Brandt notes, is that much like the ASPS logo that members use, these symbols that should immediately signify a standard in training and excellence are often buried at the bottom of a practice webpage or on an “about” page. “It is interesting that, say, if you hire somebody to work on your house, you know to look for someone who is experienced and insured in that trade and to check for the credentials,” Dr. Wu says. “I think it needs to be impressed upon people that if you’re going to go search for cosmetic surgery or any kind of procedure, that the person you’re going to is board-certified in that particular area – and not just someone who is a doctor or a self-proclaimed expert.” While such measures aren’t enforced, the deceit continues. Dr. Janis notes that while driving to a Michigan Academy of Plastic Surgeons meeting earlier this summer, he saw several billboards touting procedures such as fat treatment and various fillers performed by a particular “board-certified” doctor. “Turns out it was a board-certified OB/ GYN,” Dr. Janis says. “It incensed me, especially as this is quite confusing to the public.” From an advocacy standpoint, Dr. Greco says he would like to see the push continue for full-training disclosure – even though he concedes it’s something that likely will never materialize. “The more information we can get legally disclosed about truth in medical expertise and training will help the consumer,” Dr. Greco says. “Because even when you look at plastic surgery, it at times seems like a very

steep uphill battle. Social media is potentially delegitimizing the art and science of the profession and purely morphing it into medical entertainment. People are looking at someone’s number of followers and falsely equating that to competency – even though there’s absolutely no correlation.” Despite the ever-present existence of scope battles, Dr. Drolet says pushing for better truth in advertising is preferable to trying to limit scope of practice. “Most doctors, deep down inside, don’t want scope of practice too narrow,” he says. “Because if I’m qualified to do nerve surgery by whatever standards you’re looking at, but somebody says, ‘Oh, you didn’t do a neurosurgery residency – you shouldn’t be allowed to do nerve surgery,’ well, that’s a big part of my practice as plastic surgeon and now I’m being restricted from doing something that I should otherwise be able to do. But I do think that people who aren’t plastic surgeons advertising that they are plastic surgeons is where a line gets crossed.” Despite the frustration inherent in treating patients who suffered complications as a result of non-practitioners or as a result of traveling for lower-cost surgery, Dr. Wu also says it’s incumbent upon plastic surgeons to continue to fix the work that others could not perform. “I know there are many of us who defer seeing these patients to other surgical services when they show up in the emergency department,” she says. “It’s one thing if the patient is in extremis, but if its a patient who has a complication from a tummy tuck like a seroma or a mild infection, it’s easy to say, ‘I don’t own this complication,’ and point out that the people who aren’t board-certified plastic surgeons aren’t trained to deal with these issues. “But you can’t let the patient suffer for it,” Dr. Wu adds. “It’s our duty to take care of them. Should there be repercussions for the person that did the original procedure? Yes. But we have a responsibility to help when and where we can.” PSN

ASPS President’s Award

‘All individuals are respected’: A career in community building By Paul Snyder

any careers in plastic surgery are defined by innovation that helped advance the specialty, but many more are defined by the relationships fostered over the course of a career and the direct effect that friendship, mentorship and guidance can have on the careers of countless others. When ASPS immediate-past President Lynn Jeffers, MD, MBA, bestowed the ASPS President’s Award upon Debra Johnson, MD, during Plastic Surgery The Meeting 2020, she said the honor was due in large part to the inspiring effect that Dr. Johnson has had on so many plastic surgeons. To be sure, Dr. Johnson has built a sizable orbit of personal and professional relationships over the course of an impressive career. To date, she has volunteered in more than 60 international missions and served as ASPS president, as well as president of the California Society of Plastic Surgeons (CSPS) and on the American Board of Plastic Surgery. Her work as a plastic surgeon is defined not only by the results she’s had for her patients, but also by an extensive track record of involvement in organized plastic surgery, including numerous committees and task forces in ASPS. Yet, a career in plastic surgery wasn’t her original goal. Dr. Johnson grew up in a rural community in central California. Her parents were high-school sweethearts who married and started a family early, due to her father joining the Marines during World War II. Although neither of her parents went to college, Dr. Johnson says they never stopped encouraging her to go to college and make the most of herself. Not certain what she wanted to do with life, she says her decision to medicine was steered by the fact that her mother was an office manager for a general practitioner who one day suggested that Dr. Johnson become a doctor. By her junior year in high school, Dr. Johnson was working a small job in the E.R. at a local hospital and set her sights on a career in oncology during medical school. However, The PSF past-President Donald Laub, MD, then the plastic surgery department chair at Stanford University, took her on her first international mission trip as a medical student, which she credits for changing her focus to a future in plastic surgery. Throughout her career, Dr. Johnson remained an active participant in mission trips, which she says keep her grounded and connected to the important work that plastic surgeons are able to perform on a daily basis. Recalling one such trip, she says performing a cleft-lip surgery on a 72-year-old man exerted an enduring impact upon her. “He lived in the house of the people who brought him to me, and he’d lived his whole life in this kind of sheltered, protected environment,” Dr. Johnson remembers. “Because of his condition, he was never very social. He was nearing the end of his life. I was happy to perform the surgery, I couldn’t help but wonder about the timing. I said to him, ‘Why do you want to have this surgery now?’ There was a slight pause, and he looked at me and said, ‘Because I don’t want God to see me this way.’ ” Dr. Johnson says there are countless such

Dr. Johnson (above) during a mission trip in Mandalay, Myanmar, with a young cleft-lip patient and her mother; (left) with her husband, Mario, on the Calatrava Bridge in Bilbao during the Spanish Society of Plastic Surgeons Meeting in June 2017; and (right), with her children, Pablo and Gabi, during Pablo’s white coat ceremony at Temple University School of Medicine.

stories that reinforce the power of the work that plastic surgeons can do – sometimes in less than an hour.

Natural leader Much like her journey to the specialty itself, her journey into leadership positions wasn’t necessarily a goal from the outset but a path forged by the encouragement of others. She credits Robert Faggella Jr., MD, Jack Bruner, MD, and John Osborn, MD, with steering her to the advocacy side of Society involvement, which led to not only her time as president of the California Society of Plastic Surgeons, but also to her 2017 term as ASPS president. “It seemed like a natural connection to me,” she says of her work in state and national societies. “This is our organization; we should want to take care of it.” Dr. Johnson’s work at the state and federal levels has been an inspiration to many of her colleagues, says ASPS/PSF Vice President of Health Policy & Advocacy Gregory Greco, DO, who notes his pride in being able to call Dr. Johnson a close friend for so many years. “I was first introduced to Dr. Johnson through my own ASPS Advocacy Committee work, and it was evident from the first meeting that she had a voice, opinions and actions that defined and underscored her social, moral and humanitarian beliefs,” he says. “We are fortunate to have her as a role model and thought leader in our Society.” Reflecting on her presidency, Dr. Johnson says she’s particularly proud of the work that ASPS made in fortifying international relationships and partnerships – a pattern that has only increased in the years since. “The connections we made were important,” she notes. “We were only kind of maturing in our life of international membership, and I took great pride in being able to visit some of the international societies and spread the word of what ASPS provided their members in terms of education and networking.” Dr. Johnson’s tenure as ASPS president was also historic in that she was only the second woman in Society history to be elected president. Although more women have

followed as president for both ASPS and The PSF in the ensuing years, Dr. Johnson says the Society needs to keep its foot on the gas in terms of ensuring the organization remains an increasingly diverse community. “Women started entering medicine just about 50 years ago, and for 45 of those we hardly moved the needle on leadership,” she says. “But as we’ve made more noise, things have improved significantly. Now we have about 37 percent of plastic surgery residents as women – when I started, that number was around 12 percent. So we are seeing those numbers move, and I think the Women Plastic Surgeons Forum has been really important in terms of mentoring young women and getting them involved, and things such as the ‘Women in Plastic Surgery’ series that PRS ran a few years ago was particularly important in getting gender issues out in the open. “Diversity in all areas has become a top-ofmind issue, and we know that diverse groups perform better,” she continues. “We just need to keep pushing that agenda, and it has to start with recruitment of residents, faculty and, ultimately, the leadership of our Society to ensure we continue to have a diverse organization.” Dr. Jeffers says the example Dr. Johnson set as a leader provided an important standard for anyone who seeks a leadership role. “I first met Dr. Johnson when she was one of the faculty for the Stanford Board Review course,” Dr. Jeffers recalled when presenting Dr. Johnson with the ASPS President’s Award. “Something about her stood out and our paths crossed again later in our shared work in advocacy and organized medicine and, ultimately, when Dr. Johnson served as the second woman president of ASPS. Her dedication to advocacy is seen in her leadership, when she fights for the future of plastic surgery. As a current ASPS trustee, she continues to champion the idea of doing the right thing, and she remains active in her mentorship of others in leadership – in advocacy and life. Dr. Johnson contributes countless hours of time to plastic surgeons, ASPS and our specialty. She actively seeks to grow others and creates opportunities for others to lead. Her leadership and dedication

have inspired many – both nationally and at the state level.” The PSF past-President Paul Cederna, MD, who served as The PSF president the same year as Dr. Johnson served as ASPS president, says it was his privilege and honor to work so closely with Dr. Johnson not only in 2017, but in several areas of Society involvement through the years. “It is very rare that you find a person who thinks the way you think, whose instincts are similar to yours and whose approach to challenges is perfectly aligned with yours,” Dr. Cederna tells PSN. “That is why we had so many successful years serving the ASPS and The PSF together. Dr. Johnson is a thoughtful and insightful leader. She’s a visionary who can very effectively manage the issues of the moment, but at the same time, she could see the future and build programs to achieve that future state. “She was able to accomplish this by building diverse teams of individuals with specialized skill sets to solve some of the most complex issues our specialty faced,” Dr. Cederna adds. “Dr. Johnson has a collegial approach to problem-solving where all opinions are valued and all individuals are respected. This really brings out the best in people – I know that Dr. Johnson brought out the best in me and I’m a better leader and individual because of her.”

Strength in relationships Dr. Johnson’s career has been fortified by several mentors, colleagues and students – as well as her two children, Gabi and Pablo, and her late husband, Mario, who – like her parents – she says always encouraged her to dream big. “Family is our strongest support network,” she says. Considering all the accolades and titles held throughout an illustrious career, however, Dr. Johnson says her favorite part of being a plastic surgeon remains the patients. “They’re wonderful people,” she says. “They want their appearance to reflect their internal energy, they want to look as good as they feel and they have wonderful stories to tell. I have been so fortunate to meet some really interesting people, both in my private practice and in my international work – and it’s another way for me to be a diplomat for our specialty. You let them in, and it becomes more than just a doctor-patient relationship. You become friends. “I’ve been in practice long enough that I see people who I treated in the early 1990s coming back for a facelift in their 60s,” she says. “We talk about their kids and their career, and those ongoing relationships really mean a lot. When I do the last post-op work with a patient, I’ll always say, ‘You don’t need to come back for this problem, but all I ask is that you come back in 10 years with another issue.’ They almost always tell me they’ll be back: ‘Don’t worry.’ ” PSN

September 2021

Facing retirement: When to create your end-of-career transition plan By Enrique Fernandez, MD

Editor’s note: The following is the first of a three-part series on preparing for retirement by retired plastic surgeon Enrique Fernandez, MD. Dr. Fernandez provides more retirement preparation insight online at enriquefernandezmd.com.

he end of your plastic surgery career. It might be near at hand for some, beyond the visible horizon for others. For virtually all of us, however, it’s something that we’ve thought about to some extent at some point – in vague terms early in our careers, but steadily becoming more specific as the years accumulate. As that horizon becomes clearer, two things happen: We get more excited about the plans for how we’ll live the rest of our lives, and, as time wears on, more questions surface (typically of the “when” and “how” variety). All of the sudden, it can seem like there’s a lot to this whole “retirement” business, and it becomes abundantly clear that planning in a timely manner is essential to create the reality we’ve dreamed about.

My story As my retirement began to come into view at the end of my career, I resolved to begin planning. I was a solo practitioner who wanted to create a succession plan and invite someone to join my practice. I envisioned helping that person develop his or her own career, care for my patients and provide continuity for the relationships I had established with patients in the community. To accommodate a growing practice

September September2021 2021

and a future partner, I bought a standalone office building. I undertook a major renovation that included the creation of a surgical facility. At this point, I didn’t know the exact date at which I would retire. I felt well and enjoyed my practice – and I was grateful for the chance to serve every one of my patients. Although I could sense the end of my career nearing, I still thought it would arrive a number of years in the future. Of course, whether you have vague ideas or incredibly detailed proposals for the future, they don’t always pan out. As John Lennon once sang, “Life is what happens while you’re busy making other plans.” In my case, a colon cancer diagnosis and other health problems brought a sudden, unexpected end to my plastic surgery career. There was no more time for hazy thoughts of succession plans and a partner. I had to formalize a plan and execute it – quickly. I did precisely that and succeeded in establishing a transition, although the lack of preparation on my part made the entire process extremely difficult and painful. Now, years later, the cancer is gone and I’ve retired as a healthy and happy man – but I’ve wondered if I could have done anything differently ahead of suddenly being forced into retirement. I recognized the need to plan and began to prepare in various ways – long before I could even envision when I would end my career. The takeaway, however, is that timing is everything – and that’s even more apparent when you find yourself in a situation with no other choices. As part of my transition into retirement, I wanted to continue to fulfill the purpose I found for myself in medical

school: to improve the human condition. Although I’m no longer operating on patients, I use my time to guide colleagues and others through their own successful transition by consulting and coaching, and creating online courses. It’s an opportunity for which I’m grateful. Obviously, my particular circumstances were extreme and I’m glad they’re uncommon. Nevertheless, the end of your career – whether unexpected or arriving on the date of your choosing – is a reality for which each of us must prepare, and it would be wise to lay out your plan as far in advance as possible.

Preparation Can you prepare for the unexpected? I don’t think so – at least not entirely. We all know that unexpected (and unwelcome) circumstances can befall anyone. Still, the very nature of the unexpected makes it very difficult to anticipate and plan around. You can, however, prepare for the expected in a timely manner. This way, if life presents you with a surprise item on the menu, you have the ability to adjust as needed. The creation of a customized, end-ofcareer transition plan will enable you to establish a clear timeline for when to end your career and how to do so. The mostsound approach to devising this plan is to begin preparing when you find yourself thinking on a more frequent basis about your end of career. In my coaching and consulting work, I’ve found that most people hit this checkpoint about five years in advance of their actual retirement date. There are some doctors who will say that even five years before retirement is too ear-

ly and some factors are bound to change in that time. I agree that it’s likely some things will change; however, the key elements of your plan likely will remain fairly consistent and applicable. Why? Because the most critical preparations are for yourself. As the end of your career approaches, there are two major factors to consider: the major change retirement poses personally and professionally, as well as what the next steps for your practice should be. The change to your personal and professional life can be managed by what I refer to as your “Post Career Holistic Lifestyle Plan.” How do you want to spend your days when you no longer have to be in the office or the O.R.? What are the steps you need to take in the years, months, weeks and days leading up to retirement to make those visions a reality? Once you have an idea of what you want and what needs to be done to achieve it, it becomes easier to focus on the specifics of realizing those ideas rather than trying to navigate your way to a general idea. The business transition can be managed with the creation of a professional end-of-career transition plan. What do you want in a successor? What can be done to ensure your patients stay loyal to the practice even after you’ve left? Is there a transition plan for office staff – or are they out of work once you leave? These are all points that should be considered and planned. Remember, the end of your career is not an event. It’s a process to get to a point where you can experience both fulfillment and renewal. What you think and feel will evolve in the latter days of your career, and it’s essential to allow yourself ample time to reflect accordingly. PSN

On mentorship: What I know now that I wish I knew then Editor’s Note: The following piece is an edited version of an article in the Summer 2021 edition Plastic Surgery Resident. The full article can be found in the online-only edition of Resident in the “Publications” section of plasticsurgery.org. As a way to bring more eyes to some of the great content in the magazine, PSN will periodically reprint some of the features from Resident. By Ian L. Valerio, MD, MS, MBA (As interviewed by Lisa Gfrerer, MD, PhD)

U.S. Navy Capt. Ian Valerio, MD, MS, MBA, is a leader in reconstructive, regenerative and restorative surgery, microsurgery and peripheral nerve surgery. He’s an internationally recognized surgeon-scientist with extensive clinical plastic and reconstructive surgery experience spanning both military and civilian practices. He completed his plastic and reconstructive surgery residency at the University of Pittsburgh Medical Center and an AO Fellowship in craniofacial microsurgery in Taiwan prior to entering active duty status at the Walter Reed National Military Medical Center, Bethesda, MD. He transferred in 2015 to the U.S. Navy Active Reserves, transitioning to a civilian academic career at The Ohio State Wexner Medical Center. Dr. Valerio was recruited in 2019 to Massachusetts General Hospital/Harvard Medical School to build a comprehensive microsurgical peripheral nerve program and expand his well-funded research globally.

entorship is the most valuable thing that will help guide you through professional development and growth as a medical student to resident and

eventually senior surgeon. I strive to nurture all types of students and residents in their plastic surgery careers as I mentor and train the next generation of plastic surgeons and surgeon-scientists. Ultimately, my goal is to expand on today’s capabilities for a better tomorrow through those I train and mentor to impact our specialty. My thinking around mentorship has evolved over time, and there are some important things that I wish I had known at the beginning of my career. Rely on solid foundational relationships and mentors on a professional level. Plastic surgery is not only cross-functional, but also multidisciplinary, so mentors often extend beyond the plastic surgeons with whom you’re working or assigned. Closely work with colleagues, residents and Fellows from different specialties, as it’s important not only for clinical practice experience expansion, but also to contribute. Be a visionary and have an open mind to new experiences. I never thought I would be doing what I’m doing now. Quite frankly, many of the things I’ve adopted in my practice didn’t exist during my training – they evolved with my greater understanding and application of principles I put toward new areas of clinical medicine. With a diverse background, solid foundation and pursuit of passions and interests, you can easily transition to different or new areas that you may come across in the

future that are truly impactful in the global world and to you personally. Those who are visionaries, are adaptable, flexible, thoughtful and mindful do very well in residency and beyond. Find your passion and succeed in whatever you wish to do. Push yourself outside of your comfort zone. When you suffer failure, embrace the teaching and learning; adapt to it; and make it a healthy experience to move past. Don’t be afraid to talk about it with your mentors and confidants, as we can relate to what you’re going through. The reflections and insights gleamed from this process will make you a better surgeon and respected leader within the field. Be self-aware and self-critical, willing to reflect and self-improve. Always seek improvement in all aspects of your professional growth and development. Apply this same intensity to your outside interests and family/friends in achieving the necessary balance. Find and nourish the maturation you’ll experience with your various mentors over the years. You’ll find these to form a basis for long-lasting relationships which you will cherish for a lifetime.

Military background/interests The mission and needs of the U.S. Air Force, Army and Navy focus on tenants of quality clinical care and innovative research, but they are inherently different than the demands of civilian medical institutions and may change based upon engagements in military conflict. The mission is primarily focused on supporting those involved in combat and their families or beneficiaries. As a student and/or resident with a military background or service

commitment, it’s important to understand the complex career path to becoming a plastic surgeon that’s determined by the positions “billeted,” or allotted, to our specialty. These open positions will depend on the ebb and flow of active engagements, as more positions are available during such times given the need for our specialty’s expertise. For those who are selected to pursue plastic surgery training, it’s even more important to gain a broad background to include medicine, general and orthopedic surgery, hand and craniofacial surgery, and administrative competence – as there will be a demand for these broader skillsets in war and operational settings. Be ready to serve in different roles throughout your military career, which evolves as one advances in rank and positions. For example, after my residency training, I entered the military during a time of need in which we saw a significant amount of battle injuries. I was able to adapt civilian best practices to the military setting and a heavy combat casualty-care tempo while also still treating breast cancer patients, providing care for congenital issues and completing elective procedures common to civilian practices. Given my academic and surgeon-scientist background, I was able to apply my critical thinking around microsurgery, perforator flaps and peripheral nerve to help restore critically injured patients while also advancing applied translational research – i.e., “from the bench to the bedside.” Now that I’m in a civilian academic setting at Massachusetts General Hospital/Harvard Medical School, I’m able to expand these concepts and programs between the civilian and military settings – for even greater advancement and adoption of surgical/medical innovations into the global arena. PSN

More patient leads. At a fraction of the cost. Only 10% of ASPS members have a Connect profile. But Connect profiles get more than 40% of all consultation requests on PlasticSurgery.org. Join Connect by ASPS, the referral service exclusive to board-certified plastic surgeons. Connect offers a low $299 annual subscription fee for premium profiles after a $749 one-time activation fee.

PlasticSurgery.org/GetConnect

September 2021

ASPS Special Achievement Award Continued from page 9

Stephen Mathes, MD; John Bostwick, MD; John McCraw, MD; Louis Vasconez, MD; and we jointly contributed to the establishment, understanding and role of muscle and musculocutaneous flaps in reconstructive surgery.” Dr. Nahai also notes that his leadership roles fortified his reputation among his colleagues. “I’ve had the privilege of being a past president of The Aesthetic Society and the International Society of Aesthetic Plastic Surgery,” he says. “Very early in my career, I also served as chairman of the Plastic Surgery Research Council. I think I was honored because of my commitment to teaching, my scholarly work and, I flatter myself by saying, my ‘service to the specialty.’ ” Renato Saltz, MD, past president of the Aesthetic Society and ISAPS, worked closely with Dr. Nahai at both societies and has enjoyed a friendship with him for more than 20 years. Dr. Saltz is quick to say that Dr. Nahai’s leadership of various organizations has helped unify many areas of the plastic surgery world. “Foad is a dear friend and a great husband, father and amazing mentor,” Dr. Saltz says. “He’s a brilliant surgeon and teacher who advanced the specialty through his many publications, presentations and leadership roles at many societies and organizations, especially at ASAPS and ISAPS. His leadership and tireless enthusiasm for patient safety has made aesthetic surgery better and safer – not only in this country but worldwide. When I think of ‘servant leadership,’ I can’t think of anyone else who has done more for our specialty than Foad Nahai.” Still, Dr. Nahai is also quick to share credit for the recognition he’s received. “I strive to be humble,” he says. “That comes from my parents and early upbringing, and I’ve also had several years in English boarding schools where being humble is preferred to showing off, being self-centered or self-promoting. It’s just part of me and it’ll never change – and I’d like to think I’ve imparted some of that on my children and on my grandchildren.”

His penchant for delivering the lessons that others would want to follow extends toward his plastic surgery charges, for whom he relished being a mentor. “A good mentor is someone who takes an interest, leads by example and allows you to develop yourself and be yourself,” Dr. Nahai says. “A great mentor brings out the best in their mentee, but not encouraging the mentee to end up being just like the mentor. Sometimes that’s a huge challenge; in my early days I tried not to think that I wanted to be like Dr. X, Dr. Y or Dr. Z. Rather, I would see what inspires me and then take some from each of them – but then be myself while benefitting from my exposure to them and from what I felt were their strong points and the characteristics that I would like to emulate.” In other words, Dr. Nahai says a young surgeon should consider applying the bedside manner of one doctor, the precision of another and the scholarly acumen of another. “I like to think of myself as someone who likes to teach, and I’m always flattered when somebody I’ve trained, who has read my books or heard me lecture, refers to me as a mentor,” he says. “I flatter myself to think that I’ve been a mentor to many. In fact, I’ve been involved in training about 110 Emory residents in plastic surgery and another 40 Fellows in aesthetic surgery.” However, he politely declined to name his most impactful mentor, choosing instead to reveal that when he delivers the prestigious Trustees Talk titled “Where Would I Be Without My Mentors?” during Plastic Surgery The Meeting in Atlanta. “I’ve had several great mentors and one in particular wasn’t a plastic surgeon – he was a professor of medicine and he had the greatest influence on my career and me,” Dr. Nahai says. “I was fortunate, in that I was born on one continent, grew up in a second and established my career in a third, and on each continent I had a role model. But as far as the most impactful, I’ll reveal all of that during my Trustees Talk on Oct. 30.” PSN

Researcher: Dr. Roy

boundless, and that medical progress and possibilities are infinite.

clear desire to make a positive impact in my community, locally and at large. When further exploring career options, I didn’t have medical role models in my family and made a conscious effort to explore various career paths. I then discovered medicine and devoted physicians who were caring, empathetic and truly passionate. Wanting to emulate their work and dedication is what first attracted me to medicine. In parallel, my curiosity and analytical mindset also directed me toward research opportunities.

PSN: How do you spend your time away from the lab? Dr. Roy: When not doing research, I’m fulfilling clinical duties. I’m taking part in a craniofacial Fellowship at the University of Washington, Seattle, and hoping to pursue an academic craniofacial surgical practice. I love to spend my free time with my husband, our dogs, family and friends. I also try to prioritize an active lifestyle whether through jogging or HIIT (high intensity interval training) classes. I’m presently exploring Seattle, enjoying the local coffee shops and discovering new jogging paths while taking advantage of the nice summer weather.

Continued from page 20

PSN: What has been your favorite science project – with the exception of The PSF research? Dr. Roy: My favorite project is an ongoing one that combines my passion for craniofacial surgery with innovation; in this case, the integration of machine learning (ML) into clinical care. Our aim is to review the existing craniosynostosis pathway at the Hospital for Sick Children, Toronto, and optimize it by introducing a novel ML algorithm for abnormal head-shape triaging. This project incorporates clinical care review, quality improvement, technological expertise, clinical translation and the adoption of technology in healthcare to augment the provided care. The CRANIO multidisciplinary team has been created under the supervision of John Phillips, MD. This project is my favorite, as it is a constant reminder that research is

September 2021

PSN: What kind of sounds can most often be heard in your O.R.? Dr. Roy: As a trainee in the O.R., I go with the flow and mostly enjoy the tunes of the staff surgeons or the team’s preferred selection. When working on research or jogging, I prefer high-pace energetic pop music, Latin-based rhythms (such as the popular Rosalia) or go back to my roots with French artists performing hip hop and dance pop (Stromae, Jain and more). 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

RESIDENTS

Join us at PSTM21 in Atlanta this October and get involved in a variety of programs made just for you! RESIDENT HIGHLIGHTS: 1. Residents Reception – October 28 2. Senior Residents Conference – October 28 PlasticSurgery.org/SRC 3. Resident Scientific Paper Presentations – October 29 PlasticSurgery.org/Abstracts 4. Residents Lounge with programming

October 29-31

PlasticSurgeryTheMeeting.com/ResidentsBowl Watch residency programs from across the globe compete in the ASPS Residents Bowl Championship! Teams will be competing in this global competition to crown the best of the best. Check out highlights from the 2020 Residents Bowl and see what to expect at PlasticSurgeryTheMeeting.com/ResidentsBowl

(800) 766-4955 registration@plasticsurgery.org

ASPS welcomes newest members to its ranks The following surgeons joined ASPS on the July 2021 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 Arkansas

Georgia

Jeffrey Gibbs, MD Joseph Zakhary, MD

Olumayowa Abiodun, MD Kamran Abolmaali, MD, MRCS William Knaus II, MD Michael Mirzabeigi, MD Nirav Patel, MD, JD

California

Illinois

Aniket Sakharpe, MD, MPH

Arizona

Asra Hashmi, MD Jessica Lee, MD Naveed Nosrati, MD John Talley, MD Shuhao Zhang, MD

Colorado

Justin Cohen, MD, MHS Christodoulos Kaoutzanis, MD, MBBS

Connecticut Jillian Fortier, MD

Florida

Deniz Dayicioglu, MD Natalia Fullerton, MD, MS Lauren Kuykendall, MD Anne-Sophie Lessard, MD Rian Maercks, MD

Michael Ruebhausen, MD

Indiana

Dion Chavis, MD Yan Ortiz-Pomales, MD R. Jason VonDerHaar, MD

Kansas

Maine

Ohio

Justin Broyles, MD

Ibrahim Khansa, MD Joseph Khouri, MD Amy Kite, MD Kyle Lineberry, MD Shayda Mirhaidari, MD Wesley Sivak, MD, PhD Julia Slater, MD

Michigan

Ontario, Canada

Justin Zelones, MD

Maryland Rex Hung, MD

Massachusetts

Marissa Baca, MD Ali Charafeddine, MD

Jing Zhang, MD, PhD

Montana

Noah Prince, MD

Vincent Laurence, MD

Pennsylvania

South Carolina

A. Scarlett Aldrich, MD Ravi Garg, MD Kalila Steen, MD

Nevada

Kentucky

Eric Jablonka, MD Fares Samra, MD

John Hill, MD Konrad Sarosiek, MD

New York

Texas

Bella Avanessian, MD John Henry Pang, MD Lauren Shikowitz-Behr, MD David Whitehead, MD, MS

Olga Bachilo, MD Ryan Couvillion, MD John Eggleston, MD Bradley Eisemann, MD

Nigeria

Tathyana Fensterer, MD, PhD Amanda Silva, MD Daniel Verbist, MD

Louisiana Luke Cusimano III, MD

Thomas Lee, MD

Justin Daggett, MD Peter Felice, MD

New Jersey

Tennessee

Edward Gronet, MD Sean Hill, MD Huay-Zong Law, MD Neil Mauskar, MD Bryce Olenczak, MD Ashley Steinberg, MD

Virginia

Samita Goyal, MD Tamara Kemp, MD Inzhili Kitto, MD Paulo Piccolo, MD John Stranix, MD

Washington

Chad Bailey, MD Russell Ettinger, MD Erin Miller, MD Jennifer Sabino, MD

Wisconsin

Pamela Portschy, MD, MS

FOR ASSOCIATE MEMBERSHIP Maryland

Eliana Ferreira Ribeiro Duraes, MD, PhD,MSc, MBA

FOR INTERNATIONAL MEMBERSHIP Chile

Indonesia

Mexico

Silvana Acosta, MD Juan Jose Lombardi Azocar, MD Fernanda Deichler, MD Alison Ford, MD Ricardo Roa Gutierrez, MD Oliver Dieppa Ramírez, MD Juan Pablo Sorolla, MD Christian Salem Zamorano, MD

Krista Ekaputri, MD Irinawati Makagiansar, MD Linawati Makmur, MD

Colombia

Chiara Andretto Amodeo, MD

Filiberto Alvarez Alvarez, MD Maria Del Mar Alvarez, MD Francisco Velazquez Aranda, MD Ivan Torres Baltazar, MD Abraham Velazquez Caudillo, MD Daniel Ponce Franco, MD Maurice Aceves Guirard, MD Alberto Kalach-Mussali, MD Luis Lira Menendez, MD Abraham Juarez Lopez De Nava, MD Santiago Petersen, MD Jose David Orozco Renteria, MD Nallely Xellic Albores de la Riva, MD Priscila Rojas-Garcia, MD Luciano Alonso Rosales, MD Frantz Alexis Rossainz, MD Eduardo Ochoa Tovar, MD Brenda Luna Zepeda, MD

Luis Felipe Galvis, MD Natalia Reyes Gutierrez, MD Juan Cardenas Restrepo, MD

Dominican Republic Jorge Jimenez Toribio, MD

France Christophe Desouches, MD

Israel Meir Cohen, MD Elias Matanis, MD

Italy Japan Sandanori Akita, MD Ken Matsuda, MD, PhD

Malaysia Chai Siew Cheng, MD

Rasheed Ayobami Aranmolate, MBBS

Romania Sorin Viorel Parasca, MD Dragos Pieptu, MD, PhD

Saudi Arabia

Spain Joffre Lara Andrade, MD Miguel Gomez Bravo, MD Carlos Rubi, MD Ivan Manero Vazquez, MD

Taiwan

Mohamed Mahmoud S. Ahmed, MD

David C. C. Chuang, MD Chao-Chuan Cecil Wu, MD

Singapore

Turkey

Chrysis Sofianos, MD

Murad Aumeed Hameed Hameed, MD Hakki Izmirli, MD Oguz Kayiran, MD H. Sekin Oksar, MD Baris Yigit, MD

South Korea

United Kingdom

Gavin Kang, MD Chin-Ho Wong, MD, MBBS

South Africa

Hojun Kim, MD Ilyung Moon, MD

Nicholas Percival, MD Allen Rezai, MD Adam Sawyer, MD

September 2021

CALENDAR For additional ASPS/PSF meeting information, visit the Meetings & Education page at www.plasticsurgery.org/meetings; e-mail registration@plasticsurgery.org; or call (800) 766-4955 / (847) 228-9900. Dates, locations and program information are subject to change without notice.

SEPTEMB ER

What do more than

11,000

Plastic Surgeons have in common?

11-12

Secondary Optimizing Aesthetic Surgery Symposium 2021 Vienna, Austria Contact: (+49) 89-18-90460 Web: sos2021.eu

18-20

18th Annual International IFATS Conference Fort Lauderdale, Fla. Contact: (435) 602-1329 Web: ifats.org

DECEMBER

23-25

Americas Hernia Society Annual Meeting Austin Contact: (847) 228-3302 Web: americasherniasociety.org

3-5

Cutting Edge Livestream

Online Contact: (212) 327-4681 Web: page.inplayer.com/cuttingedgelivestream

9-12

O CTO B ER 12-14

AEC 4.7 Facial Aesthetics

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

Virtual Contact: (020) 7831 5161 Web: bapras.org.uk

ASPS and PRS PRS is a member benefit of ASPS

Online Contact: (800) 766-4955 Web: plasticsurgerythemeeting.com Directly provided by ASPS, MSS

18-19

ASPS Hot Topics

Virtual Contact: (800) 766-4955 Web: plasticsurgerythemeeting.com Directly provided by ASPS

Senior Residents Conference

Not an ASPS Member?

JOIN TODAY.

PlasticSurgery.org/Join The Member Service Center is available from 8:30 a.m. – 5:00 p.m. (CST), Monday through Friday.

Atlanta Contact: (800) 766-4955 Web: plasticsurgerythemeeting.com Sponsored by ACAPS, ASPS, YPS

September 2021

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

2nd Annual SESPRS and ISAPS Periorbital and Facial Symposium Atlanta Contact: (435) 901-2544 Web: sesprs.org

28-30

37th Annual Atlanta Breast Surgery Symposium Atlanta Contact: (435) 901-2544 Web: sesprs.org

FEBRUARY 2022

ASPS/TRS Rhinoplasty Symposium Atlanta Contact: (800) 766-4955 Web: plasticsurgerythemeeting.com Directly provided by ASPS, TRS

29-Nov. 1

Plastic Surgery The Meeting 2021 Atlanta Contact: (800) 766-4955 Web: plasticsurgerythemeeting.com Directly provided by ASPS

13-16

WPS Retreat 2022

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

25-26

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

N O V EM B ER 5-7

International: +1-847-228-9900

Facial and Rhinoplasty Symposium

Email: Membership@PlasticSurgery.org

Call: In US and Canada: 800-766-4955

13-16

CALENDAR

ASPS/MSS Migraine Surgery Virtual Symposium

JANUARY 2022

North Carolina Society of Plastic Surgeons Annual Meeting Asheville, N.C. Contact: (435) 200-8272 Web: ncsps.com

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

Legislative Update Continued from page 14

many cited debt as a concern and a possible disincentive for entering fully into private practice, as it may not be financially feasible for physicians entering practice. Other attendees shared that the stability the academic setting offers is appealing – both in terms of income and caseload. For these residents and Fellows, an interest in research or more specialized areas, such as craniofacial, is also a compelling reason to pursue academic practice.

Impact of non-physician providers The forum also addressed topics that have been at the forefront of the Society’s advocacy efforts – ongoing attempts by organizations representing midlevel, non-physician practitioners to expand the scope of practice for those they represent, as well as “cosmetic surgeons” posing as plastic surgeons. Attendees agreed that although the issue of “cosmetic surgeons” posing as plastic surgeons should be a serious consideration for new plastic surgeons evaluating cosmetic practice, patients ultimately care about the results. Regarding the trend of non-physicians’ efforts toward scope expansion, attendees said the Society should focus its messaging on a culture of safety and outcomes; stressing that plastic surgeons are trained and uniquely equipped to treat complications if they occur. But residents also emphasized that demonstrating that plastic surgeons are the only professionals qualified to perform invasive procedures is difficult without the proper data. Attendees asked that ASPS make a concerted effort to gather data on patient outcomes to help support efforts in this area, as well as continue promoting the value of board certification and training in ensuring patients’ safety and avoiding adverse outcomes. Although the residents and Fellows acknowledged concerns with the trend of non-physicians’ efforts toward scope expansion, they also stressed that it’s incumbent upon the practice to not become discouraged by other specialties encroaching upon plastic surgery’s scope. Rather, it’s the physician’s duty to educate patients about the importance of board-certified plastic surgeons. The

need to redefine the plastic surgeon’s role within the context of the changing healthcare environment was also discussed, including how surgeons can work with non-physicians in the best interest of the patient.

Future role of plastic surgeons When asked “If plastic surgeons could dictate their role in the delivery system of 2041, what would the ideal version of that role be?,” forum attendees identified the safe and reliable delivery of the full gamut of procedures in which plastic surgeons are trained. In addition, participants stressed the importance of continuing to focus on developing the most complex procedures. For example, face transplantation was identified as a complex procedure that cannot be performed by other physicians.

Payors and reimbursement When considering the role of the U.S. government as a payor in a future healthcare system, attendees argued that greater government control over reimbursement may be a disincentive to providing reconstructive services. They also suggested that it could serve as an incentive for a higher number of plastic surgeons to enter private practice in order to remain free from government control, as well as that of insurance companies or hospital administrators. As identified by participants, the top environmental and systemic drivers of plastic surgeon reimbursement in 2041 are likely to be: • Government intervention as a payor – potentially a public option or single payor system • New practice paradigms and aesthetic opportunities enabled by research and development, that is itself enabled by broader scientific advancement • Patient outcomes • Private pay • Value-based payment systems where outcomes dictate reimbursement level and referrals • Bundled payments In order to effectively respond to these

drivers and ensure strategic advantages for plastic surgeons within the future healthcare environment, participants said it’s imperative to educate patients and policymakers on the specialty’s role in healthcare, with a particular emphasis on involvement in the process of determining what’s considered “value,” and how value-based payments are made. They also noted the importance of establishing the requisite credibility to advocate for formal requirements that surgeries can only be performed by physician specialists with appropriate privileges.

New horizons in plastic surgery Regarding scientific advancements that could significantly impact plastic surgery and its patients, vascularized composite allotransplantation (VCA) and advancements in scarless wound-healing were identified. Other anticipated breakthroughs and advancements noted include: • HoloLens – augmented reality overlayed on the patient for surgical approaches • Optimization of radiofrequency devices • Stem cells – PRP and PRF Anti-aging biopharmaceutical techniques, reconstructive surgery, cleft lip/palate procedures and wound healing were listed as the areas of the specialty in which the most impactful technological advancements are expected. Participants also suggested that plastic surgeons could begin working in larger numbers in procedural domains that are newer or have other specialties currently in them, such as targeted muscle reinnervation (TMR), peripheral nerve and lymphedema surgery, VCA and migraine treatment.

health systems; however, plastic surgeons are likely to be one of the few specialties that will be able to maintain a strong foothold in independent practice. As such, attendees urged ASPS to continue to support private practice and work to raise awareness of this option and its sustainability through exposure in training, dedicated resources and increased education on private-practice business methodology within residency programs. In acknowledgment of a growing trend and an advocacy focus for the Society, participants felt that management of botched aesthetic procedures and complications due to poor techniques will increase in direct proportion to the prevalence of med spa-based procedures and efforts within various state legislatures to permit them. The need for plastic surgeons to work together to negotiate with insurers and health systems was also identified to help ensure fair reimbursement and working conditions for physicians. Plastic surgery is widely regarded as a collaborative practice focused on innovative solutions to issues throughout the continuum of care. Within this changing healthcare environment, forum attendees felt that collaboration should remain a priority, together with a focus on areas in which there are more R&D opportunities, such as wound care, congenital anomaly treatments and transgender health.

Taking action The insight and perspectives gained from this forum will be invaluable in helping shape the Society’s strategic priorities and advocacy objectives. ASPS will work to address the areas identified as priorities and concerns by participants and will continue to engage with residents and Fellows on the issues impacting the specialty. PSN

The road ahead In 20 years, residents and Fellows believe the aesthetic component of plastic surgery will remain significant, but solo practice will decrease and shift toward group practice in both the independent and employed practice settings. However, they predict employed practice – whether hospital, academic, chain/ private equity or independent – will become the predominant practice model. Most physician practices will likely be bought-out by

On Legal Grounds Continued from page 12

tive effect of large debt as a result of what’s possibly life-saving care. No one imagines a complication will occur to them, but the reality is that when so many unknowns about care are provided, the risks increase. Rarely is surgery a one-and-done procedure. There’s important aftercare and follow-up required to achieve a satisfactory and desired goal. It will be difficult to find a local, experienced surgeon to assume care for someone else’s surgery. If the local surgeon was not good enough to perform the surgery, why should they now be considered good enough for aftercare? Surgeons on call in an E.R. have a contractual obligation to provide care – but not for free. Furthermore, insurance will usually deny coverage. If considering surgery abroad, the patient has significant risks to consider in making such a decision. The imagined savings from a lower-cost procedure can be totally lost in solving complications that arise from the procedure, which could also lead to permanent health issues. The surgeons caring for the catastrophes created when the patient returns must be diligent and aware of the risks for themselves. They can easily become the target. Documentation is critical and discussion with family members is also important. The on-call plastic surgeon at a facility is often stuck having to care for such a patient, but the surgeon should be respectful, honest and forthcoming about costs – and the future costs of care – with signed documentations to verify the discussions. Diligent care can help resolve a horrible condition into a happy, grateful and future patient. PSN

September 2021

CLASSIFIEDS

OPPORTUNITIES

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 https://www.breastcenter.com Tampa Bay, Florida Well established 100% aesthetic practice seeks BC / BE Plastic Surgeon. Full or Part time - flexible hours. Resume to: BPS500@aol.com Plastic Surgery Opportunity - Midwest Location Well-established, well-rounded, private practice with Midwest location (Iowa/Illinois). Competitive salary with both cosmetic and reconstructive variety with excellent quality of life. Accredited in-office OR suite. On-campus multi-specialty surgicenter with buy-in potential; associateship with early partnership potential. E-mail your resume to psc@plasticsurgeryqc.com or fax (563) 359-4781.

September 2021

Successful Upstate New York Practice Is Expanding Thriving, innovative private practice (95% cosmetic procedures), with an in-house AAAHC accredited surgery center, is seeking an experienced Board Certified Plastic Surgeon in Rochester, New York. The practice has a 24-year history of excellence and includes two Board Certified Plastic Surgeons and two Board Certified Facial Plastic Surgeons. We are looking for a fifth surgeon to join the practice with experience and interest in body contouring procedures and plastic surgery of the breast and body. Salary is commensurate with training and experience. Must be trained in the U.S. in plastic surgery and board certified or board certified eligible. Please eMail CV or inquiries to the Practice Administrator, Denise A. Stinardo at DStinardo@Quatela.com

Boca Raton, Florida - Practice for Sale Turnkey operation of a Plastic Surgery Practice and Medical Spa available for sale in beautiful Boca Raton, Florida. 5,500 square foot facility includes a fully accredited Operating Room by the AAAASF and a beautiful newly renovated Spa. Please email to buyrentpractice@gmail.com Northwest Indiana Seeks Plastic Surgeon Busy, growing, and expanding 100% aesthetic plastic surgery practice is seeking a board eligible/ board certified plastic surgeon to join the practice. The candidate can choose to mix in reconstructive cases if needed or desired. Non-surgical services on site including nurse injectors, an aesthetician, and laser procedures. Two offices located in Northwest Indiana just a short drive from Chicago. Benefits available. If interested, please send resume to gegalante@galantemd.com.

Please forward your CV to: huntingtonmanagementgroup@google.com

Growing Beverly Hills Practice Busy advanced awake liposuction based practice looking for an enthusiastic, skilled, caring, BC/ BE plastic surgeon for a minimum of 2-3 days per week/weekend and a minimum 2 year commitment. Experience with awake liposuction is required. Must be willing to learn advanced techniques with hands-on training, be able to promote the brand and work some Saturday’s. Prefer someone who cares about their reputation and online reviews. Must have excellent before and after photos. Interested? Please email manager@idealfaceandbody.com or call 310-887-9999 for more details.

Sunny Florida Busy aesthetic practice in business 25 years seeks experienced BC plastic surgeon. Full time or supplement your own practice with a part time position. vmcallister@premierecenter.com

Central Valley Cosmetic Surgery Practice Plastic Surgeon Wanted FT or PT. Central Valley, CA 100% Cosmetic surgery practice looking for FT or PT BC/BE Plastic Surgeon. Email: jobs@plasticsurgeon.net

NYC/Long Island Expanding Long Island/NYC Practice seeking BC/BE Plastic Surgeon to join our aesthetic/ reconstructive practice. Hand Fellowship preferred. We have two fully equipped and accredited AAAASF O.R.’s and a beautifully designed Med Spa. Competitive salary and benefits offered. Please apply if you feel your skills and experience will add to the meticulous expertise we provide.

Weekend Opportunity: Hair Transplant Surgeon Minneapolis The Hair Restoration Institute of Minnesota is seeking a board-certified plastic surgeon to join our clinic 2-4 days per month (weekends or weekdays) to supervise medical hair transplant procedures. Strong existing team and generous compensation. Please email CV to Nathan Bruschi: Nathan@HRIMN.com Park Avenue, NYC Busy plastic surgery practice located in NYC seeking BC plastic surgeon experienced in cosmetic and reconstructive surgery for full time or part time position. Onsite AAAASF surgical suite with laser center and medspa. Will provide marketing and practice resources. Great opportunity to grow your own practice. If interested, please send inquiry and CV to: aestheticdoc@aol.com 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

CLASSIFIEDS

Free Standing Medical Building For Sale +/-6,840 sf free standing medical building with 2 accredited operating rooms and potential to create 2 additional operating rooms. Currently occupied by a well-established, successful plastic surgeon. Monument signage, 46,000 AADT, near 5 hospitals, 1501 Forest Hill Blvd, West Palm Beach, FL. Contact MJ Ridenour, Coldwell Banker Commercial NRT 561-995-8210 Oregon Private Practice Well established and highly successful solo private practice looking for an associate in a beautiful college town. This opportunity is perfect for someone who is looking for a balance of cosmetic and reconstructive surgery as well as work and life. The Pacific Northwest outdoor recreational opportunities are immense and the mid-size town is an excellent place to raise a family. Competitive compensation model, incentive package and partnership track. Email CV to: 2021recruiting@gmail.com Houston Aesthetics-Driven Medical Practice For Sale Gorgeous, state of the art medical/anti-aging practice for sale near Houston. The current doctor is interested in exploring their transition options, including selling to a group or an individual. The practice itself is expansive yet relaxing, with a total of 13 exam rooms. In addition, there is a consult room, a nutrition room and an IV therapy room. Collections of $3.4 million and EBITDA $400,000. With multiple doctors and a PA on staff, patients receive highly specialized care in regenerative and functional medicine. To learn more, contact Kaile Vierstra with Professional Transition Strategies: kaile@professionaltransition.com or call 719-694-8320.

Savannah, Ga. Four surgeon single specialty plastic surgery practice located in the beautiful city of Savannah seeking new associate who is a team player interested in partnership over a three to five year span. Free standing facility with AAAA certified OR as well a Skin Institute with two aestheticians and a PA dedicated to injections. We are a broad spectrum general practice but there is ample opportunity for niche development. Ultimate board certification is a must. Compensation includes base salary with added productivity incentive. Serious inquiries: rstefanko@savannahplastic.com Board Certified/Board Eligible Plastic Surgeon & Microsurgeon Extremely busy, cutting-edge microsurgical breast reconstruction practice seeking to expand its team. Fellowship training and/or extensive experience in microsurgery is a must. Practice performs over 700 perforator flaps per year as well as the full spectrum of breast procedures, lymphedema surgery and cosmetic surgery.

BC/BE Plastic Surgeon Opportunity Busy Cosmetic & Reconstructive Plastic Surgery Private Practice in Houston Memorial Plastic Surgery (MPS), an upscale and thriving private practice in Houston, Texas, is seeking a Board Certified/Board Eligible Plastic Surgeon to join their elite group. MPS has a ready-made patient base with the opportunity to perform a broad base of surgical procedures, including breast reconstruction and cosmetic surgery of the face, breast, and body - applicants with DIEP flap microsurgery experience and/or high interest in rhinoplasty and facial aesthetics strongly considered. Located inside a new Class-A medical facility with beautiful decor, private offices, AAAHC accredited surgical suites, and direct access to an onsite AAAHC accredited ASC. Premier location within close proximity to downtown Houston and the world-renowned Texas Medical Center, and offers diverse cultural dining & entertainment options with excellent neighborhoods to raise a family.

Competitive salary with partnership track. Located in San Antonio, Texas.

Competitive compensation models, investment opportunities, and partnership track.

Please email CV to:

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

Practice Administrator HR@prmaplasticsurgery.com La Jolla/San Diego California Plastic Surgery Opportunity Well established private practice, with 2 AAAASF certified OR’s, seeks a well-rounded BE/BC Plastic Surgeon. Opportunity for both Reconstructive and Cosmetic surgery procedures. Office sharing arrangement based on productivity. Email resume and or Adriana@Solteromd.com.

questions

Pacific Northwest Opportunity Plastic surgeon wanted for practice in stunning college town in PNW. Established Eugene, OR clinic seeks BC/E surgeon to join us. • Competitive salary & benefits • Modern new office • Must cover hand call, CAQ nice, not required Send email of interest and CV meichelles@meldrumplasticsurgery.com

Plastic Surgery & Aesthetics Practice For Sale Research Triangle Area, North Carolina

to:

100% Aesthetic Practice in Dallas Well-established plastic surgery practice focused on body contouring seeks plastic surgeon associate to join already busy, growing team. Compensation: Highly competitive compensation package offered to include base salary, potential productivity bonus, medical malpractice, health insurance and possible future partnership opportunity. Applicant: The successful candidate will be board certified/board eligible in Plastic Surgery. We are looking for an enthusiastic surgeon interested in being part of a team and helping build the premier multi-specialty plastic surgery practice in the country. About the Practice: North Texas Plastic Surgery has three offices and medspas located in Southlake, Plano and Dallas. The practice has a fully accredited AAAASF four operating room surgery center and a large established surgical and non-surgical patient base. The founding surgeon, Dr. Sacha Obaid is a member of the RealSelf 100, has been named a Top Doc by Fort Worth magazine numerous times and has been called a “Rising Star” by Texas Monthly. For more information about our practice, please visit http://www.northtexasplasticsurgery.com/ Contact: All inquiries are confidential and can be submitted online via email to Sandy at sandy@ northtexasps.com. If you have any further questions, please feel free to reach out at 817-416-8080.

WHY WORK AT SOUTHCOAST HEALTH?

• Looking for an outstanding practice opportunity in the Raleigh-Durham-Chapel Hill region of North Carolina? • Interested in acquiring a solid and extensive client base built up over almost 20 years? • Want to expand your current practice? • Looking to break out and away from one of the major corporate-like medical entities? • Need quad-A operating facilities combined with an elegant and expansive office space? Well-regarded plastic surgeon with a strong fee for service business wishes to sell his independent practice of twenty years to a well-qualified surgeon/owner. Nursing, front office and aesthetic services staff may also be included with purchase. Excellent location, loyal client base delivering strong repeat service business, high-end offices and a quality, well-trained staff are just some of the attractive features of this turnkey opportunity. Owner willing to remain for training purposes if desired by the purchaser. Selling due to retirement. Outstanding facility under long-term lease is just one of the many additional features of the practice. This is a rare opportunity! For more information, please contact: Lawrence T. Loeser President Piedmont Business Advisors 919-225-2728 lloeser@piedmontbusinessadvisors.com

Plastic Reconstructive Surgery Opportunity – Coastal Massachusetts Competitive Salary with Productivity Based Incentives Southcoast Health is focused on bringing together high-quality Physicians to deliver exceptional care and services. We are the region’s largest integrated network of multidisciplinary Physicians and Advanced Practice Practitioners. Position Highlights • • • • • • • • • • • •

Great opportunity to join our busy cosmetic and reconstructive plastic surgery practice Offers a well-established patient base and referral system Opportunities to perform a broad spectrum of surgical procedures Must have a strong interest in facial trauma/fracture reconstruction as well as general plastic reconstructive/cosmetic surgery Interest in breast reconstruction with DIEP flap experience and/or bariatric contouring are advantages Board certified or board eligible in Plastic Surgery Competitive Salary with Productivity Based Incentives Sign-on Bonus Program Excellent benefit package including; 41 days PTO and 6% match on retirement after 2 years Relocation assistance Malpractice coverage of $2M / $6M Excellent work life balance

Community Highlights • • • •

Four-season coastal living with surf, sand, trails and a whole host of outdoor activities Multi-cultural communities with great family-oriented neighborhoods Excellent private and public schools Situated 60 minutes south of Boston, 30 minutes west of Cape Cod and 30 minutes southeast of Providence, RI with convenient access to major highways

About Southcoast Health Southcoast Health is one of the largest and fastest growing health systems in New England. Since its inception in 1996, Southcoast has become a sought-after destination for health care professionals. As a thriving part of the New England medical community, Southcoast Health offers practice excellence in an environment you want to call home. For more information contact Holly Lestage @ 508-525-3585 or lestageh@southcoast.org

September 2021

CLASSIFIEDS

Busy San Diego Cosmetic Practice Seeks Plastic/ Cosmetic Surgeon We are looking for someone to perform primarily body contouring procedures to assist in the high volume of requested procedures. Currently booking 3 months out but have facilities to handle load just need surgeon. Independent contractor receives a percent of total fee without worry of the business end. Ideal for a new surgeon or established surgeon looking for more cases. Please email resume to charlessarosy@gmail.com or call 619-697-1325. Chicago Cosmetic Practice Seeks 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 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. Plastic/Cosmetic Surgery Practice For Sale ASAPS/ASPS B/C plastic surgeon retiring soon, with 40+ years of private practice in Miami, Florida. Nicely appointed 2,700 sq ft office & AAAASF certified operating room. Staff present > 10 years. Prebooked for rest of 2021,150 cosmetic surgeries. Large IG/Real Self presence. Yearly gross revenue in excess $2 million, with tremendous growth potential. All offers will be reviewed, immediate sell anticipated. Inquiries to VickyPX123@gmail.com.

Faculty with Hand Surgery Fellowship Training, Dual Appointment with Plastic Surgery and Orthopedic Surgery The University of Iowa Department of Surgery, Division of Plastic & Reconstructive Surgery, is accepting applications for a faculty position with specialized interest and training in Hand Surgery. This candidate would be a member of the Hand Surgery Team, in collaboration with Orthopedic Surgery. This position is open rank and may be tenure or clinical (non-tenure) track dependent on the individual. Candidates must be graduates of an accredited Plastic Surgery training program and an accredited Hand Fellowship or equivalent. Applicants must be board certified/eligible in Plastic Surgery, or equivalent, and eligible for a CAQ in Hand Surgery, or equivalent. Research experience which enables procurement of outside funding is required for tenure track appointments. Applicants with established research are preferred. Applicants must demonstrate effective interpersonal and communication skills and be committed to ongoing performance improvement. Dedication to enhancing a diverse workforce and an academic environment is vital. Applicant credentials are subject to verification; background checks will be conducted on final candidates. To apply, visit the University of Iowa website at http://jobs.uiowa.edu, requisition #74234. For additional information contact: Jerrod Keith, MD Division Director, Plastic and Reconstructive Surgery Department of Surgery University of Iowa Health Care jerrod-keith@uiowa.edu (319) 384-5972 The University of Iowa is an equal opportunity/affirmative action employer. All qualified applicants are encouraged to apply and will receive consideration for employment free from discrimination on the basis of race, creed, color, national origin, age, sex, pregnancy, sexual orientation, gender identity, genetic information, religion, associational preferences, status as a qualified individual with a disability, or status as a protected veteran.

Plastic/Reconstructive Opportunity with Partnership Track Long Island & NYC Excellent opportunity with partnership track. Well-established cosmetic plastic surgery practice with locations in Long Island and Manhattan seeks a plastic/reconstructive board certified/board-eligible surgeon to join our thriving practice. Modern offices, professional team environment, state-of-the-art and accredited facilities, knowledgeable and professional staff, competitive compensation and benefits. Greenbergcosmeticsurgery.com To apply, forward CV to docstg@aol.com or call 516-364-4200

September 2021

TRAINING Chicago Northshore Fellowship Top-Ranked Facial Plastic Surgery Practice on the Northshore of Chicago with exciting Fellowship opportunity Beginning Fall 2021. Primary focus on facial aesthetic surgery with a strong emphasis on rhinoplasty and revision rhinoplasty- Over 400 rhinoplasties performed each year. The fellow will acquire significant experience with office-based surgeries, including AWAKE facelifts, brow lifts, blepharoplasties (upper and lower), otoplasties, liposuction, panniculectomies, bodyTite procedures, minimally invasive/non-surgical procedures and injectables. Significant training opportunities with Mohs procedures provided through a dedicated clinic working directly with a team of Dermatologist. Fellows will learn non-clinical skills in business operations which include: coding, practice management, optimizing clinical flow, and how to engage effectively to retain a high functioning team. Opportunity to be involved in Practice meetings where P&Ls are evaluated and discussed, and operational decisions are made. The fellow will also be involved in the accreditation process of a new OR facility and the opening of a new 8000 sqft private surgical institute. Please contact Brittany Warner via email at bwarner@warnerinstitute.com or call 847-558-8888

Oregon medical license prior to the start date. Competitive salary & optional call stipend. Health insurance and malpractice insurance are provided. For inquiries, contact niloo@drmovassaghi.com. Beaumont Integrated Reconstructive Microsurgery and Craniofacial Fellowship (CMF Micro) The Division of Plastic and Reconstructive Surgery at Beaumont Health offers a 1- year Fellowship combining microsurgery & craniofacial surgery. This training experience is in one practice with Dr. Kongkrit Chaiyasate and his associates. The Fellow participates in microsurgical cases including perforator flap breast reconstruction, head & neck free flap reconstruction (congenital, traumatic and oncologic), pediatric microsurgery, lymphedema reconstruction (LVA and LN transplant) & extremity free flap reconstruction. The Fellow is anticipated to graduate with 120+ flaps. A one-month elective abroad is provided. The Fellow is expected to take part in facial reconstruction following Mohs resections, implant-based breast reconstruction & complex reconstructive cases. The Fellow plays a pivotal role in the monthly multidisciplinary Cleft Palate & Craniofacial Clinic. Each year, the craniofacial team performs at least 30 primary cleft lip & palate repairs, 60 secondary cleft lip & palate repairs including septorhinoplasty, 20 intracranial procedures including cranial distraction, 5 midface & mandible distractions. The Fellow will be able to develop skills in both fields and be able to bridge the gap using both disciplines for maximum patient outcomes. 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.edu. Oregon - Aesthetic Fellowship Opening July 2022 ASAPS-endorsed aesthetic Fellowship that includes a full spectrum of aesthetic surgery services within an established successful private practice setting. The experience entails broad, handson exposure to comprehensive facial surgery (customized face-lifting and rhinoplasty), primary and revisionary aesthetic breast surgery, breast reconstruction, body contouring surgery as well as independent operating experience. It also encompasses exciting and cutting edge non-invasive and minimally invasive technologies treatments including hair restoration and skin resurfacing. The Fellow will be exposed to our full medical spa with a wide range of technologies, including skin tightening, body contouring and light and laser technologies. The clinical setting is a rewarding experience that emphasizes a full scale approach including patient management, assessment training, practice management, business strategy and leadership. There will also be formal injectable training with hands on experience during the fellow clinic. This Fellowship also has a strong mentorship component with monthly formal lectures/journal clubs. Educational engagement and research are expected with all expenses covered for accepted papers at the annual ASAPS meeting. There will also be opportunities to enhance education and training via nationally organized meetings, webinars and local preceptorships. Applicants to the Fellowship program must have completed a residency in a plastic surgery program accredited by the ACGME and be broad eligible or board certified in plastic surgery by the Fellowship start date and have or obtain an

MD Anderson Microsurgery Fellowship Clinical Fellowship positions are available beginning 7/1/2022 at the University of Texas, MD Anderson Cancer Center in oncology-related reconstruction and microsurgery. A wide variety of complex reconstructive procedures are performed each year with a high volume of microvascular cases, especially autologous breast, complex head and neck, lymphatic, and perforator flap reconstructions. Opportunities are available to participate in microsurgery laboratory training and established basic science and clinical research projects. Fellowship duration: 12 months. Please send letter of intent and CV to: Matthew M. Hanasono, M.D. Director of the Microsurgery Fellowship Program, Department of Plastic Surgery, Unit 1488 MD Anderson Cancer Center 1400 Pressler Houston, Texas 77030 (713)794-1247 Email: mhanasono@mdanderson.org Aesthetic Fellowship in Texas North Texas Plastic Surgery is proud to offer an aesthetic fellowship under the direction of senior partner, Dr. Sacha Obaid. Very competitive salary and benefits are provided. The fellow will have the ability to assist in over 1,000 cosmetic cases per year with a heavy emphasis on breast, butt, and body contouring. In addition, graduated independent operating responsibility will be given to the fellow, and a “fellow clinic” will be established with the expectation that the fellow will independently book a large volume of cases. In addition to the operative experience, the fellow will be involved in a thriving med spa featuring topical skin care, injectables, non-ablative skin treatments and non-invasive body contouring. Applicants must have, or obtain prior to commencement, a Texas medical license, hospital privileges, and be BC/BE in plastic surgery. Fellowship opportunities are available to begin July 2022, deadline is January 1, 2022. For more information, please contact Linsey at linsey@northtexasps.com or check out our website, northtexasplasticsurgery.com.

Classified Ad Policy

Rates for printed classified ads are based on word count and must be paid prior to publication. Logos, boxes and color enhancements can be designed for additional fee. The editors do not investigate positions of employment and assume no responsibility for them. ASPS reserves the right to accept, reject or cancel any advertisements in its sole discretion.No text will be taken over the phone. Cancellations not accepted after closing date. To place a classified ad, email: Jeanne Embrey Advertising Coordinator jembrey@plasticsurgery.org Visit the Job Opportunity Board plasticsurgery.org/job.

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.

TULSA PLASTIC SURGEON PROUD OF HIS ‘BIRD MAN’ REPUTATION

lastic surgeons have been gone by nicknames ranging from “Doc” to “Patch” and even “Sawbones,” but Archibald “Arch” Miller, MD, Tulsa, Okla., might be the only ASPS member known as “Bird Man.” He earned that moniker from a 20-plus-year interest in raising and providing shelter to Australian black swans, the endangered Hawai’ian Ne Ne geese and an assortment of ducks. His connection with his graceful waterbirds even includes conversation, he says.

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.

“They emit a high-pitched cry that starts when they see me walk onto my back deck,” he says. “Most of the time, it seems as if they’re saying: ‘Hey, boss, how are you doing, you brought the food for us, I hope.’ After I put out the food, they say ‘Thanks for bringing that.’ When I leave, it’s ‘Goodbye,’ and they swim off. It’s similar to when a dog barks to greet you when you come home or wants something.” Dr. Miller moved to Tulsa from North Carolina in the mid-1980s to land that contains a lake measuring about 60-by-350 yards. Two decades ago, a world-traveling neighbor displayed photos of Australian black swans taken during a trip Down Under. Impressed by these creatures, Dr. Miller located a local woman who owned a mated pair that he bought. “This pair had several broods over the years; most of them we sold to improve the lake so they’d have a better life. Some stayed and became like family.” This connection can be so deep that An Australian black swan keeps watch over its cyga mourning period – which includes nets on the Tulsa lakeside property of ASPS member neighbors – becomes necessary with Archibald Miller, MD. the loss of a cynet, which can occur through predation but more often when heavy Oklahoma rains wash them out of the lake and into storm drains. “The parents try to protect them, but they can’t always do that,” Dr. Miller says. “That’s the toughest thing about this. There’s a retired judge and a retired investment banker who are emotionally invested in the swans, and they almost cry when we lose one of these babies. I’m close, too. You hate seeing these little miracles die. They start out as tiny fluff-balls of grey, they get bigger, they begin following Mom and Dad – and you get attached to them. They’re beautiful and a part of nature, so when that happens, it’s hard.” Each mated pair will average three eggs per year, but well more than half won’t hatch for various reasons, he says. Of those that do, about half of those will never reach adulthood, which comes at about 30 months. His avian companions are much more a source of relaxation and peace than concern. “Working with them gives me an appreciation of the beauty of life and how valuable life is, and how small things can bring you peace,” Dr. Miller says. “When I go to work and things aren’t working right or I feel as if I’m not doing something well, I look forward to seeing and talking to my birds. It helps my soul to raise these birds and it makes me appreciate life, because it’s so delicate.” The duration of Dr. Miller’s activity with his swans and Hawai’ian geese have allowed his grandchildren to become involved with and appreciate their beauty – and in one way, the apples haven’t fallen far from the tree. “When they come here, I take them down to water’s edge and the swans will take bread right out of their hands,” he says. “They’re older, so they don’t come as much, but when they do, the swans make sure they talk to them, too.” PSN

5 YEARS AGO IN PSN As new social media platforms drew increased engagement from plastic surgeons, ASPS leadership had to wrestle with new questions of patient safety and professional ethics, many of which were raised in the September 2016 issue of PSN: “There’s nothing at all wrong with Snapchat as a vehicle in and of itself. It’s a great medium that allows us to reach a wide audience with a very scripted message – which then disappears. What some of my colleagues and I are very concerned about are video postings that can be misleading and that ostensibly look as if the posting surgeon is paying more attention to Snapchat than to the surgery, which could be a patient-safety issue.” – 2016 ASPS President David Song, MD, MBA Chicago PSN

In this issue, we present ASPS member and U.S. Army Lt. Col. Owen Johnson III, MD, Colorado Springs, Colo., who practices at Evans Army Community Hospital and serves as an assistant professor of surgery at Uniformed Services University of the Health Sciences, Bethesda, Md. Dr. Johnson, who spent several months as chief of surgery at the 75th Combat Support Hospital, Kuwait, is a current member of the ASPS Development Committee and Emerging Trends Subcommittee, and he’s served on several additional Society committees and panels. Dr. Johnson found time between pursuing his aviation interests and the demands of fatherhood to answer the following questions for PSN: The single-greatest influence on my decision to become a plastic surgeon was... My time as an Army surgeon at Walter Reed Army Medical Center during the height of the wars in Iraq and Afghanistan (2004-10). While caring for numerous, injured soldiers with devastating wounds, I developed a keen interest and passion for the complex reconstructive surgeries being performed to treat them. Ranging from chimeric free flaps to nerve grafts to simple scar revisions or botulinum toxin injections for facial palsy, plastic surgeons helped elevate our war wounded from simply surviving to living again. An operation I no longer perform is... Laparoscopic Nissen fundoplication. In addition to the ABPS, I’m certified by the American Board of Surgery and for a couple years was a general surgeon who did most of the complex non-bariatric minimally invasive procedures in my group’s practice. As fun and technical as those cases were, I love what I do as a plastic and reconstructive surgeon even more, so those days are now behind me.

The single-greatest historical contribution to plastic surgery was... The combat deployment of Ralph Millard, MD, to the Korean War with a Marine mobile hospital unit. While in theater, he conceived of and perfected the Millard rotation-advancement cleft lip repair, treating numerous afflicted Korean children. Many years later (although modified), it remains the most commonly used technique for cleft lip repair in the world today. He also performed a Westernization of the Asian Eyelid on a girl working on the military camp. Due both to post-war American influence and rapidly evolving surgical concepts, South Korea is now a global plastic surgery leader in double-eyelid blepharoplasty, facial plastic surgery, calf reduction, minimally invasive breast reconstruction and supermicrosurgery.

Lt. Col. Owen Johnson III, MD

The biggest surprise I ever had in the O.R. was... When I became the patient! My reconstructive practice was comprehensive, and I’d worked for about two years with a busy sales rep in orthopedic surgery when I needed a hip arthroscopy. I saw an excellent surgeon who operated in another part of the city at another hospital, and as I was lying on the O.R. table, I suddenly saw this rep’s face pop into my field of vision – smiling, waving and happy to be helping on my case. He cheerfully exclaimed, “Hi, Dr. Johnson! Good luck!” My immediate verbal reaction was, “Oh, shhh…” and that’s the last thing I remember before waking up. Thankfully for all involved, the bone anchors seem to be holding up well. My all-time favorite movie is... Top Gun. With a great soundtrack, great actors, great lines and non-stop action, what’s not to like? I’m now a commercial instrument-rated pilot and I love flying and aviation – honestly, the seed was probably planted with this movie. It was also one of the first movies I remember seeing in the theater with my parents when I was a kid. I was obsessed enough that afterward they modified an old football helmet and stenciled “Maverick” across the front so I could sit on my bed and pretend to be a hotshot fighter pilot doing all the maneuvers. I tend to fly more carefully in real life, of course. The best vacation I ever took was... A week hiking and camping in Redwood National Park, followed by a week in Napa with my beautiful wife, Nicole. Not only did we have a great time in some of the most magical settings imaginable, we learned a ton about assessing, drinking and appreciating wine. It would also turn out to be our last real vacation before kids. The best thing a grateful patient gave me was... A “Grow a Pair of Boobs!” sponge-toy gag gift that expands when saturated in water. It was given to me from a breast cancer patient I treated for nearly three years with not only multi-staged bilateral Dr. Johnson and his wife, Nicole, take a break while tourthe Castello di Amorosa winery in Napa, Calif., in breast reconstruction (advanced disease) but also ing May 2017 supermicrosurgical lymphovenous bypass to help her stage 2 arm lymphedema after axillary dissection and radiation. She and her husband were vacationing in Las Vegas when she saw them; she told me: “I thought of all your team has done for me and I had to get them for you!” Her upbeat attitude and sense of humor was inspirational. In breast cancer reconstruction, some of our most valuable work is allowing the patients to cry and then allowing them to laugh. Helping them accept and get through their disease and all that comes with it is part of our role in “closing the loop” on cancer. This gift sits on my desk. Anyone who walks into my office with a serious disposition is immediately softened up and laughing when they see it. And who knows? Maybe with tissue engineering and 3D printing, one day we will be able to. PSN September 2021

Connect. Collaborate. Transform.

OCT. 29-NOV. 1, 2021

The thrills, fun, innovation and experience are back at PSTM21 in Atlanta! • Four full days of programming designed for your entire practice

• Face-to-face Social Events and Networking

• Access to on-demand content before the meeting and post-meeting access to recorded lectures and panels

• The latest innovations on full display in the Exhibit Hall

• Earn CME and Patient Safety credits in up to 11 concurrent sessions of programming

• Close the Loop 5K and PSF Silent Auction

• Hands-on simulation labs, world-renowned keynote speakers and more

• Insights from industry at the Innovation Theater • Opening and Closing Ceremonies, receptions galore, and making masks fun at the Masquerade Gala

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9 10 OUT OF

Consumers choose MENTOR® MemoryGel® Xtra Breast Implants as feeling more like a natural breast 14

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

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