Plastic Surgery News, July/August 2021 by PlasticSurgeryNews

July/August 2021

ALL ROADS LEAD TO ATLANTA Plastic Surgery The Meeting 2021 returns to an in-person event with plenty of educational and networking opportunities taking place Oct. 29 - Nov. 1. Page 23

An interview with HHS Assistant Secretary for Health Rachel Levine, MD Page 8

ASPS takes part in World Plastic Surgery Day Page 11

2022 Slate of Candidates Page 26

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.

July/August 2021

ADVERTORIAL

Help grow your practice by optimizing your website. Your website is a digital representation of your practice. So, just like your physical location, make sure it’s attractive and easy to navigate. By implementing some, or all, of the recommendations below, patients can find you easier and you’ll help free up your team to remain focused on care. A strong online presence starts with a quality website designed to generate a response from potential new patients. Your website should always have a strong call to action that motivates visitors and tells them what you want them to do. For example, “Schedule a consultation today.” Position yourself as the go-to provider in your market by including expert content such as videos and articles on your site. Personalize your content and make it relevant by including topics patients care about. Include educational information or shoot a short video or offer an article addressing each topic and feature it on your website.

Make it easier to find. Search Engine Optimization (SEO) is the practice of using keywords, search phrases and sitemaps to make sure your website can easily be found by search engines like Google or Bing. If you’re not showing up on search engines, patients can’t find you when researching cosmetic procedures. To measure the effectiveness of your website, track your conversion rates with a tool like Google Analytics and determine what percentage of your visitors actually result in a consultation.

Make it mobile-friendly. As much as 70% of all internet traffic comes via mobile devices. If your website isn’t designed to display content on a mobile device or is difficult to use on a phone, people may immediately leave your site and never come back. The good news is most web designers create sites with mobile in mind. If your website is due for an update, look for a design firm that builds responsive websites. Responsive sites automatically adapt to the screen they’re on, meaning they work on any device no matter if it’s a laptop, phone or tablet.

Make payments easier. Since cost may be a significant concern for patients, it’s important to include a financing page on your site if you don’t already have one. Showing potential patients that you offer financing options may help them schedule a consultation and move forward with your full recommended plan. CareCredit offers several ready-to-use assets you can utilize to complement your practice’s website and add value to your patients’ experience.

✓Add your custom link for a contactless experience. A custom link can be added to your website or quotes you provide your patients and shared via social channels, email or text. Patients can learn about the CareCredit credit card, apply and pay securely using their own device – anytime, anywhere.

✓ Payment calculators help patients budget for procedures.

CareCredit’s Payment Calculator allows current and potential patients to view available financing options and estimated monthly payments*. It’s a simple way to add a lot of value quickly and easily.

✓Add a pay or apply button. Graphics, like buttons, help communicate the availability of financing quickly while keeping site visitors engaged longer.

Key takeaway. Making your practice’s website as attractive, helpful and user friendly as possible will do wonders for your practice’s perception. Consumers overwhelmingly prefer doing things digitally and you’ll find greater patient satisfaction as you implement the tips above.

75% of people base the credibility of a business on how their website looks.2 Join the CareCredit network.

Call 866-247-3049 or visit carecredit.com/psn

Already enrolled? Access your exclusive tools, including custom

Google’s Display Ad Network reaches 90% of global internet users.1

* Subject to credit approval. Minimum monthly payments required. See carecredit.com for details. 1 Neely, P. (2019, July 25). 10 Display Advertising Statistics Every PPC Marketer Needs to Know. Aquisio.com.https:// www.acquisio.com/blog/agency/10-display-advertising-statistics-every-ppc-marketer-needs-to-know/ 2 Hufford, B. (2019, November 11). 20+ Web Design Statistics You’ll Need to Create the Perfect Website for 2020. July/August 2021 Cliquestudios.com. https://cliquestudios.com/web-design-statistics/

link, at carecredit.com/providercenter

ASPS members receive reduced processing rates.

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). ©2021 Synchrony 3 Bank PSN2021CA

IN THIS ISSUE FEATURES 07 Keeping an eye on state and federal regulations as waivers expire

Plastic Surgery News

Waivers relating to insurance, HIPAA protections and more that took effect due to the pandemic could expire soon.

08 PSN exclusive interview: Rachel Levine, MD, HHS Assistant Secretary For Health

Dr. Levine, the first openly transgender federal official to be confirmed by the Senate, will be a speaker at PSTM21.

08 Remembering Lawrence Robbins, MD, 1938-2021

ASPS PRESIDENT

Joseph Losee, MD joseph.losee@chp.edu

In addition being a leader in several medical societies, Dr. Robbins was a specialty pioneer in Florida.

CHIEF MEDICAL EDITOR

09 PRS raises its own bar – again

Bruce Mast, MD bruce.mast@surgery.ufl.edu

The journal once again leads all plastic surgery journals, with its latest 4.730 Impact Factor being its highest yet.

11 Getting involved in World Plastic Surgery Day

Scot B. Glasberg, MD scotbg@gmail.com

18 A unique kind of training experience

EXECUTIVE VICE PRESIDENT

ASPS Life Member Andy Wexler, MD, recounts a summer as a fisherman in Greenland and the challenges he faced.

23 COVER: Plastic Surgery The Meeting heads to Atlanta

ASSOCIATE MEDICAL EDITORS

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

An idea that took root in India a decade ago is now bringing more international exposure to the specialty.

July/August 2021 Vol. 32 No. 5 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.

Michael Costelloe mcostelloe@plasticsurgery.org STAFF VP OF COMMUNICATIONS

Mike Stokes mstokes@plasticsurgery.org MANAGING EDITOR

Education and entertainment await as in-person events return with Plastic Surgery The Meeting 2021.

Paul Snyder psnyder@plasticsurgery.org

SENIOR NEWS EDITOR

ASPS/PSF 2022 SLATE OF CANDIDATES Begins on Page 26

Jim Leonardo jleonardo@plasticsurgery.org ASSOCIATE EDITOR

Kendra Y. Mims kmims@plasticsurgery.org CONTRIBUTING EDITORS

Sanjay Daluvoy, MD; Joseph Gryskiewicz, MD; Josef Hadeed, MD; Eric Lai, MD; Sean Li, MD; Alexander Mericli, 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

COLUMNS 06 President’s Message 06 Editor’s Message 10 CPT Corner 12 On Legal Grounds 12 The Higher Ground 14 Legislative Update

15 Social Media Focus 16 Practice Management Insight 33 Calendar 34 Classifieds 38 The Last Stitch

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

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

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.

July/August 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

PSTM 2021 PREMIER SUPPORTERS: SAPPHIRE: Allergan Aesthetics, an AbbVie company PLATINUM: Mentor | 3M Health Care GOLD: MTF Biologics July/August 2021

PRESIDENT’S MESSAGE

The PSF plays a critical role in the evolution of plastic surgery By Gayle Gordillo, MD The PSF President

s we prepare to see each other in person again at the 90th Annual Plastic Surgery The Meeting in Atlanta, there’s much to look forward to regarding the ground our specialty will break in the coming years, but also plenty to reflect on in terms of the research that led us to where we are today. In my career, I’ve been fortunate to know the help that The PSF can provide in terms of advancing research and how it can positively shape our specialty (and the medical community at large), but it may not be so apparent to those not actively participating in The PSF activities. My colleague, ASPS President Joseph Losee, MD, has already noted in this space how small our specialty is within the larger house of medicine and the challenges inherent in trying to make our voice heard. it may not be so apparent to those not actively participating in The Foundation’s activities. Several years ago, Christine Rohde, MD, proposed a randomized, multi-institutional clinical trial comparing antibiotic regimens for tissue expander-based breast reconstruction. With increased scrutiny on the use and dosage of antibiotics, there have been efforts to determine the “ideal” amount of antibiotics to prescribe, but of course, the issue of complications or infections can easily upset that “ideal” amount. “When I first brought this up, I basically was told it was a nice idea, but there wasn’t

a lot of interest in it,” Dr. Rohde recalls. “In the intervening years, I worked on developing a proposal that perhaps could be done on a smaller scale – but I was never really happy with the idea of that, because I wanted to do something that would really be convincing and practice-changing. Other groups had tried to secure NIH funding for it, and though they scored well, they didn’t get the funding, so I thought this study would never happen.” Then The PSF stepped in to support this project, which now includes a diverse group of researchers across five institutions. Patients are now being enrolled for the study – and Dr. Rohde remains adamant that the results of this research will be practice changing. “The PSF is so important in that it not only funds this high-quality research, it also actively encourages improvement in the overall quality of plastic surgery as a whole,” Dr. Rohde says. “The effects go beyond our specialty.” Christopher Pannucci, MD, notes that both ASPS and The PSF identified venous thromboembolism (VTE) as a critical patient-safety issue as far back as 2008, with membership showing significant interest in research on how best to prevent the complication from happening. Thanks to funding from The PSF, Dr. Pannucci was not only able to take part in the groundbreaking Venous Thromboembolism Prevention Study that ultimately would enroll more than 3,300 patients and result in five research papers still being referenced today, but he also received a NEPS grant to examine the pharmacokinetics of enoxaparin, a commonly prescribed blood

thinner given for VTE prevention after plastic surgery procedures. “Utilizing The PSF funding, I was able to create research infrastructure pivotal to demonstrate to national funding agencies the capacity to perform clinical trials,” Dr. Pannucci tells me. “The infrastructure created by that research grant was important in obtaining an R03 Grant from the AHRQ.” The PSF-derived data provided Dr. Pannucci with the preliminary data for the ‘FIVE trial’ application, and that study – the second-largest randomized controlled trial ever conducted in plastic surgery – was published in April’s PRS. “The infrastructure that the funds helped to create was leveraged to conduct 13 clinical trials at the University of Utah over a six-year period,” he says. “The trials all examined how best to dose perioperative anticoagulants, and all are now published in the peer-reviewed medical literature.” Beyond forging pathways for improved data and research in the future, The PSF is there to address critical issues facing our specialty. A couple years ago when patients in the Miami area were dying from gluteal fat grafting procedures, ASPS/PSF sent plastic surgeons to Miami to attend the autopsies on those patients. To address this crisis, The PSF convened an international multi-society Gluteal Fat Grafting Task Force, co-chaired by ASPS President-elect J. Peter Rubin, MD, MBA, that included the Aesthetic Society (ASAPS), and the International Society of Aesthetic Plastic Surgery (ISAPS). The investigative team developed a proposal to study the problem and develop safety recommendations. This proposal was reviewed and refined

by an ad hoc PSF study section to optimize the chances for success of the group’s work. The Foundation’s ability to provide logistical and administrative support for the task force was vital as that type of study would not have been funded by the NIH. He adds that a tremendous amount of coordination was necessary to bring together all the talented investigators involved. “Funding from The PSF was instrumental in enabling important safety research on gluteal fat grafting and yielding data on anatomic information that members could use to perform the operation more safely,” Dr. Rubin says. “That information was not only shared at Plastic Surgery The Meeting, but also the annual meetings of our collaborating partners, ASAPS and ISAPS – both of which also contributed to financing the study – and it will also be published in the medical journals of the collaborating societies under a MOU in the near future.” The anatomic knowledge derived from cadaver studies in Florida can be used to help prevent patient mortality. My President’s Panel in Atlanta will expound on this topic and provide more detail into not only why continuing to contribute to The Foundation is vital, but also provide more concrete examples of how we’re shaping the future of plastic surgery and healthcare at large. The work we do each and every day is important to every ASPS member, and The PSF remains a vital link in ensuring that work and research continue – because as so many can attest, there aren’t many other institu-tions that will help finance this work. We make things happen, and I’m excited to see you in Atlanta and talk further about what the future holds for our membership and our specialty. PSN

EDITOR’S MESSAGE

The commoditization of medicine: The good, the bad and the ugly By Bruce Mast, MD PSN Chief Medical Editor

would venture to guess that none of us entered medical school thinking our careers would be part of an industry. We most likely envisioned ourselves as professionals, purveying the noble arts of healing. However, as time progressed from my medical school matriculation in the mid1980s, medicine has been squarely placed into the melee of the healthcare industry. This led to changes, activities and operations that together can borrow a title from one of Clint Eastwood’s westerns: The Good, the Bad and the Ugly.

The good The industrialization of healthcare spurred marketplace changes in physician employment. In years past, most physicians were in private practice – either solo or small groups. Healthcare systems sought to employ physicians, thereby securing a more reliable flow of patients. These systems look at the entirety of revenue that a doctor’s patient brings to them, not just the professional fees. This contributed to a steady increase in physician compensation over the past 10 years, despite most insurance and Medicare rates failing to keep up with cost-of-living increases. Plastic surgeons benefited from this shift in employment as many hospitals recognized the benefits of what we do, choosing to directly employ us. Still, a large percentage of plastic surgeons remain self-employed. Even plastic surgeons

in solo and small practices benefited from commercialization of medicine. Attention to market share, competitor encroachment, consult conversion rates, returns on investment and overhead management are among the business concepts necessary for success. These efforts are often designed to fend-off competitors – many of whom are not plastic surgeons. Ours is likely one of the few specialties, if not the only one, that must deal with this as an ongoing battle. That’s because what we do is attractive to other doctors. We must be diligent to prevent the loss of our domain. By embracing commercial methodologies, we situate ourselves better to fend-off the competition and wouldbe plastic surgeons. Furthermore, plastic surgeons have incorporated a diversified business structure of additional or alternative revenue sources beyond the office consult and the O.R. Non-surgical aesthetics, medical spas and licensed O.R.s are examples that were far less prevalent 20 years ago.

The bad As medicine is increasingly treated as a commercial industry, time-honored principles of practicing within one’s specialty of training have faded. As previously noted, we continuously are entrenched in battle, warding-off those who wish to do what we do. Family-medicine doctors doing liposuction, optometrists doing eyelid surgery, pharmacists treating chronic ailments, advanced practice providers practicing independently, ENT and OB/GYN doctors doing breast augmen-

tation, oral surgeons doing facelifts and rhinoplasties, general surgeons doing oncoplastic breast reconstruction and abdominoplasties – the list goes on. These are all examples of such practice infringement, either real or attempted. ASPS advocacy remains fully engaged in all these areas in combination with local professional societies, most often with successful outcomes. Nevertheless, these and many other issues continue to show up year after year throughout the United States. No matter what argument is put forth, it’s hard for me to see any true medical or quality justification for such practice shifts. To me, the overwhelming motive is financial gain. As medicine continues its commoditization, patients and their conditions are being viewed as sources of revenue. Seeking that revenue without proper training or knowledge seems to be the continued impetus for those who seek to expand their professional boundaries. This view has also resulted in poor care within one’s own scope and specialty. Examples of unnecessary testing and interventions, as well as insurance fraud and pill-mills, speak to the patient being viewed as a source of income, rather than an individual in need of healthcare.

The ugly Perhaps the biggest change in the business of healthcare is the entry of large hospital systems and venture capitalists. Several large regional and national hospital systems emerged over the past 20 years, some of which are very aggressive at buying-up hospitals and physician practices, resulting in capturing patient flow within their system and market share for various

health conditions. The days of the community hospital, entrenched in a particular area and committed to taking care of the health needs of its citizens, are rapidly disappearing. Such pure, local not-for-profit hospitals are being gobbled up by pseudo not-for-profit systems, as well as for-profit hospital chains. Academic medical systems also stepped into the fray, mostly out of a reactionary necessity in order to preserve patient flow and continue to support their missions of patient care, education and research. Although good can arise from such changes, there are significant potential downsides when for-profit ownership is involved. The primary motivation of any for-profit business entity is to make money. In the case of a for-profit healthcare entity, it’s safe to say that their business priority is to maximize profit, while providing quality care. This is entirely different than the pure not-for-profits, whose primary motivation is to provide quality care while not losing money. It’s not a matter of semantics, either. When profit comes before quality, the latter often suffers. This is where the vulnerability exists in the healthcare industry. To illustrate, let’s look at the clothing industry. Aggressive market grabs and expansion can lead to poor-quality products. If that were to occur, the output would be a poorly made shirt – hardly a life-changing consequence. However, a reduction in quality in healthcare can have dire, life-altering or life-ending ramifications. What about venture capitalists and healthcare? The venture capitalists who entered the picture, most notably in hospital-based physician practice management/ownership (as well Continued on page 30

July/August 2021

Be aware of telehealth regulations as pandemic-related waivers expire patient’s current physicians.

By Paul Snyder

lthough the COVID-19 pandemic spurred the widespread integration of telehealth services in plastic surgery practices around the country, many pandemic-related waivers that took effect last year to support the sharp uptick in telemedicine are beginning to expire as the country continues to ease restrictions that have been in place for more than a year. “Both ASPS and the AMA are monitoring regulations around the country as waivers begin to expire and are working to keep protections in place that benefit plastic surgeons,” says ASPS immediate-past President Lynn Jeffers, MD, MBA, a member of the AMA Council of Medical Services. “Going forward, certain aspects of telemedicine will play a greater part in practices, but there are certain patient interactions, such as physical exams, that will need to take place in person. Certainly it comes down to your own judgment on what parts of telemedicine you want to incorporate more regularly into your practice, but we must keep patient protection and patient safety paramount.” Due to the emergence of the Delta variant of the coronavirus, the federal public health emergency (PHE) declaration and the waivers attached (which have already been renewed five times) are likely to continue. At the time of writing, there was no indication that the Biden administration would not sign a sixth extension. ASPS and other medical organizations are watching how policies at the federal and state levels will change in the coming weeks, and the Society will be supportive of congressional efforts to ensure that patients continue to have access to certain telehealth policies post-pandemic.

Crossing state lines Some of the important changes may come into play at the state level – Dr. Jeffers notes that some of the expiring waivers related to telehealth consults or visits correspond with seeing patients who are out of state. The Doctors Company (TDC) provided information on continuing to see patients in different states, noting that although licensing restrictions eased during the PHE, doctors should be careful about ongoing interactions with patients across state lines, as both could involve malpractice and a criminal offense. Several states last year relaxed licensing requirements to encourage medical professionals to cross state lines to assist in the emergency. Many states also waived licensing requirements specific to the use of telehealth. The Federation of State Medical Boards has a database of licensing requirements and waivers that can be viewed at fsmb.org. In states that haven’t waived license requirements, physicians should comply.

• Advocate that physician payments should be fair and equitable, regardless of whether the service is performed via audio-only; two-way audio-video; or in person. • Recognize access to broadband internet as a social determinant of health. Dr. Jeffers notes that efforts are underway at the federal and state levels relating to insurance reimbursement rates for virtual vs. in-person visits. Some payers are reducing some telehealth coverage and payment policies, and government and private payers have argued (even prior to the pandemic) that widespread telehealth could increase overall spending on healthcare. With complex reimbursement rates and documentation standards relating to telemedicine, there remain barriers for patients and physicians. ASPS will continue to monitor and provide updates on insurance-related matters as more information becomes available. The Society also encourages members to closely monitor announcements from payers with which they work to stay abreast of any potential reimbursement changes or denials for telehealth services. It’s also important that your practice notifies patients about the collection of copays for telehealth visits. Answering or placing phone calls outside of a plastic surgeon’s state of license is common, but TDC notes that it can still present risks in terms of licensure and insurance coverage. Documentation remains critical when a physician is acting under the duress of a patient emergency. To support telemedicine, some state licensing boards have agreed to streamline the process for licensure in multiple states. More information can be found on the website for the Interstate Medical Licensure Compact at imlcc.org.

Boosting telemedicine In June, the AMA House of Delegates adopted telemedicine-related policy to: • Encourage initiatives to measure and strengthen digital literacy, with an emphasis on programs designed with and for historically marginalized and minoritized populations. • Encourage telehealth solution and service providers to implement design functionality, content, user interface and service-access best practices with and for historically minoritized and marginalized communities, including addressing culture, language, technology accessibility and digital literacy within these populations. • Support efforts to design telehealth technology, including voice-activated technology, with and for those with difficulty

accessing technology, such as older adults and people with vision impairment and other disabilities. • Encourage hospitals, health systems and health plans to invest in initiatives aimed at designing access to care via telehealth with and for historically marginalized and minoritized communities, including improving physician and nonphysician provider diversity, offering training and technology support for equity-centered participatory design, and launching new and innovative outreach campaigns to inform and educate communities about telehealth. • Support expanding physician practice eligibility for programs that assist qualifying healthcare entities – including physician practices – in purchasing necessary services and equipment, in order to provide telehealth services to augment the broadband infrastructure for, and increase connected device use, among historically marginalized, minoritized and underserved populations. • Support efforts to ensure payers allow all contracted physicians to provide care via telehealth. • Oppose efforts by health plans to use cost-sharing as a means to incentivize or require the use of telehealth or in-person care or incentivize care from a separate or preferred telehealth network over the

Data protection In conjunction with the necessary increases in the adaptation of telehealth services, several waivers took effect that ease HIPAA restriction to make virtual doctor-patient interactions more accessible. Even with eased restrictions, doctors are encouraged to remain up-to-date with the regulations, but also have liability and risk mitigation strategies for data privacy, as well as policy, coding and reimbursement. As of Jan. 20, the HHS Office of Civil Rights said it will “exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA rules against covered healthcare providers in connection with the good-faith provision of telehealth during the COVID-19 nationwide PHE.” More information and guidance can be found in the “Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency” at hhs.gov. It is anticipated that these waivers will not continue past the term of the PHE, so plastic surgeons should make plans to switch to a HIPAA-compliant platform if they are not already using one. Public-facing social-media networks, however, such as Facebook Live, Twitch or TikTok should not be used for telehealth. The federal notification also does not impact state privacy laws; therefore, you should check your state for specific requirements. PSN

ADA compliance lawsuits push members to update websites, videos By Paul Snyder & Gina McClure

ollowing news in late May and early June about plastic surgeons being hit with lawsuits over websites that were deemed to be noncompliant with the Americans with Disabilities Act (ADA), some ASPS members report that various web-hosting and other online media companies are able to bring their websites into compliance within a few days. The lawsuits – several of which arose in California – often stem from videos on doctors’ websites. For example, if a video with dialogue does not contain subtitles to make it accessible for a hearing-impaired patient, July/August 2021

the website (and company) could be found in violation of the ADA. However, the list of potential offenses is lengthy, ranging from the use of particular colors on websites, to whether videos use “radio-style” narration for someone who might only be consuming the audio portion of the video, to the use of unique headings and labels on every page to ensure obvious differentiation. Unfortunately, every instance of noncompliance can add to a website’s total fine, with penalties starting at around $4,000 per offense (i.e., each individual video), and in some cases, exceeding $300,000. Penalties can vary based on the venue, the judge and even the

attorney of the plaintiff who files the claim. ASPS member Mark Mason, MD, DDS, says the videos on his site – which are provided by Understand.com – were updated within a period of three days after news spread of the compliance matter. “We do have some videos that are not provided by Understand.com, so I have other services helping to take care of the subtitles there at an extra expense, but that’s what you have to do at this point,” he says. “I find it interesting that these lawsuits are going after plastic surgeons when you can go on YouTube and find millions of videos that don’t have subtitles. Maybe they think we all have deep pockets.”

ASPS members have also reported using various media companies online that were able to provide closed captioning for videos within a few days. Members are advised to review all video content on their practice websites to ensure it features subtitles/closed captioning – or they risk subjecting themselves to potential fines and/or legal action. ASPS is continuing to monitor the situation and will provide additional resources to members. In the interim, the Society can provide the following basic guidance: Continued on page 30

Plastic Surgery The Meeting 2021 Preview

Q&A with HHS Assistant Secretary for Health Rachel Levine, MD By Paul Snyder

here are many reasons to look forward to the return of in-person events at Plastic Surgery The Meeting 2021 in Atlanta, but one of the most anticipated guests is Rachel Levine, MD, assistant secretary for Health in the U.S. Department of Health and Human Services. Dr. Levine made history earlier this year as the first openly transgender federal official to be confirmed by the Senate. She was nominated for this position by President Joe Biden on the strength of her accomplishments as Pennsylvania’s secretary of health, which saw her not only lead the state’s response to the COVID-19 pandemic, but also tackle issues such as the opioid crisis, health equity and healthcare for LGBTQ+ individuals. Dr. Levine is a Fellow of the American Academy of Pediatrics, the Society for Adolescent Health and Medicine and the Academy for Eating Disorders. She also served as Association of State and Territorial Health Officials president. In addition to her recent posts in medicine and government, Dr. Levine is the author of numerous publications on the opioid crisis, adolescent medicine, eating disorders and LGBTQ+ medicine. Ahead of her presentation in Atlanta at the annual meeting, she took time to speak to PSN about some of the matters she’s now focused on at the federal level – and how plastic surgeons can affect change at the national level. PSN: What are your three main goals as HHS assistant secretary for Health? Dr. Levine: COVID-19 has to remain my most urgent and primary focus. We can see a light at the end of the tunnel with our robust vaccination program, but we’re not done yet and we have to continue to expand our vaccination program. We’re addressing vaccine hesitancy and we need a strong equity component in our vaccination program. As a pediatrician and adolescent medicine specialist myself, it’s important to make sure right now that with the vaccine approved for 12- to 17-year-olds, we get our medical teams vaccinated. The second is something I’ve worked on for many years at that intersection between physical health issues and mental behavioral health issues. When I was at Penn State, I started and ran their eating-disorder program, and at the state and federal level, I’m concentrating on mental-health issues – particularly substance-use disorder issues, such as opioid addiction and the nation’s overdose crisis. I’m co-chair of the Behavioral Health Coordinating Council, which was just formed by the HHS secretary, and we’re going to be working

on a number of mental-health issues that are facing the nation. The third is environmental health. We’re creating the office of Assistant Secretary for Health of Climate Change and Health Equity, which will involve environmental issues and environmental justice – we need to work to protect disadvantaged communities and vulnerable populations that experience a disproportionate share of climate impacts. PSN: What lessons learned from Pennsylvania’s response to COVID-19 helped craft the national response? Dr. Levine: One of the important lessons of the pandemic is that we’re all interconnected, and that brings up the issue of healthcare disparities and equity. COVID-19 exposed the area below the surface and we absolutely have to work on that. The situation highlighted the importance of public health, and at local, state, federal and international levels, public health officials need to collaborate and coordinate. We need the resources, workforce and IT capabilities to protect the health of our nation and the world – and we’re going to need sustainable funding. We’ve also expanded telemedicine significantly in the United States during the pandemic and will be looking at telemedicine regulations that have been suspended, current telemedicine practices and what we need to continue. PSN: What immediate steps need to be taken in combating the opioid crisis? Dr. Levine: We had a program in Pennsylvania I like to call “opioid stewardship,” the parallel being to antibiotic stewardship. Antibiotics are essential medicines and have allowed us to deal with so many infections, but due to overuse, there are severe issues in terms of bacterial and microbial resistance. Opioids are also essential medicines for acute care and patients with severe chronic pain, but clearly, the over-prescription of opioids has been one factor among many in the overdose crisis in this nation over the past decade or more. We’ve worked in Pennsylvania and we’re going to work nationally with the medical community and other specialties on the judicious and careful prescription of opioids. We’ve already reached out to the AAMC about education on pain and addiction. We want physicians to have continuing medical education about that. We brought prescribing guidelines to the Board of Medicine in Pennsylvania, and every state now has a prescription drug monitoring program. We want to make sure that we strengthen the knowledge in those programs about the over-prescription of pain medications. It’s an important issue

Rachel Levine, MD for plastic surgeons in terms of post-op pain and chronic pain. PSN: There have been articles in the past – and this gets into the public misperception of plastic surgery – about overprescribing opioids for cosmetic procedures. Given that our doctors are also reattaching limbs, treating patients with severe burns and performing transplants, pain management plans can differ. Dr. Levine: That’s what we get into with the stewardship issue – we don’t want patients to suffer major pain or chronic pain. But the default has been, “30 days of Vicodin,” and we can’t continue to do that after surgery. There must be a balance. We don’t want people to suffer, but we must be very cautious about how opiates are prescribed. PSN: ASPS has been working to combat recent bills in various states that seek to regulate and criminalize transgender surgery for minors, as well as punish doctors who perform the procedures. Are there efforts being made at the national level to protect these doctors and patients, and what are your concerns about what the passage of such legislation in more states might lead to? Dr. Levine: I thank ASPS for advocating for LGBTQ+ individuals and, in this case, for transgender youth. It’s so challenging and unfortunate that these laws being passed are directed against transgender youth – who are vulnerable to bullying and harassment, and this significantly exacerbates that situation. My view is that this is politics; unfortunately, some people are using transgender youth as a wedge issue. This includes trying to pro-

hibit transgender youths from participating in sports, and the most egregious are the discriminatory bills against gender-affirming care for transgender youth. We need to advocate at all levels. I will be working on two fronts – speaking about it publicly and then advocating with policy. We will be working across HHS and with the Biden administration on bills, rules and regulations to protect LGBTQ+ individuals. One example of success that HHS has already achieved is that the Office of Civil Rights declared that its interpretation of Section 1557 of the Affordable Care Act is that the term “sex” includes sexual and gender minorities, sexual orientation and gender identity. All aspects of the ACA will be looked at under that light. That will have a significant impact. The amazing thing is that we have a president that supports, advocates for and is the biggest ally I know for the LGBTQ+ community. There have been executive orders about this and in his first address to Congress, he said – and I always keep the quote with me – “To all transgender Americans watching at home, especially the young people: You’re so brave. I want you to know your President has your back.” I want transgender youth and LGBTQ+ youth – and adults – to know that I have their back, and I will continue to lead at the federal level and do everything I possibly can on their behalf. PSN: What are some of the most important or immediate steps plastic surgeons can take in helping inform national healthcare policy? Dr. Levine: The plastic surgery community is small but mighty. You have a strong voice and it’s important not to become complacent. Use that voice at every level. We need your voice advocating at the congressional, state and local levels for healthcare equity, and to protect all vulnerable communities. I often quote – and it’s not a joke – Yoda from Star Wars: “Fear is the path to the dark side. Fear leads to anger, anger leads to hate, hate leads to suffering.” People fear what they don’t understand. Educating people about LGBTQ+ individuals goes a long way toward dispelling fear and other negative emotions that can lead to these regressive bills. Acceptance starts at the local level and all of us can work toward that. You can do that by using the right pronouns, using the right names, medical records or working with your staff in offices, medical centers and medical schools. Don’t underestimate the impact people have on state legislatures by writing letters, testifying and advocating even through the press about the bills that we’ve been talking about. Medical centers and academic institutions have a powerful voice, and elected officials pay attention. If we use our voice, it can be a powerful tool to turn the tide. PSN

Lawrence Robbins, MD, 1938-2021

Remembering ‘an excellent plastic surgeon and wonderful friend’ By Paul Snyder

uneral services were held July 2 for Lawrence Robbins, MD, who passed away peacefully on June 30 at age 83. Dr. Robbins, a native of White Plains, N.Y., moved with his family to Surfside, Fla., while he was still in grade school. During his illustrious career, he served as chief of plastic surgery at Mount Sinai and at the Miami Heart Institute. In 1982, Dr. Robbins opened the first licensed private ambulatory plastic surgery center in Miami Beach. ASPS past President Alan Matarasso, MD, recalls that he was finishing medical school when he first became aware of Dr. Robbins. “He had a busy practice and a fine reputation,” Dr.

Matarasso says. “A few years later, our paths began to cross regularly. As I began my career, Larry held numerous leadership positions and was a sought-after lecturer, particularly on facelifting. In the 1990s, he was among a number Lawrence Robbins, MD of excellent and wellknown aesthetic surgeons practicing in south Florida.” Dr. Robbins held numerous elected positions in medical societies, including ASPS, the Greater Miami Society of Plastic

and Reconstructive Surgeons, the Florida Society of Plastic Surgeons and The Aesthetic Society, for which he served as president in 1997. “He had one of the early aesthetic surgery Fellowships and accredited office O.R.s in our field,” Dr. Matarasso says. “Over time, our careers coincided and our friendship blossomed. Larry was an excellent surgeon and continued to run a busy practice until health issues forced him to retire prematurely. I last saw Larry at Plastic Surgery The Meeting 2019 in San Diego, shortly before the COVID-19 pandemic began. He was happy with his life and splitting his time between south Florida and San Diego, which for him was certainly the best of both worlds.” Dr. Robbins career includes several published articles, guest speaker appearances and the submission of forewords

for multiple plastic surgery books. He was a recipient of the 2005 ASPS Honors Committee Education Award for his contributions to the education of plastic surgeons during his years in practice in Miami Beach, and he was also inducted into the Iron Arrow Honor Society – the highest honor that can be attained at the University of Miami – in 2006. Dr. Robbins is survived by his daughter, Jessica Marino; son-in-law Gregory Marino; and his two granddaughters, Zari Marino and Alexa “Lexi” Marino. The family requests donations be made to the Alzheimer’s Association (alz.org) in memory of Dr. Robbins. “He was an excellent plastic surgeon and a wonderful friend,” Dr. Matrasso says. “The plastic surgery community is deeply saddened by his loss.” PSN

July/August 2021

PRS smashes its own record for the fourth time in five years By Paul Snyder

he influence and impact of PRS continues to grow. The benchmarking and analytics tool InCites in June released its 2021 Journal Citation Report, revealing that PRS bested the 4.209 Impact Factor from last year that had, until this year’s 4.730 Impact Factor, been its highest mark. A journal’s Impact Factor is a measure of how frequently the average article in the publication is cited throughout scientific literature during the year (calculated by dividing the number of citations in a year by the total number of articles published in the two previous years). Of 210 total journals in the “surgery” category, PRS ranks 29 – the highest entry for any plastic surgery-focused publication – and again it’s the No. 1 plastic surgery journal in the world. The milestone is significant not only in the sense that it marks the fourth record-breaking Impact Factor in the past five years, but it’s also the fifth consecutive year that PRS topped 30,000 total citations. In fact, in the past year, PRS was cited more than 45,600 times. “This is not only phenomenal news, it’s also a quantum leap in terms of the influence that PRS enjoys as the specialty’s most respected journal,” says PRS Editor-in-Chief Rod Rohrich, MD. “It’s a reflection of the hard work of the authors, editors, reviewers, editorial board and staff, without whom we simply wouldn’t have this success. Considering the number of submissions we see every year, we have a very low acceptance rate, but the quality of content that’s printed in PRS makes the journal what it is. This is the motherlode for plastic surgery.” Although an Impact Factor is not the only metric upon which a journal’s quality and content is based, it remains an important gauge in determining influence. Authors, readers and advertisers consider Impact Factor scores in selecting which journals to work with or read. As in recent years, several of the most-cited articles from PRS focused on topics relating to breast implants

– including breast implant illness, BIA-ALCL, capsular contracture and reconstruction. However, articles relating to gender inequality and lower-extremity trauma reconstruction also gained a lot of attention. “The increase in the PRS Impact Factor over the past five years indicates the academic relevance and influence of the articles published in the white journal – not only in plastic surgery, but also over a broad spectrum of both surgical and nonsurgical specialties that focus on reconstructive and cosmetic issues,” says James Stuzin, MD, co-editor of PRS. “This year’s increase reflects the ever-increasing breadth of interest that remains the focus of PRS.” Kevin C. Chung, MD, MS, who will succeed Dr. Rohrich as PRS editor-in-chief next year, says he looks forward to embracing the challenge of keeping PRS in the upper echelon of medical journals. “I’m gratified to see the continued increase in our Impact Factor, which is a testament to the confidence of authors in submitting their best work to us,” Dr. Chung says. “PRS belongs in the select list of elite surgical journals. As I assume the editor-in-chief position in January, I will work closely with the editorial board to maintain the highest quality of publications for our worldwide, expanding readership.” Dr. Rohrich says that it’s a pleasure to end his term as the journal’s editor-in-chief on a prestigious high note, but he’s more proud – and grateful to everyone with whom he worked – to cement the importance of plastic surgery research in the larger academic field. “Former PRS Editor-in-Chief Robert Goldwyn, MD, gave me one piece of advice when I was coming in – and that was to nourish the baby and let it grow. ‘Do that,’ he told me, ‘and it will be strong and healthy.’ I’m proud of where the journal is now; it’s really come into its own in the scope of academic medicine. The science of what we do matters around the world – and I’m sure that influence will continue to grow in the future.” PSN

July/August 2021

(listed alphabetically) Breast Implant Illness: A Way Forward. Magnusson, Mark R.; Cooter, Rod D.; Rakhorst, Hinne; McGuire, Patricia A.; Adams, William P. Jr; Deva, Anand K. Complications and Patient-Reported Outcomes after Abdominally Based Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. Erdmann-Sager, Jessica; Wilkins, Edwin G.; Pusic, Andrea L.; Qi, Ji; Hamill, Jennifer B.; Kim, Hyungjin Myra; Guldbrandsen, Gretchen E.; Chun, Yoon S. Current Risk Estimate of Breast Implant-Associated Anaplastic Large Cell Lymphoma in Textured Breast Implants. Collett, David J.; Rakhorst, Hinne; Lennox, Peter; Magnusson, Mark; Cooter, Rodney; Deva, Anand K. The Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand Confirms the Highest Risk for Grade 4 Surface Breast Implants. Magnusson, Mark; Beath, Kenneth; Cooter, Rodney; Locke, Michelle; Prince, H. Miles; Elder, Elisabeth; Deva, Anand K. The Functional Influence of Breast Implant Outer Shell Morphology on Bacterial Attachment and Growth. Jones, Phoebe; Mempin, Maria; Hu, Honghua; Chowdhury, Durdana; Foley, Matthew; Cooter, Rodney; Adams, William P. Jr; Vickery, Karen; Deva, Anand K. Gender Inequality for Women in Plastic Surgery: A Systematic Scoping Review. Bucknor, Alexandra; Kamali, Parisa; Phillips, Nicole; Mathijssen, Irene; Rakhorst, Hinne; Lin, Samuel J.; Furnas, Heather How to Diagnose and Treat Breast Implant-Associated Anaplastic Large Cell Lymphoma. Clemens, Mark W.; Brody, Garry S.; Mahabir, Raman C.; Miranda, Roberto N. Muscle versus Fasciocutaneous Free Flaps in Lower Extremity Traumatic Reconstruction: A Multicenter Outcomes Analysis. Cho, Eugenia H.; Shammas, Ronnie L.; Carney, Martin J.; Weissler, Jason M.; Bauder, Andrew R.; Glener, Adam D.; Kovach, Stephen J.; Hollenbeck, Scott T.; Levin, L. Scott A Prospective Comparison of Short-Term Outcomes of Subpectoral and Prepectoral Strattice-Based Immediate Breast Reconstruction. Baker, Benjamin G.; Irri, Renu; MacCallum, Vivienne; Chattopadhyay, Rahul; Murphy, John; Harvey, James R. Risk Factor Analysis for Capsular Contracture: A 10-Year Sientra Study Using Round, Smooth, and Textured Implants for Breast Augmentation. Calobrace, M. Bradley; Stevens, W. Grant; Capizzi, Peter J.; Cohen, Robert; Godinez, Tess; Beckstrand, Maggi

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Arami A, Gurevitz S, Palti R, Menachem S, Berelowitz M, Yaffe B. The Use of Medicinal Leeches for the Treatment of Venous Congestion in Replanted or Revascularized Digits. J Hand Surg Am. 2018 Oct;43(10):949.e1-949.e5. doi: 10.1016/j.jhsa.2018.02.018. Epub 2018 Mar 27. PMID: 29602653.

Herlin C, Bertheuil N, Bekara F, Boissiere F, Sinna R, Chaput B. Leech therapy in flap salvage: Systematic review and practical recommendations. Ann Chir Plast Esthet. 2017 Apr;62(2):e1-e13. doi: 10.1016/j. anplas.2016.06.004. Epub 2016 Jul 15. PMID: 27427444.

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Nguyen MQ, Crosby MA, Skoracki RJ, Hanasono MM. Outcomes of flap salvage with medicinal leech therapy. Microsurgery. 2012 Jul;32(5):351-7. doi: 10.1002/ micr.21960. Epub 2012 Mar 31. PMID: 22473683.

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his year’s Breast Reconstruction Awareness Close the Loop 5K will be held during Plastic Surgery The Meeting 2021 in Atlanta – but you (and your friends and family) can participate from wherever you are anytime between now and Oct. 31. The Close the Loop 5K will conclude Sunday, Oct. 31 at 9:30 a.m. (Halloween costumes are encouraged.) All winners will be recognized during the annual meeting’s Closing Ceremonies. In 2020, the Close the Loop 5K concluded with more than 320 participants and 30 teams raising more $100K for Breast Reconstruction Awareness. Even if you don’t plan on attending Plastic Surgery The Meeting, you can still participate in the 2021 Breast Reconstruction Awareness Close the Loop Virtual 5K. Register for the Close the Loop 5K or donate to the Breast Reconstruction Awareness Campaign as a virtual participant at https://p2p.onecause.com/bra5k. You can also register as a member of a team (no limit on team size), team captain or create a new team. Take part not only in a great event, but a way to educate, engage and empower women to make the decision that is best for them following a diagnosis with breast cancer. PSN

Top 10 most-cited PRS articles from the past two years

CPT CORNER

A primer on expanding your understanding of muscle flap codes “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 Eric Lai, MD; Sean Li, MD; Christopher Shale, MD; and Alexander Mericli, MD

he 1573X family of CPT codes represent muscle, myocutaneous and fasciocutaneous rotational flaps, but they don’t describe any form of free-tissue transfer with microvascular anastomosis. Muscle, myocutaneous or fasciocutaneous flaps should never be confused with adjacent tissue transfers, where skin or subcutaneous tissue alone is typically advanced to fill a defect. ASPS teaches that the 1573X “family” of codes are used for flaps in which large, vascularized muscle or fascial units (and potentially the overlying skin) are mobilized and transferred for reconstructive purposes. This includes transfer of these muscle or fascia-based flaps for the filling of oncologic defects, coverage of compromised surgical sites or functional muscle transfer. Coding within the 1573X family is based on the donor site location of the flap as outlined in the CPT book’s introductory language. Coding guidelines from the AMA state that more than one muscle-flap code may be reported for a single defect if separate muscles are independently raised and transposed. These codes cover the following technical aspects of a pedicled flap: • Elevation of the flap • Preservation of the named blood supply/ nerve • Inclusion of the skin paddle, if necessary • Transfer and inset of the flap • Closure of the donor site as:

These codes do not include aspects such

• Tumor resection • Wound bed preparation • Placement of a tissue expander or implant • Placement of a skin graft for coverage of the flap or donor site In order to reduce the likelihood of insurance reimbursement denial, technical aspects of the surgery that should be specifically noted in the operative dictation of these codes include: • Flap elevation • Identification and preservation of a named, vascular pedicle • Inset of the flap • Closure of the donor site Pedicled flap codes are based on the donor site of elevation, not the recipient site – e.g., a trapezius flap elevated for coverage of a posterior scalp defect would be reported with code 15734 (trunk), not 15733 (head & neck). Elevating tissue and performing an advancement of a random pattern flap should not be reported with the 1573X codes. Nor should a flap containing muscle fibers or fascia without specifically preserving the vascular pedicle. Codes 15734 and 15738 support the -80 modifier to reimburse an assistant surgeon; the remaining codes do not.

Use of modifiers AMA coding guidelines allow for more than one flap code to be reported if separate

TABLE I: CODING FOR FLAPS CODE

DESCRIPTOR

RVU

15730

Midface flap (ie, zygomaticofacial flap) with preservation of vascular pedicle(s)

13.50

15731

Forehead flap with preservation of vascular pedicle (eg, axial pattern flap, paramedian forehead flap)

14.38

15733

Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (i.e., buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae)

15.68

15734

Muscle, myocutaneous, or fasciocutaneous flap; trunk

23.00

15736

Muscle, myocutaneous, or fasciocutaneous flap; upper extremity

17.04

15738

Muscle, myocutaneous, or fasciocutaneous flap; lower extremity

19.04

19361

Breast reconstruction; with latissimus dorsi flap

23.36

muscle flaps are used to cover a single defect. This point can be confusing and deserves a detailed explanation. For example, bilateral paraspinous muscle flaps to obliterate a spinal wound defect should be coded as separate right and left flaps, as opposed to using the -50 bilateral modifier. If two “trunk” flaps are performed that are not accurately described as “left and right,” then the -59 distinct procedural modifier should be used. For instance, if a right vertical rectus abdominis myocutaneous (VRAM) flap was used to reconstruct a perineal defect and a right component separation was used to reconstruct the abdominal wall donor site, 15734 would be used to describe the VRAM flap, and 15734-59 would be used for the unilateral component separation.

Head and neck flaps In 2018, the previous code for pedicled head and neck flaps – 15732 – was retired and replaced with 15733. This code specifically lists the only flaps that may be coded with 15733, which are the buccinator muscle, genioglossus, temporalis, masseter, sternocleidomastoid and levator scapulae. The forehead flap is represented by its own code (15731) and is not covered by 15733. In 2018, a new code was introduced, 15730. This code is described as a “midface flap” or “zygomaticofacial flap” and is intended to describe the standard midface lift used for support of the lower eyelid during reconstructive procedures. Use of this code requires more than just a little undermining of the midface. Dissection includes a lateral canthotomy with inferior cantholysis to the orbital rim, followed by dissection over the orbital rim and maxilla with preservation of the neurovascular bundles. The midface tissues (or flap) are then released and anchored to the deep temporal fascia, orbital rim, and/ or lateral nasal wall.

Pedicled flaps There are two specific CPT codes dedicated to pedicled flaps in breast reconstruction: 19361, for breast reconstruction with a latissimus flap; and 19367, for pedicled transverse rectus abdominis myocutaneous flap. Pedicled-flap codes do not cover the placement of a tissue expander or implant, which should be reported separately. If a radical mastectomy is performed, say, in the setting of inflammatory breast cancer, and a latissimus dorsi flap is needed for skin closure/chest wall reconstruction, then the 15734 code should be used, not 19361. Use of 19361 intimates that specific effort is dedicated to shaping the flap into a breast, either via insetting techniques or device placement. As the incidence of oncoplastic breast surgery continues to increase, certain pedicled fasciocutaneous flaps may be used to obliterate segmental mastectomy defects within the breast. In this scenario, if a latissimus dorsi muscle or myocutaneous flap is

buried in the defect, then 19361 should be used. However, if a perforator fasciocutaneous flap is employed, such as a lateral intercostal artery perforator (LICAP) flap, a thoracodorsal artery perforator (TDAP) flap, or lateral thoracic artery perforator (LTAP) flap, then 15734 is the most appropriate code to use. It’s important for meeting the criteria for reporting 15734 that these flaps include dissection of the pedicle and are not simply adjacent tissue-transfers based on the blood supply from the perforators. Remember, ASPS teaches that if it wasn’t documented, it wasn’t done. Just because an adjacent tissue transfer can include a small amount of fascia or muscle, this doesn’t mean that it is then reported with the 1573X family, which is used for the movement of entire muscles or larger volumes of tissue with preserved vascularity. When coding for muscle flaps, operative notes should include descriptions of the work to dissect the muscle or fascial flap including elevation of the muscle, preservation of the blood supply, and then transfer (transposing) of the muscle to a new area (inset) to complete the reconstructive procedure. To ensure preservation of the blood supply, surgeons often use terms such as “identified the pedicle” or “preserved the perforator” in their documentation. Operative notes may also indicate the flap is observed for congestion, with repositioning and change in flap orientation performed as needed. Of note, preservation of a nerve supply is not routinely noted during myocutaneous flaps, as reinnervation may not be medically necessary in all cases.

Case examples Case One A 75-year-old male with spinal-hardware infection undergoes reconstruction of his midline thoracic wound. The wound bed was debrided excising nonviable soft tissue. This included excising skin, subcutaneous tissue and muscle measuring 8x10 cm. Left and right paraspinous muscles were mobilized based on the lateral perforators and advanced to obliterate the dead space at the midline. The overlying skin and superficial fascia was closed in three layers. The wound measured 18 cm. in length. Coding: Codes used for this case would be 11043 for debridement of skin and subcutaneous tissue and muscle (first 20cm2); and 11046 x3 (for the subsequent 20cm2), 15734 and 15734 with “left” and “right” modifiers for the paraspinous muscle flaps, as they are both distinct procedures. The skin closure should not be separately coded as it would be covered with the flap harvest. For paraspinous flaps, the entire muscular unit is reported as one flap. It’s not appropriate to separately report the transfer of the iliocostalis, spinalis and longissimus when all three are mobilized together.

A pedicled right vertical rectus abdominis myocutaneous flap was elevated based on the deep inferior epigastric vessel to reconstruct the perineal defect. The donor site fascia was closed with a right component separation. The overlying skin and superficial fascia was closed in three layers. The wound measured 24 cm. in length. Coding: Codes used for this case would be 15734 for the VRAM, 15734-59 for the component separation using the -59 modifier as it is its own distinct procedure. You would not code for the closure length. It should also be noted that were the VRAM to extend to the thigh, it would still be coded as 15734 as it’s the donor site that determines the code, not the recipient site Case Three A 33-year-old female presents with a traumatic medial ankle wound resulting from a tibula/ fibula fracture. The fracture has been fixated internally by orthopedic surgery and she presents for soft tissue coverage. The wound was debrided by excising nonviable tissue. This included skin and subcutaneous tissue overlying the fracture and hardware measuring 5x6 cm. A propeller fasciocutaneous flap based on a posterior tibial perforator was designed and rotated into the defect for coverage. The flap dissection included isolation of the perforator pedicle all the way back to the posterior tibial artery, with freeing the vessel from the adjacent soft tissues. A split thickness skin graft measuring 7x5 cm. was utilized to close the donor site. Coding: Codes used for this case would be 11010 for 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, 15738 for the fasciocutaneous perforator flap and 15100 for the split thickness skin graft to cover the donor site of the propeller flap. If a perforator is simply included in a local flap such as a keystone flap, this would not be reported with 15738, but instead with the appropriate adjacent tissue-transfer codes based on size of the flap and defect. Case Four A 77-year-old male presents after Mohs excision of a BCC with a 2x1.5 cm. defect of the left nasal ala. He previously had numerous defects closed on the nose and he undergoes a first-stage nasolabial flap based off a perforator of the angular artery. The perforator is carefully dissected free and a small cuff of muscle is left on the proximal flap. The flap inset looks good and the plan is for second-stage division and inset of the flap at a later date. Coding: The code used for this case is 14060. Although the flap includes a perforator off a known vessel, it’s not one of the specifically listed flaps which allows for the 15733 code. It should be noted, however, that the second-stage surgery would be coded as 1563058, as this is a planned return to the O.R. for the same diagnosis/problem. PSN

Case Two A 54-year-old male undergoes abdominoperineal resection and perineal reconstruction.

July/August 2021

World Plastic Surgery Day sheds light on the importance of the specialty By Paul Snyder

lthough ASPS participated in World Plastic Surgery Day for the first time on July 15, the idea is not a new one. India has celebrated a National Plastic Surgery Day for the past decade and the roots for what is now an internationally recognized day can be found in the efforts planted there 10 years ago. Raja Sabapathy, MD, who was president of the Association of Plastic Surgeons of India in 2011, pushed the idea to fruition in his home country, with the purpose being to take a day to recognize the humanitarian aspects of plastic surgeons throughout local communities. Though the concept is going international this year, Dr. Sabapahty tells PSN that, in India at least, the idea remains a “work in progress.” “The problem in developing countries is that in the delivery of tertiary-level healthcare, there is a gap between need and availability,” he says. “Unfortunately, there exists another gap between availability and utilization, and the existence of this second gap is an avoidable tragedy. “Bridging the first gap requires resources and capacity building, which relies on government efforts, policies and procedures,” Dr. Sabapathy adds. “The second gap between availability and utilization is due to a lack of awareness, access and affordability. World Plastic Surgery day provides an opportunity for plastic surgeons to bridge the gap themselves.” Although the United States isn’t a developing country, the concept of providing more awareness on the full scope of what plastic surgeons do falls right in line with the efforts ASPS continues to pursue through the Plastic Surgery Education Campaign – through initiatives such as The Innovators series (plasticsurgery.org/innovators), Breast Reconstruction Day and others – says ASPS past President Robert X. Murphy Jr., MD, MS. “The important thing is continuing to spread the message of just what it is that we do,” he says. “The work we do contributes to so many different aspects of wellness – we deal in the preservation of life and improving the quality of life.” Dr. Murphy says the Society’s increasing collaboration at the international level over the past few years has shown that the problems plastic surgeons face in one country are rarely unique to that particular area. “There are plastic surgeons in so many countries trying to make others understand that what they do is more than what you see on reality TV,” he says. Dr. Sabapathy reiterates that people around the world simply do not know the true scope of plastic surgery. “All the other specialties are linked to organ systems, so it is easy for people to reach out,” he says. “Orthopaedics, bone doctor; ophthalmologist, eye doctor; cardiologist, heart doctor; and the list goes on. Plastic surgeons operate from head to foot, on all age groups and on all sexes. It’s an advantage, but it is also our biggest disadvantage. The public generally perceives plastic surgeons as an elite group who would do only aesthetic surgery – but they miss out on the reconstructive surgical aspects.”

and advance our specialty: You could invite a student (medical or undergraduate) to shadow you so as to promote interest in the specialty; organize a town hall or panels with members of the community to focus on ways that plastic surgeons can better serve their needs; or engage in education directed to underserved members of the community on services that plastic surgeons can provide and how they may access these services.” In recognition of World Plastic Surgery Day, ASPS hosted a “Reconstructive Roundtable” with ASPS President Joseph Losee, MD; ASPS President-elect J. Peter Rubin, MD, MBA; The PSF past President Paul Cederna, MD; and Sheri Slezak, MD, chief of the Division of Plastic Surgery at the University of Maryland. The theme of the roundtable will be “form and function” and will feature the participants doing a deep dive into various aspects of reconstructive surgery, from breast

A look at the “Reconstructive Roundtable.” reconstruction and craniofacial surgery to body contouring after massive weight loss and robotics. The public-facing content is available on ASPS social media channels. As the years pass, Dr. Murphy says he hopes to see more ideas take root and the day grow in popularity – and significance – the way Breast Reconstruction Awareness Day has over the past decade. The efforts made to date in India have

drawn increasing media coverage and helped prospective patients – and those who might not have ever realized plastic surgery could be an option – reach out to doctors in their community. Dr. Sabapathy notes that many plastic surgeons organize camps on that day, or on the eve of the Plastic Surgery Day that run for an entire week. Patients who participate in the camp might have their procedure done free or at a concessional cost. “Every patient who benefits becomes an ambassador for the specialty,” he says. Although the logistics of doing procedures free of charge in the confines of the U.S. healthcare system might preclude similar efforts stateside, Dr. Gosain reiterates that humanitarian work on behalf of the specialty doesn’t stop (or necessarily start) in the O.R. “This is a day of giving back to the communities we serve,” he says. “May each of us join our international colleagues in doing so.” PSN

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The PSF past President Arun Gosain, MD, says World Plastic Surgery Day presents a unique opportunity for domestic ASPS members to work with global partners in advancing the humanitarian aspects of the specialty. “Whereas surgeons in many low- and middle-income countries choose to provide at least one reconstructive surgical procedure pro bono on that day, we realize that this may not be feasible in the U.S. healthcare system,” Dr. Gosain notes. “However, there are other ways that each of us might choose to highlight

ON LEGAL GROUNDS

Risks and penalties posed by the 21st Century Cares Act “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.

Withholding information must also be avoided. Case One: Dr. L. Donegan operated on a difficult patient with a skin tumor thought to be a basal-cell carcinoma on the upper back. Scheduling the procedure proved to be difficult and, ultimately, the surgery was performed with frozen section margins clear of tumor. The area healed slowly, which was thought to be due to the patient’s non-compliance. The patient deemed the resulting scar as unacceptable, despite topical scar aid treatments. The patient received the final written report, which revealed a margin with tumor, a month later. The final pathology also revealed a baso-squamous tumor. Dr. Donegan, having difficulty with this patient, did not share the pathology report. Thinking the scar might be revised anyway, he figured, “Why further inflame the situation?” With a two-year statute of limitations during which a lawsuit must be filed, Dr. Donegan waited until after the two years passed and there was no recurrence noted.

By Neal R. Reisman, MD, JD

he 21st Century Cures Act, which took effect April 5, limits and penalizes any interference of the secure exchange and use of electronic health information by patients, physicians and healthcare organizations. The law includes provisions to promote health information interoperability and patient access to their records, as well as to prevent information blocking. Information blocking can include restrictive and unfair contractual limitations on physicians’ use and exchange of medical information, excessive fees to create or connect with other information systems and creating obstacles for patient access to their records. There are efficiencies and positives for physicians and patients that will arise from this law, but a potentially unanticipated set of risks is also a possibility, due to easier accessibility of patient medical records. These risks cluster around the concepts of intentional misinformation, fraudulent concealment and patient-centered language use.

Intentional misinformation Failure to include important knowledge about patient care could reach the level of “fraudulent concealment,” which not only taxes the statute of limitation in filing a lawsuit, but also invites the stigma of fraud in

care. Intentionally misinforming patients to avoid mistakes – or hide a bad result or test – has severe implications legally and can affect medical licensure. I have a policy in my practice to provide patients with any pathology or lab reports for their own records. Certainly, any procedures utilizing particular devices should prompt a doctor to share a device record with the pa-

tient. Many health facilities let patients access their medical information via web portals or mobile applications such as “My Chart.” If a practice does not have the ability to provide such access, it would be wise to figure out how to make this medical information available in a secure method. State medical boards include requirements for providing medical record information when requested in a timely manner.

Intentionally withholding information that could help the patient make any informed decisions about their care could be deemed “fraudulent concealment.” Such action negates the statute of limitations from barring a lawsuit to be filed. In addition, intentional deception can void malpractice coverage and trigger state medical board actions, jeopardizing one’s license to practice. It’s always advisable to be honest with patients and find an appropriate time and demeanor to discuss events.

Patient-centered language Another potential tripwire in making medical records more easily available to patients is the language used within those records. The power language can have not only on patient care but also on patient outcomes is profound. Continued on page 30

THE HIGHER GROUND

The ethical dilemma posed by estimating resection amounts for breast reduction By Joe Gryskiewicz, MD

“The Higher Ground” columnist Joe Gryskiewicz, MD, is a former chair of the ASPS Ethics Committee, a past member of the ASPS Judicial Council, and he has been in practice for more than 30 years. Readers are encouraged to submit queries to him at drjoe@tcplasticsurgery.com. Names will be withheld, and the views expressed in this column are those of the author and should not be considered legal advice. Q: When is it ethical to recommend that a patient self-pay for a breast reduction? Insurance companies require a large amount of tissue to be removed for compensation, and I know of some colleagues who don’t mind low reimbursement rates – or are sympathetic to patients who don’t have as much expendable income – telling patients that because of these requirements, their breasts will be smaller than they desire. To “guarantee” pre-approval coverage, then, the doctor overestimates to the carrier the amount of tissue to be removed. Seems ethically dubious to me. I also know of plastic surgeons who aren’t happy with reimbursement rates, so they tell the patient upfront that she will not be happy having to remove the required amount of tissue

necessary for reimbursement, and then tell her to pick her desired size – but she will have to self-pay, and at a higher price. Again, this seems ethically questionable. Given that the estimated amount necessary for preauthorization is rarely the same as the actual amount removed (whether it’s more or less) and the insurance company usually still pays, it seems that it would be better – or at least more honest – to send an accurate estimate to the insurer in the first place. If coverage is denied, then you could let the patient decide if she would like to self-pay. A: Dealing with insurance carriers can be a churlish business. I agree that the ethical route is to submit the case to the insurer and, depending on the answer, let the patient decide. Your question is interesting, however, in that it actually sets up multiple scenarios: 1. The surgeon overestimates the resection amount to obtain coverage: Unethical 2. The surgeon underestimates the resection amount to obtain denial and force the patient to self-pay: Unethical 3. The surgeon accurately estimates the resection amount and is approved: Ethical 4. The surgeon accurately estimates the resection amount and is denied: Ethical

The actual medical outcome to this PA request depends on the patient’s BMI and estimated resection, but the surgeon’s motive – whether they are making their best effort and being honest – also plays a big part. Your colleagues might deserve the benefit of the doubt, but I believe that there are doctors underestimating the weight in order to coax the patient into self-paying for the procedure. Other surgeons believe breast reductions should be covered – regardless of the resection amount – and probably overestimate to obtain coverage. These surgeons believe they are caregivers trying to alleviate back, neck and shoulder pain in their prospective patients, so to heck with insurance formula requirements. They rarely get caught – but that doesn’t make it any more honest. However, surgeons who overestimate or underestimate should be aware of some potential pitfalls that might await them. For example, some states have a review process wherein an estimate for the insurance company could be deemed insufficient after the fact and your precertification could be revoked. In this case, the patient should be provided with the self-pay rate. If you willingly overestimate the resection amount to compel insurance authorization, you’re committing insurance fraud. Insurance companies can and will ask for operative reports to verify the amount of tissue required for a procedure. They could also request a pathology report to verify the patient’s resected tissue weight. Many years ago, I had an insurance company authorize a breast reduction for a teenage

patient. After the operation, however, the company refused to pay me because I was slightly short of the authorized weight on one side – a mere 15 grams, if you can believe it. Although I explained my intraoperative thinking in my dictation (including a dusky nipple), the insurer would not be swayed. The patient’s parents were livid with me. It took many appeals, but the insurance panel ultimately decided to cover the hospital costs for the patient. It was a stressful experience that I never want to repeat. I also recently heard from a member who had his estimate denied for coverage, but the patient agreed to self-pay. However, the patient’s mother continued to pursue the matter with the insurance company after the procedure. This eventually led to the insurance company approving the breast reduction and paying our member – which forced him to refund the cosmetic payment paid by the patient and accept the insurance reimbursement, which was only one-third of what the self-pay charge had been. When I was chief of surgery, it came to my attention that a plastic surgeon colleague soaked the breast reduction specimens in saline (for an hour or so while closing) before submitting to pathology. This kind of insurance fraud could result in jail time. Patients at the extremes of too big or too small make these decisions easy, but it is the area under the center of the bell curve that can be challenging. Nevertheless, it’s best to be honest and ethical. Don’t play games, as the results can often prove too costly to a practice or reputation. PSN July/August 2021

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LEGISLATIVE UPDATE

PA scope expansion efforts reach new extreme with title change basic medical sciences, behavioral sciences and behavioral ethics. In the clinical component, students complete more than 2,000 hours of clinical rotations. This training affords PAs a knowledge and skill base that allows them to work as critical components of the healthcare team – but it still pales in comparison to the 15,000-plus clinical hours typically logged by physicians in training. Due to the clear 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, among other measures. Supervision requirements center on the need for a written collaborative agreement with a physician that can outline the procedures a PA is allowed to perform. Supervision is determined at the practice level in 31 states, and by the state medical board or within state law in 19 states.

By Tyler Neese

rganizations representing midlevel practitioners continue their attempts to expand the scope of practice for those they represent. Such efforts on behalf of physician assistants (PA) recently changed tack and became much more aggressive, as the American Academy of Physician Assistants (AAPA) voted to change the profession’s title from “physician assistant” to “physician associate.” This latest attempt at scope expansion could carry significant implications for plastic surgery and the broader medical community. ASPS is actively working to oppose the move and voice concerns to the PA and policymaking communities.

Background The AAPA House of Delegates (HOD) on May 24 passed a resolution affirming “physician associate” as the official title for the PA profession by a majority vote of 198 to 68. According to AAPA, the vote followed several hours of deliberation by HOD members and, “several years of study by an international marketing and communications firm.” In its announcement regarding the name

change, AAPA stated that its Board of Directors will now begin discussions to implement the policy and noted that it’s “inappropriate for PAs to hold themselves out as ‘physician associates’ at this time until legislative and

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

regulatory changes are made to incorporate the new title.” This action by the HOD preempted standard processes – in which such changes are dictated by legislation or through regulatory channels – and suggests that PAs could be putting the cart before the horse. Although such an approach could result in varying degrees of success, it might also prove a difficult proposition without legislative backing and the support of lawmakers and regulators. The concept of the physician assistant dates back to 1961, when Charles L. Hudson, MD, first introduced the role in the Journal of the American Medical Association. Dr. Hudson’s proposal described “an advanced medical assistant with special training, intermediate between that of the technician and that of the doctor, who could not only handle many technical procedures, but could also take some degree of medical responsibility.” In 1965, Eugene A. Stead Jr., MD, established the first PA educational program at Duke University, with four former Navy medical corpsmen representing its inaugural class. In 1967, the first PA graduates from the Duke University PA Program begin practicing. The same year, the first program to train surgical PAs was established at the University of Alabama, Birmingham.

Training and requirements • ASPS joined the Alabama Society of Plastic and Reconstructive Surgeons in opposing legislation that would have significantly expanded the scope of practice for optometrists. The bill was postponed to next year’s session. • ASPS worked with the Mountain West Society of Plastic Surgeons to oppose legislation in Colorado that would create a new government-appointed board to set price controls through an “upper payment limit” on prescription drug reimbursements. The legislation allows the board to create new regulations at will, with no apparent parameters. • The Society collaborated with the Louisiana Society of Plastic Surgeons to oppose a bill that would have allowed for full independent practice by NPs and also created an Independent Practice Authority Board. The bill failed to pass. • Alongside the Southeastern Society of Plastic Surgeons, ASPS shared opposition to Missouri legislation that would have criminalized any gender-affirming care for minors. The bill failed to become law. • In Nevada, ASPS and the Mountain West Society of Plastic Surgeons commented on a bill that would have given the state’s Board of Cosmetology complete authority to promulgate any rules it deemed relevant to esthetician scope of practice. The bill was then amended in its entirety and focused entirely on licensing instead of scope.

The PA educational curriculum is modeled on medical school curriculum, involving both didactic and clinical education training. In the didactic phase, students complete courses in

Overview of PA expansion efforts Efforts to expand PA scope of practice are not new, and this most recent action by AAPA is simply the latest in its attempts to achieve autonomy for PAs. These efforts accelerated in 2017 through AAPA’s Optimal Team Practice model, which advocates for the total elimination of any legal or regulatory requirement that PAs must maintain a relationship with a physician. In recent years – and in no small part because of the AAPA’s coordinated and strategic effort – an alarming trend has emerged in statehouses throughout the country in which legislation has been introduced, significantly reducing the supervision requirements for PAs, allowing them to work more independently and to directly deliver healthcare services. As a result of these bills, some states transitioned from care models in which PAs were supervised by physicians to systems in which they can now “collaborate” with doctors. Other states reduced, or in some cases eliminated, requirements pertaining to chart review and supervision. Some legislative efforts went as far as eliminating the requirement that a supervising physician be physically co-located with the PA. Throughout the 2021 legislative season, ASPS has been actively working with state and regional partners to oppose harmful PA scope expansion legislation. The Society opposed an Indiana bill that would permit independent practice by PAs in any licensed healthcare facility that has a credentialing process – a move that ASPS warned “represents a dangerous expansion of Continued on page 32

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 May and June help play a key part in the specialty’s success on Capitol Hill. California Debra Johnson, MDI Douglas Sunde, MD Winnie Tong, MD Florida William Carter, MD L Andrew Rosenthal, MD

Michigan H Mariam Awada, MD Missouri Justin Sacks, MD, MBAu New Jersey Nikita Shulzhenko, MD

Kansas W. Thomas Lawrence, MD

New York H Keith Blechman, MD u Robert Grant, MD Alan Matarasso, MDI H Malcolm Roth, MD Benjamin Schultz, MDn Paul Weiss, MDu Ohio R. Michael Johnson, MDI

South Carolina Carlos Martinez, MDn Texas C. Bob Basu, MD, MBA, MPHI Warren Ellsworth IV, MDu West Virginia Mihail Climov, MDn

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

July/August 2021

SOCIAL MEDIA FOCUS

Social media in 2021: Opportunities on newer platforms? By Josef Hadeed, MD

t’s now widely accepted that most businesses – including plastic surgery practices – should have a presence on social media. Prospective patients are increasingly turning to social media over other traditional forms of advertising when searching for a plastic surgeon. Still, posting on social media can be overwhelming for the practice and/or practitioner – a conundrum compounded by the arrival of newer platforms. Although businesses typically post content on the older, more established platforms, newer platforms can provide alternative options for plastic surgeons to promote their practices. However, the mere existence of a platform doesn’t guarantee that posting content to that site will provide a return on investment. All of which begs the question: Is it worthwhile for plastic surgeons to pay attention to these newer platforms?

TikTok TikTok exploded in popularity over the past year, becoming one of the world’s fastest-growing apps that allows users to create and share video content. At the time of this writing, the hashtag #plasticsurgery has 7.3 billion views on TikTok. Other platforms allow editing and sharing videos, but TikTok allows users to view content from accounts relevant to them without having to go through the time-consuming process of finding them. Regardless of whether you post procedural videos, patient testimonials or educational content, there’s a good chance that your marketing will have some value. However, you must consider your target audience. Almost two-thirds of TikTok users fall between age 10-29. Posting content about facelifts – not matter how educational – might not attract

much attention from the typical user, whereas content related to breast augmentation could garner more interest. Also, in contrast to most other social media platforms, the majority of TikTok users reside outside the United States. So while it may be easy to grow your following based on the content you publish, that may not necessarily translate into prospective patients calling your office to schedule an appointment.

Clubhouse Clubhouse has enjoyed steady gains in influence and popularity since it was first launched last year. This platform allows users to share audio clips with one another in virtual rooms. When a user enters a room, the audio is turned on and interested users can join the discussion if the moderator allows them to participate. This format allows you to connect with other colleagues within plastic surgery, as well as others outside the specialty. The audio format makes Clubhouse feel like an interactive podcast, so there’s an opportunity to create a more personal feel on the platform. One of the current drawbacks of Clubhouse is that it’s currently invite-only. Another user must invite you to enable access to the virtual rooms. If you’re accepted, you will have instantaneous access to all other users – including some of the most prominent business leaders and entrepreneurs in the world. Although Clubhouse is currently business-centric, there could be an opportunity for plastic surgeons to reach out and interact directly with consumers. There might also be opportunities to educate the public about plastic surgery and to engage in patient-safety initiatives. Another potential pitfall of the platform is that the moderator of the room must monitor what the participants are saying – since the content is completely audio-based, there could be the possibility of creating liability.

Parler

Launched in 2020, Parler is touted as an alternative to Twitter. Although the design and interface may be similar to Twitter, the functionality differs. For instance, Twitter posts are limited to 280 characters, but Parler allows up to 1,000 characters. Having the flexibility to say more is nice; sometimes it’s best to get your point across with fewer words. Parler is also a hashtag-centric platform because its algorithm only searches for hashtags and usernames. This can make specific searches easier, but bear in mind that you also must tag content appropriately and hope that users are searching for that content using a variety of hashtags.

Telegram The COVID-19 pandemic provided plenty of runway for Telegram to take off. With more than 500 million active users, Telegram at the time of this writing ranked 11th among the most used social media platform worldwide, with more than 70 billion messages shared daily. Unlike WhatsApp, which limits the size of its groups to 200, there are no limits on Telegram groups. Thus, when you send a message on Telegram, it can significantly increase the reach of your brand. Telegram marketing operates within groups, so consumers feel like they’re part of a broader community with similar interests. Marketing can be more impactful because customers feel like they are being communicated with directly.

pandemic and the United States election. It has recently attracted the attention of many content creators due to the flexibility that the platform offers, as well as the fewer restrictions on what can be posted to the site. Like YouTube, viewers can vote on videos and leave comments. There’s also the option to livestream content. Unlike YouTube, which often boosts content that has high engagement – thus giving popular creators an advantage – Rumble levels the playing field and displays videos in chronological order rather than recommending content.

Takeaway For now, social media marketing is dominated by the traditional platforms of Facebook, Twitter, Instagram and YouTube. Familiarity with these platforms, along with the levels of engagement they provide, likely means they aren’t going to be overtaken anytime soon. Other platforms, such as Snapchat, seem to have fizzled-out almost as quickly as they were introduced. Although alternatives to the conventional platforms exist, one needs to be cognizant of how they differ from the networks we’ve become accustomed to, as well as the particular demographic which populates these platforms. The latter is vitally important for effective marketing of your practice – both in what you do, and who you are. It’s important to remember to publish content that’s tasteful and educational, and to keep the messaging of your brand consistent across all platforms. PSN

Rumble Rumble is an online video platform alternative to YouTube. Although it has been around since 2013, it began to expand its user base last year after restrictions were placed by YouTube on content relating to the coronavirus

Dr. Hadeed is chair of the Social Media Subcommittee and is in private practice, splitting his time evenly between Beverly Hills and Miami. You can follow his social media channels via @josefhadeedmd.

Top ASPS social media posts for June 2021

July/August 2021

PRACTICE MANAGEMENT INSIGHT

A life (and practice) lesson: How to play well in the sandbox By Sanjay Daluvoy, MD

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

go. Emotions. Equity. Economics. The world of solo private practices is quickly becoming obsolete across all medical specialities. With increasing financial pressures in private practice and the explosive growth of hospital-employed surgeons, we’re seeing this trend spill over to plastic surgery as well. However, our specialty has two unique features: the ability to run a surgery center and have a substantial (if not entire) proportion of our practice being self-pay. These two important conditions help make it possible to successfully continue private practice, albeit in the group format of two or more physicians. We’ve all heard the horror stories of disaster partnerships that significantly consume both financial and emotional energy. In reality, there are no perfect partnerships. Geography, markets and personalities all vary greatly, which makes finding and creating a perfect partnership an impossible quest. However, there are partnerships and models that do a better job in maintaining harmony, which in turn leads to thriving practices. All partnerships must start with respect. We all want people to respect us, but this can only be attained when you respect others. Understanding yourself is the first step on this journey. As with any meaningful relationship, you need to know your strengths and acknowledge your weaknesses, ensuring that you remain humble. The ability to recognize that we don’t always know the answer and can actually benefit from listening to others’ perspectives improves communication lines. More importantly, however, it creates respect. That mutual respect needs to be protected

and cultivated. You will have moments where your ego or that of your partner(s) could tarnish that respect, so it’s important in those instances to put your ego aside and continue to center yourself and your practice around this important core element.

The cost of compromise Everyone understands the intrinsic benefits of a partnership, such as sharing clinical knowledge and experience, pooling capital, sharing expenses and/or leveraging a bigger team. However, few understand that this comes at the cost of compromise. This doesn’t mean compromising your beliefs or values – there must be a balance. You won’t be the sole decision-maker. Most type-A personalities are strong-minded and believe we alone know the answer to every problem. Such brashness often sparks conflict and breakdown of trust. You must incorporate the ideas and feedback of your partner(s), even if it isn’t exactly what you want to do. Find common ground and don’t always assume the worst. You have to fight the urge of being greedy and self-centered. One scenario may not be

the ideal for your specific practice, but if it works for the group, then you might find that you actually come out ahead in the long run. Managing your emotions is key to a successful practice. This will build trust, the second core element of a healthy practice. If there’s mutual respect and trust, partnerships can overcome most obstacles and challenges. Without those core elements, failure is just a matter of time – no matter how well the structure is set-up.

Equity and economics Two structural elements that help establish a healthy practice are equity and sound economics. Equity doesn’t necessarily mean everything has to be equally shared, although that possibility shouldn’t be entirely discounted, either. The fundamental principle is to have a very clean and detailed operating agreement. This agreement should clearly define how resources such as staff, space and supplies will be utilized and shared. It should address marketing and patient-care coordination, including patient rotations. Spelling-out these business functions can be tedious and,

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during the good times, almost absurd or silly. However, the more clarity that’s established, the more it will pay dividends during stressful times and when memories get foggy or practices go through their natural ebbs and flows. The key is to create an equitable structure either by shares (percentage ownership) or by utilization. Once this is set, it becomes the mantra or guiding principle for the organization and helps align the shared team members – who can become innocent bystanders in partner conflict. The team can function on a higher level in an environment fueled by positivity rather than fear. Any deviation from this operating system should be handled at the level of a board meeting or with some previously agreed upon third-party mediation (which should be outlined in the operating agreement). This can be a trusted accountant, business advisor or a group attorney who has the overarching practice’s interests in mind rather than loyalty to a specific partner. Finances must also be addressed in the operating agreement. Revenues and expenses need to be examined and allocated accordingly. Often, a partner focuses on how much revenue he or she brings into a practice without realizing they’re also adding more overhead and expense. Allocation of both revenues and expenses need to pre-determined in the operative agreement. This includes discussing professional fees, O.R. facility fees (if there’s a surgery center) and non-surgical revenues (e.g., ancillaries such as injectables, skin care and non-invasive treatment). One straightforward mechanism is to return all professional fees to the surgeon while allocating all O.R. facility fees and non-surgical revenues to the practice. There should be an upfront discussion about separate companies associated and affiliated with the practice. Some examples include a separate company for the medspa or real estate. If all practice partners are not involved in these other entities, that situation can be ripe for strife. For example, when renewing office-space lease terms, there’s an inherent conflict of interest for the partners who own the building as well. My experience (and common sense) would tell you that they will favor the terms for the building. There’s more potential financial gain on that side for this subset of partners. There are ways to avoid or minimize this type of conflict, such as when a surgeon is up for partner in the practice, they’re also automatically up for partnership in the building and/or these other entities. However, operating agreements might have very different terms and may include a more sizeable buy-in like any other asset. Founding or more senior partners may ask why they should dilute their shares. The reason again centers on the long view. This mechanism can be used for a retiring partner to exit without having to need a liquidation event. The partnerships that have the “secret sauce” for success are the ones where partners respect and trust each other. They have clearly defined operative agreements and/or systems that allocate resources according to an equitable or utilization-based structure. Once partners can create this modus operandi, they can then elevate the entire practice and organization to a new level and focus more energies on patient care. The combined skill sets, experiences and knowledge of the partners will complement each other and exponentially improve their surgical performance and outcomes. At the end of the day, this results in delivering excellence in patient care. This is the ultimate measure of a successful practice. PSN Dr. Daluvoy is a member of the Practice Management Committee and is in private practice in Raleigh, N.C. July/August 2021

PRS Global Open adjusts article processing charges for low-income countries By Paul Snyder

n its continued efforts to disseminate and share the highest-caliber plastic surgery research from around the world, PRS Global Open is removing some of the hurdles that authors from low-income countries face when submitting their research. The open-access journal, with the support of publisher Wolters Kluwer, is taking the step of distributing article-processing-charge waivers for corresponding authors who reside in low-income countries. Under a new structure, low-income countries (as defined by the World Health Organization’s Hinari List) are split into two groups, with article authors who come from Group A now eligible to receive a 100 percent discount on the article processing charges, and those from Group B now eligible to receive a 50 percent discount. Although discounts already existed for authors from these countries – authors in Group A previously received a 50 percent publication discount and those in Group B received a 20 percent discount – PRS Global Open Editor-in-Chief Jeffrey Janis, MD, says he thought the help wasn’t quite enough. “I felt we could do better,” he says. “It’s short-sighted to keep barriers for submission high if we’re looking to attract authors. That just potentially robs the world of experiences that could be shared to expand the knowledge base of plastic surgeons around the world.” According to the breakdown, countries, areas and territories that are part of Group A fulfill any of the following criteria: • Part of the United Nations Least Developed Countries List and/or • Total Gross National Income (GNI) is at or less than $500 million

This map from the World Health Organization shows the countries classified into Group A (in blue) and Group B (in orange). • Total GNI is at or less than $5 billion where Gross National Income per capita (GNIpc) is at or less than $10,000 • Total GNI is at or less than $15 billion where GNIpc is at or less than $3,000 • Total GNI is at or less than $200 billion where: • Human Development Indicator (HDI) is at or less than 0.60 and/or • GNIpc is at or less than $1,500 Countries, areas and territories that are part of Group B fulfill any of the following criteria: • GNIpc is at or less than $6,300 where

Healthy Life Expectancy (HALE) is at or less than 55 • Total GNI is at or less than $1.5 billion • Total GNI is at or less than $25 billion where GNIpc is at or less than $10,000 • Total GNI is at or less than $300 billion where: • HDI is at or less than 0.67 and/or • GNIpc is at or less than $6,300 The reduced publication charges, of course, do not guarantee acceptance or publication in PRS Global Open, as the journal will continue to conduct rigorous peer review and edits of all material submitted for publication.

Although other journals engage in debate over what percentage of authors constitute justification for the waivers (say, if the majority of authors come from countries that don’t fall into Group A or B) and whether the journal and publisher will put in the time and effort to discern which authors contributed which pieces of the research, Dr. Janis says if the corresponding author is from a low-income country, that’s good enough for him. “Why make this process more difficult?” he asks. “We should welcome research with open arms, not high hurdles. In the end, it’s the readers that benefit the most. The journal serves as a medical megaphone for plastic surgeons throughout the world. This is what open access is all about.” PSN

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July/August 2021

A whale tale

A summer ‘break’ abroad forges love of work – and adventure By Jim Leonardo

The Daniel en route to the fishing grounds.

nglers are notorious for spinning tales about their catches, but few will ever top the true big-fish story of ASPS Life Member and ASMS past President Andy Wexler, MD, Pacific Palisades, Calif., who spent the summer of 1972 with five Dartmouth ski teammates on a commercial fishing boat north of the Arctic Circle in Greenland. For three months, Dr. Wexler removed himself from civilization and disconnected from communication with home in an environment where you ate what you killed or caught; where you could be summoned to the icy waters literally at any hour (the midnight sun at the top of the world allows for such work hours); and where he and his friends were once deposited in the remote Greenland tundra where they had to hunt to keep food in their bellies. The excursion culminated in a grueling encounter with a 40-ton humpback whale in the Davis Strait. “It was a summer ‘break’ consisting of brutal, physical labor,” Dr Wexler recalls. “Three of us were Outward Bound instructors and all were very accomplished woodsmen, but every day we felt seriously challenged.”

Crewing with a classmate

Dr. Wexler, wearing his Phillips Academy Andover prep school letter sweater, stands at the bow of the Daniel.

The adventure was set into motion when Lars, a Dartmouth teammate and Greenland native, asked if Dr. Wexler and four other teammates on the Dartmouth ski team would work as crew that summer on one of two fishing boats owned and operated by Lars’ father. Days later, the young

men boarded a flight to Copenhagen, and then to U.S.-controlled Sondstrom Air Base in Sonder Strong Ford, Greenland. “The villages in Greenland are isolated, and there’s no good way to get to them,” Dr. Wexler says. “Travel on the islands – where many villages sit – in the winter is done through dog sled or snowmobile; when the ice breaks up in the summer, it’s by boat. A third method is by helicopter, which we did, but we had to camp on the tundra for three days before the weather allowed it to fly.” The chopper flew Lars and his American teammates through the fjords to a village named Sukkertoppen but known to locals as Maniitsoq – “the Hard Place” – on the coast of the Davis Strait, a small parcel of livable island inhabited by about 2,000 people in little cottages built upon rock and snow, along with a few government buildings and a nearby fish factory. Dr. Wexler and his friends were taken to a small cottage, where they would live while working on the Daniel, a wooden, 44-foot fishing boat. “The non-Greenlandic population included a Danish schoolteacher, doctor and a few merchants, but the locals had never seen Americans before,” he recalls. “They were extremely lovely, friendly and open to us – in spite of the language barrier. The local language is Danish, but on the boat they spoke the native Greenlandic language of Kalaalisut. In order to communicate on the boat, we had to go from English to Danish to Kalaalisut. It would’ve been impossible without Lars translating for us.” Suffice to say, communication is important on a commercial fishing boat, as the profession ranks among the world’s most dangerous. “We were on a small boat rolling in the waves, with fish blood all over the deck that made it quite slippery,” Dr. Wexler tells PSN. “There were winches and net haulers pitching back and forth overhead and sharp knives everywhere. If you went overboard in that water, by the time the boat came around to pick you up, it would be too late. You don’t have much survival time in below-freezing salt water infused with ice. That’s what we worked in for hours. “It’s brutal, dangerous, cold and hard work – all of us were very strong, young guys and serious athletes – and after the first few weeks of this, we thought we were going to die,” he laughs. “We wore long johns and woolens with oil skins over those, and thin, wool gloves with which we pulled-up heavy nets – each one taking a few hours. Then we’d have six to 13 tons of codfish on board, which five guys had to clean by hand.” Once done, the boat returned to shore and the fish were transferred to a Danish processing plant. The Americans were paid a percentage of each catch, which allowed Dr. Wexler to pay for airfare for the trip with about $600 to spare. As the

hours on the job accumulated, so too did the difficulty. “The hours are: You fish when it’s time to fish,” he says. “Because we were in the Arctic Circle, the sun was up for 24 hours, and with daylight all the time, we’d work 16-20 hours straight. Between nets, we’d crash in the bunk room below the deck in the bow of the boat. We’d catch sleep when we could, eat when we could and work when the captain said it’s time to fish. “It’s a very hard life; if you want breakfast, you catch it,” Dr. Wexler adds. “You survive on fish and hardtack, a biscuit made from flour, water and salt. We’d be out on the water sometimes 48 hours at a time. When we had a break, we’d take advantage of social events in the village. But when the captain called you back – whatever time of day or night – you report to the boat and work.”

The hard road to acceptance Quick to learn and adapt to the lifestyle, Dr. Wexler and his friends eventually earned the respect of the locals, he says. “I got pretty good at cleaning fish,” he notes. “I could clean a 40-pound cod in under 10 seconds and with three knife strokes. Salmon could take a little longer.” It was one particular incident, however, that cemented the reputation of the college students as hard, capable workers. A Greenlander who was exiled from the community once chewed out the boat’s captain for putting foreigners on his boat. “He lived alone for years by the side of an isolated fjord in a single room, old-style Greenlandic house made of tundra sod,” Dr. Wexler says of the angry resident, known as Ole, who had actually been found guilty of murder years earlier. The legal code at that time only allowed for a forced relocation to remote Greenland instead of jail. “He survived by hunting and fishing, and through the good will of the community – people would leave him necessities such as bullets and oil for his lamps, allowing him to maintain his lonely existence,” Dr. Wexler explains. “One day, our boat was fishing in his fjord, so we stopped to deliver supplies. He looked ancient – though I’m sure he was much younger than he looked – and was tough as reindeer sinew. After seeing us, he began to berate the captain in the native language. Lars told us later that Ole reprimanded him for having foreigners crew his boat instead of Greenlanders. But by that time, we’d been there a month and had gotten up-to-speed. The captain told Ole: ‘They eat and drink like us, they sleep like us, they laugh like us and they work hard. They are just like us.’ At that moment, we felt like we had become Greenlandic fishermen.” That approval spilled into the local scene. “We were initially accepted solely be-

July/August 2021

cause we were the guests of a prominent fisherman, but then they saw we were like them in many ways,” Dr. Wexler says. “They invited us to everything; the Greenlandic Innuit culture is very hospitable, due to its roots in survival culture. Everyone’s dependent upon helping one another to survive in such a harsh environment.” The children in particular found the American travelers fascinating. “We were such oddities that we became like the ‘Pied Piper’ – hordes of children would follow us all day and crowd around our cottage windows, watching us constantly,” Dr. Wexler remembers. “We were given local names, as well. One American became ‘the bearded one’ or ‘muskox,’ and for some reason I was ‘Ajortaussuak,’ which translates to ‘the big, bad one” – I think because I have a good sense of humor and fooled around a lot.”

A surprising ‘score’ As integrated as Dr. Wexler and his friends became, no one expected that the Americans would help bring home one of the biggest scores of the summer: a whale. “This was a big deal, bringing in a 45-foot humpback,” Dr. Wexler says. “Whales feed the village for a long time through the skin, meat and blubber they provide – they smoke it and then put into the permafrost to keep. “That day, we had two boats out: the Daniel, and a second boat that had two harpoons aboard that were shot from a cannon,” he adds. “The Daniel had a crow’s nest about 40 feet above the deck, and one of the crewmen saw the whale from there. The second boat took over with its harpoons and got a hit – I saw the harpoons later, and although they were thick iron, they were twisted like pretzels from the impact.” Dr. Wexler remembers the process of bringing down a 45-foot whale as “brutal” and says he felt terrible about it. “It’s not a quick process; they drag the boat and sometimes they dive,” he notes. “These are highly intelligent animals. On the other hand, it was going to feed an entire village for an extended period, so I understand that need. However, I’m not at all a supporter of commercial whaling; they should be protected from that.” Both sighting and scoring hits on whales are extremely difficult, but the real work begins after towing it to shore. “A 45-foot whale weighs about 40 tons, so we cut 35 tons of meat and blubber from this animal,” he recalls. “I was inside the whale – and literally treading intestines to keep from drowning in the peritoneal cavity. “We were processing the whale for three straight days and nights; we used large knives to make the cuts and big hooks to pull off blanket pieces of the external blubber and skin,” Dr. Wexler

July/August 2021

says. “We cut huge chunks of the red meat, which is below the blubber layer, and on this little island we piled 7-foot stacks of meat with huge slabs of blubber and skin. When we got hungry, we took hunks of the skin and chewed that; the belly skin, which is several inches thick, is a delicacy. We ate it raw with a sliver of white blubber. It has the consistency of inner tube, but it was tasty. The women also boiled a lot of meat in big pots so we could eat while we worked.” Word of this unprecedented catch spread quickly. “That summer, three large whales were taken on the west coast of Greenland – one of which was ours,” he says. “When we traveled up the coast afterward people would say: ‘Oh, you caught a whale this summer.’ It’s a small community, so everyone knew what was going on. Smaller whales weren’t that rare; humpback whales are much larger, infrequently seen and more difficult to catch. Add the fact that five American guys were on the crew, and it became a real rarity.”

Dr. Wexler, (above) on the lookout for reindeer on the tundra while his classmates rest; and (below) taking a break from processing a whale onshore. “We were processing the whale for three straight days and nights,” he recalls.

Growing up quickly There were plenty of challenges awaiting these five Americans, but none involved “roughing it” more than the 10 days spent in the rain on a thin tundra far from the village and situated between the ocean and the ice cap. Each year, Lars or his father would spend time on the tundra in order to bring back meat that would help the family through the coming winter. That summer, the task fell to the Dartmouth teammates. “When the boat dropped us off, all we had was a kayak, two rifles, our oil skins, a few fish nets, a leaky tent – and no food,” Dr. Wexler notes. “In the beginning, all we ate was fish. After five days in the freezing rain, we bagged a reindeer. Once we found the herd, we crawled on our belly for two hours to get in range because they’d easily see someone standing. Then one guy flushed them to the rifle side and that was it. “We carried this reindeer, which weighed several hundred pounds, for five hours back to camp, where we built a smoker and hung that meat and several pounds of fish we’d caught,” he adds. “After 10 days, we packed it all up – and the family had some winter meat supplies.” The work in Greenland was the most demanding ever required of Dr. Wexler, but it prepared him for plastic surgery – and the rest of life. “I arrived as a 19-year-old entirely cutoff from his parents by thousands of miles and no communication system except the mail,” he says. “It very much led me to develop my own self-sufficiency – because we were responsible for our own safety, lives and livelihood. The ability to face great challenges and overcome them – even though I was exhausted – just added to my self-confidence. My subsistence

was entirely within my own hands as I faced challenges of culture, work and the persistent cold, discomfort and physical exhaustion that I had to conquer daily.” Though that kind of experience is not required for a career in plastic surgery, Dr. Wexler says the fortitude gained from his time in the Arctic Circle prepared him for plastic surgery residency. “Doing gross anatomy on a whale and working those types of hours with that hard, physical work set me up to be a surgeon in many ways,” he says. “It taught me a lot of discipline and how to endure a lot, and it gave me additional mental strength. I also gained 10 pounds of muscle, because it was a full-protein diet on top of a ‘weight workout,’ all day, every day.” It also forged his still-thriving adventurous spirit. “I’ve been to about 60 countries and worked in roughly 20 of them in plastic surgery,” Dr. Wexler says. “I’ve climbed mountains all over the world, including Kilimanjaro, I’ve hiked the jungles of Borneo after traveling up-river by dugout canoe, I’ve floated the Amazon in a canoe and I’ve completed the Annapurna (Nepal) base camp trek. I’ve been in some of the world’s most remote areas, but Greenland was the beginning of my true love of doing that. “While working on the boat in a highly dangerous occupation, the decisions I made could literally be the difference between life and death,” he adds. “For the first time in my life, I was totally independent and free.” PSN

1 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.

July/August 2021

Trust. Evidence. Experience. It’s what AlloDerm RTM is made of. ™

No other ADM has been trusted with more than 2.5 million implantations.2 No other ADM has more publications, with hundreds of scientific* and clinical articles.3 And no other ADM has the extensive experience of AlloDerm™ RTM, 25 years and counting.1 *Correlation of these results, based on animal studies, to results in humans has not been established.

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

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

To learn more, visit 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. Wainwright DJ. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns. 1995;21(4):243-248. 2. Data on file, Allergan. 2018. 2021 Sales July/August Data. 3. Data on file, Allergan. PubMed search performed in June 2020.

The PSF Pilot Research Grant

Equipping patients to produce their own therapeutic agents The highly translational approach to scientific inquiry put forth by The PSF past President Paul Cederna, MD, is one that also has impacted my strategy. I’ve had several conversations with Jay Agarwal, MD, to consider the problem of unmet needs in patients who require biologic therapies. I’ve also been able to incorporate interesting findings from Jay Austen, MD, and Raphael Lee, MD, ScD, to advance this technology. In the basic science world, Vicki Rosen, PhD, at Harvard School of Dental Medicine; Xiaoyang Wu, PhD, at the University of Chicago; and Yuji Mishina, PhD, at the University of Michigan; are all supportive collaborators and mentors.

By Jim Leonardo

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

THE RESEARCHER

FOCUS ON PLASTIC SURGERY RESEARCH

Shailesh Agarwal, MD Title: Assistant Professor of Surgery, Harvard Medical School and Associate Surgeon, Brigham and Women’s Hospital, Boston Award: The PSF Pilot Research Grant Project: Production of Autologous Adipose Bioreactors Through Ex Vivo Gene Editing PSN: Why have you targeted autologous adipose bioreactors and ex vivo gene editing in your research? Dr. Agarwal: I’m interested in addressing the shortcomings of current biologic therapies that require substantial amounts of manufacturing and processing infrastructure. I want to bring this into the body so that patients’ bodies are equipped with the means to produce their own therapeutic agents as required. PSN: What have you learned thus far? Dr. Agarwal: Our work has been progressing well. We’ve identified diseases or conditions that would serve to benefit from this technology, as well as candidate therapeutic agents for endogenous expression. Along the way, we’ve learned about the limitations of synthesis, expression and therapeutic secretion, and about the challenges of regulated expression. We’re also looking at strategies to provide therapeutic expression through either endogenous or exogenous regulatory mechanisms. PSN: What do you see as this project’s practical applicability? Dr. Agarwal: This research has significant

Clockwise from top: Dr. Agarwal in the lab with Mengfan Wu (left) and Ziyu Chen; with his daughter, Zoya, and wife, Mehnaz, enjoying the ocean breeze on the shore of Cape Cod, Mass.; and posing for a selfie with Mehnaz, during a helicopter ride. implications for our management of diseases that can be treated with biologic agents. I see this as having immediate applications for patients with severe local pathology, as well as chronic systemic pathology for which current therapeutic strategies are cumbersome or impractical. PSN: Has anything unexpected surfaced? Dr. Agarwal: We’ve identified strategies to improve expression levels based on the research of other individuals in plastic surgery. It’s really amazing to see how we can bring in unrelated research in unforeseen ways to this technology and further strengthen our approach. PSN: What might be behind this change? Dr. Agarwal: We have some ideas, but these are speculation at this time. We’re pursuing

avenues to understand how to improve gene delivery and intracellular expression/secretion mechanisms. PSN: Who are your mentors and key collaborators on this project? Dr. Agarwal: At this stage, I’ve had mentors who’ve helped set me up to develop this idea into a scientifically valid approach. In the plastic surgery world, Ben Levi, MD, has been my longstanding mentor who has encouraged me to develop my hypotheses so they can be scientifically examined. Indranil Sinha, MD, has been a very supportive mentor and colleague at Brigham and Women’s Hospital, and we enjoy talking about science. Dennis Orgill, MD, PhD, is a mentor who provides a pragmatic perspective to balancing science and clinical requirements.

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:

PSN: What did you want to be when you were growing up? Dr. Agarwal: When I was in middle and high school, I wanted to be a scientist, because I would read the headlines about discoveries. Time in the lab matured my interest and understanding of the hard work required to build a lab, and the commitment required even when things aren’t moving in the expected direction. PSN: What has been your favorite science project – with the exception of The PSF research? Dr. Agarwal: During my senior year of high school, I was the captain of the Science Olympiad team – a series of 18 events with about 15 people on the team, each assigned to different events. It was my responsibility to work with the other team members to find out what each person’s strengths were so that we could optimize our outcome and keep people feeling proud of the events they were assigned. Our team finished second in the state and advanced to the National competition – the first time our school did that in 16 years. PSN: How do you spend your time away from the lab? Dr. Agarwal: I spend my time with my wife, Mehnaz, and 3-year-old daughter, Zoya. This is our first summer in Boston with COVID-19 restrictions gradually lifted, and our daughter is enjoying the park, restaurants and even traveling. We’ve resumed vacationing and are looking forward to our next trip to Cape Cod this summer. My wife and I enjoy running and hiking together, or just catching our breath and watching something together on TV. PSN: What kind of sounds can most often be heard in your O.R.? Dr. Agarwal: On Spotify, it’s “Chill Tracks” or “Night Rider” playlists – which are progressive house and electronic music. I have a separate playlist of “guitar rock” that includes a range of artists including Jimi Hendrix, Eric Clapton, The White Stripes and The Black Keys. If choosing a single artist, I often play Odesza. 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 July/August 2021

Live from Atlanta...

There’s plenty to look forward to – not least of all a return to in-person events – at Plastic Surgery The Meeting 2021 in Atlanta. By Kendra Y. Mims-Applewhite

July/August July/August 2021 2021

fter successfully navigating the uncharted territory posed by 2020 and the COVID-19 pandemic with the first-ever virtual Plastic Surgery The Meeting – which broke new ground in education and engagement with innovative virtual courses, networking events and social activities – ASPS is pleased to announce a return to the in-person format in October. Plastic Surgery The Meeting, the premier educational and networking event in plastic surgery, will take place Oct. 29-Nov. 1 in Atlanta, providing plastic surgeons with an innovative, one-of-a-kind, unparalleled experience with exceptional educational programming, social events, family fun, wellness activities, virtual events and much more. “After having most of the world on travel restrictions for over a year, we look forward to an exciting meeting in Atlanta,” says Annual Meeting Council Chair Dennis P. Orgill, MD, PhD. “We have a comprehensive and diverse program which will provide a robust educational venue. If you aren’t able to attend, the sessions will also be available virtually. There are many on-demand sessions that will be available during and after the meeting. I look forward to seeing everyone in Atlanta.”

The 90th ASPS/PSF/ASMS/TRS Annual Scientific Meeting will take place at the Georgia World Congress Center. Plastic Surgery The Meeting has provided generations of plastic surgeons the education needed to grow all aspects of their surgical career and practice. With this year’s program of more than 250 educational offerings – and up to 11 live concurrent sessions onsite – attendees will be able create a custom-tailored learning experience and immerse themselves in new live and on-demand content that covers all aspects of the specialty. On-demand sessions can be viewed by virtual and in-person attendees any time between Oct. 9-Nov. 30. This year’s tracks include aesthetic; reconstructive; ASMS education and events; breast; practice management; craniomaxillofacial; and hand and upper extremities. Attendees can expect the return of popular programs, including the ASPS Presidents Panel, The PSF Presidents Panel, Patients of Courage: Triumph Over Adversity Awards, Maliniac Lecture, Trustees Talk, Rhinoplasty Symposium and the Migraine Surgery Symposium. In addition, all registrants will have access to the virtual platform and can attend Plastic Surgery The Meeting virtually this year. Virtual offerings include more than 20 hours of live stream education sessions, more than 70

hours of on-demand programming and access to more than 900 abstracts. “The hybrid program will feature comprehensive panels and courses from our five clinical tracks along with innovative special programming highlighting the future of plastic surgery,” says Annual Meeting Council Co-Chair Liza Wu, MD, MBA. “We will honor and celebrate diversity within our ranks while focusing on equity and inclusion as we move forward in the post-COVID era.”

Social experiences Emerging from more than a year’s worth social isolation and quarantine, plastic surgeons can look forward to attending networking events and catching up with peers during their time in Atlanta. From cocktail receptions to lounges and Connect Zones in the Exhibit Hall, this year’s meeting offers numerous, face-to-face social events where attendees can comfortably connect, interact and share their experiences and lessons learned during an unprecedented time in history. Attendees are invited to celebrate inno-

Safety first Plastic Surgery The Meeting 2021 is designed with attendees’ safety in mind. ASPS is actively monitoring developments surrounding COVID-19, as the health and safety of our members, families and staff is our top priority. The Society is fully engaged with local, state and national officials to implement procedures to safeguard everyone as we welcome members back to an in-person meeting. Please see the Centers for Disease Control and Prevention’s travel recommendations during COVID at cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html. At the time of this writing, a national Executive Order requires people to wear face masks while using public transportation throughout the United States. This includes airports, airplanes, trains, subways, buses, taxis and rideshare services. Masks are mandatory at all times inside Hartsfield-Jackson Atlanta International Airport. The City of Atlanta requires masks for public buildings owned or leased by the city. Private businesses may mandate mask requirements at their discretion. The Georgia World Congress Center does not require masks to be worn – but ASPS will make masks available for anyone who wishes to wear one. We do ask that anyone not vaccinated wear a mask. ASPS will also make available hand sanitation stations throughout the Georgia World Congress Center.

vations in the specialty and a historic year with their colleagues and friends on Oct. 29 for Opening Ceremonies, which will feature the longtime favorite Patients of Courage: Triumph Over Adversity Awards program to honor three inspiring reconstructive patients, as well as the Presidential Address, Special Achievement awards, the inaugural Noordhoff Humanitarian Award and more. The Welcome Reception immediately follows Opening Ceremonies. The Masquerade Gala on Oct. 30 will include food, beverage and live entertainment – including the return of the ASPS Jam Band in person, which features domestic and international members. International attendees and The PSF donors will receive a complimentary ticket with their registration, but anyone can register to attend the black-tie event (although masquerade masks are not required, they are highly encouraged). Several receptions and alumni events are slated to take place on Oct. 30-31, including the YPS Reception, WPS Reception, President’s Reception and more.

Something for all Attendees will also have the chance to explore all that Atlanta has to offer, including the Martin Luther King Jr., National Historic Site; National Center for Civil and Human Rights; High Museum of Art; World of Coca-Cola; and College Football Hall of Fame. Family-fun activities can also be found at the Georgia Aquarium, Zoo Atlanta, the Porsche Experience Center or Legoland Discovery Center. In addition to health-and-safety precautions in place at the time of writing (see sidebar), Atlanta will have safety protocols in place throughout the meeting. Atlanta Ambassadors enhance the public safety environment downtown by adding additional patrols on the streets and in common areas throughout Downtown Improvement District’s 220 blocks. In addition to ambassadors on the streets, there will be ambassadors

monitoring downtown surveillance cameras as well as the police department’s monitoring station. During large-scale special events and demonstrations, ambassadors communicate with public safety officials directly from the Joint Operations Command Center. Surgeons traveling to the meeting with children are encouraged to take advantage of the popular ASPS Kids Zone while they attend sessions and programs. On-site childcare is available to all children of registered attendees, spouses or guests ages 6 months through 12 years for a nominal fee. The advanced registration deadline is Oct. 1.

Collaboration ASPS and The Migraine Surgery Society will host the Migraine Surgery Symposium on Oct. 16 and dive into the science, anatomy and surgical treatment of the trigger sites. The virtual program features addresses from renowned surgeons and dynamic panel discussions. Attendees can join the symposium from the comfort of their home or office. Educational sessions include “Medication Overuse Headaches and Patient Selection for Surgery;” “Variations in Nerve Anatomy;” “Post-Operative Medication Management;” “Secondary Surgeries: How to Deal with Surgical Failure;” and “Migraine Surgical Video.” ASPS will also team up with The Rhinoplasty Society to present this year’s Rhinoplasty Symposium, “Precision Meets Preservation: Rhinoplasty and Beyond!” The live, half-day program takes place Oct. 28, allowing attendees to take a deep dive into rhinoplasty education. Experts will discuss a hybrid approach to rhinoplasty and lead discussions on optimizing patient outcome results, avoiding pitfalls, best practices and preventing complications. This popular, in-person event will also feature panel discussions on challenging primary rhinoplasty cases and lessons learned.

Exhibit Hall This year’s meeting will feature nearly 200 exhibiting companies to showcase new and more efficient products and services from more July/August 2021

I’m excited about reconnecting with colleagues in Atlanta. We have a plethora of exciting events, keynote speakers and educational programs to enhance our attendees’ overall conference experience and bring the meeting to a new level. – ASPS President Joseph Losee, MD

than 50 categories, all designed to help plastic surgeons enhance their brand and elevate their practice to the next level. Members can search for exhibiting companies that are part of the Society’s new Vendor Connect program from their mobile device and access their profiles to connect and chat with a representative. In addition to hundreds of exhibitors, attendees should schedule time to visit key areas of the Exhibit Hall to enhance their conference experience – such as the ASPS Resource Center, First-Time Exhibitors Pavilion, Industry Spotlight at Center Stage, Poster Viewing Area, Plastic Surgeon Connect Booth, PRS View Video Studio, Recharge and Connect Lounge and the Residents Bowl Arena. Trick-or-treating is also slated to take place in the Exhibit Hall from 4-6 p.m. Oct. 30.

Support The PSF There are several ways to support The PSF and Breast Reconstruction Awareness USA at this year’s meeting. The “Close the Loop” 5K will be held at the Centennial Olympic Park in Atlanta at 7:30 a.m. Oct. 31. (Halloween costumes are encouraged on race day). You can also register to run or walk the race virtually and participate anytime between now and Oct. 31. The Virtual Close the Loop 5K in 2020 concluded with more than 320 participants and 30 teams that raised more than $100,000 for Breast Reconstruction Awareness. Encourage your family and friends to join your fundraising efforts and support The PSF’s mission to raise awareness. Every registrant will receive a race packet that includes a T-shirt, button and an “I Participated” medal. Funds generated from the Close the Loop 5K will be awarded to organizations through the Breast Reconstruction Awareness Campaign, and provide educational opportunities and financial assistance to organizations that support uninsured or under-insured women who choose to have breast reconstruction following a lumpectomy or mastectomy due to breast cancer. The Close the Loop 5K will conclude at 9:30 a.m. Oct. 31 (virJuly/August 2021

tual participants should upload their time before 9:30 a.m. EST on race day). Recognition for all winners will be made at Closing Ceremonies. To register for the Close the Loop 5K or donate to the Breast Reconstruction Awareness Campaign as a virtual participant, visit p2p.onecause.com/bra5k/home. Members are also invited to participate in The PSF Silent Auction, a virtual fundraising event. The 50-plus featured items – donated by exhibitors, corporate sponsors and local businesses in support of the Foundation – include surgery-recovery care packages, medical supplies, sports memorabilia, vacations and other fun items. Participants can bid online between Oct. 25 and Nov. 1, until the auction concludes at midnight. All funds generated from the auction will be donated to The PSF. To browse items or donate auction items, visit one.bidpal.net/psfauctionpstm21/donate-item.

• Netherlands • New Zealand • Norway • Pakistan • Philippines • Romania • Singapore • South Africa • South Korea • Spain • Switzerland • Taiwan • Thailand • Turkey • United Kingdom • Venezuela All members/presenters of ASPS Global Partners are eligible to register at the member rate and will receive formal recognition during Opening Ceremonies.

International presence

Hot topics and focused sessions

The Society is pleased to welcome all ASPS Global Partners as Guest Nation Partners to Plastic Surgery The Meeting 2021. This year features the largest slate of Guest Nations in the meeting’s history. The expanded Guest Nation program will recognize and honor the following Global Partners:

Plastic surgeons can explore the hottest issues impacting the specialty and join the virtual Hot Topics discussions surrounding the latest cutting-edge research, social media best practices and applied technology on Oct. 18-19. The add-on fee to attend this year’s Hot Topics program is only $25 (a $125 savings from previous meetings). Expert-led panels will explore the following topics:

• Argentina • Australia • Belgium • Brazil • Chile • Colombia • Cyprus • Dominican Republic • Egypt • France • Germany • India • Indonesia • Ireland • Israel • Italy • Japan • Mexico

• Injectables and fillers (panels to include exosomes, facial fillers) • Reconstruction: Fat grafting/breast (panels to include mesh, breast implants, nerve) • Energy devices for fat, skin and muscle (panels to include energy/skin tightening, cellulite, MMS) • Ultrasound imaging updates • Practice management and social media (panels to include social media; “cool” new technology)

minimally invasive facial procedures and more ASPS continues to lead the conversation on breast implant safety and equip plastic surgeons with information and resources on the current science surrounding BIA-ALCL and breast implant illness. This year’s meeting includes 30 breast tracks that will cover all aspects of cosmetic and reconstructive breast surgery, including talks on surgical techniques, managing infected implants and an ultrasound in surgery and the breast simulation lab. Keynote speakers for this year’s meeting include HHS Assistant Secretary for Health Rachel Levine, MD, (see exclusive interview on page 8) and The Permanente Medical Group President and CEO Robert Pearl, MD. The ASPS President’s Panel, “Our Role in the Future of Breast Surgery: Do We Have One?” on Oct. 30, will feature panelists Jeffrey Janis, MD; Linda Phillips, MD; Keith Brandt, MD; Michael Neumeister, MD; and Dr. Wu, who will discuss scope-of-practice challenges and concerns about oncoplastic surgeons performing plastic surgery breast procedures. “We’re going to talk about the history of oncoplastic surgery and address breast surgeons in America being trained in plastic surgery, and the American Society of Breast Surgeons certifying oncoplastic surgeons and requiring plastic surgery operations,” ASPS President Joseph Losee, MD, explains. “We’re also going to discuss whether or not plastic surgery legitimately expands our scope of practice into breast surgery through education. “This panel is just one of the many informative and timely topics we will cover at Plastic Surgery The Meeting,” he adds. “I’m excited about reconnecting with colleagues in Atlanta. We have a plethora of exciting events, keynote speakers and educational programs to enhance our attendees’ overall conference experience and bring the meeting to a new level.” Sponsors for Plastic Surgery The Meeting 2021 include Allergan Aesthetics, an AbbVie company; Mentor Worldwide LLC; 3M Health Care; and MTF Biologics. Registration is now open, and the early-bird rate is available until Aug. 20. Visit plasticsurgerythemeeting.com for more information on this year’s events. PSN

• Others: Anesthesia/pain management;

2022 SLATE OF CANDIDATES

ASPS The ASPS Active Members listed below are nominated to serve as Society or Foundation Officers and Directors, and as Trustees, Judicial Council members, Ethics Committee members and a Conflict of Interest Committee member for the duration of their terms, commencing Nov. 1, 2021. An email was sent on July 1 to all Active and Life Active members informing them of the ASPS and PSF slate of nominees, electronic balloting process and website information. Members will have 30 days to vote on the slate, per Society and Foundation bylaws.

President J. PETER RUBIN, MD, MBA Pittsburgh

Academic Position/Title: UPMC Endowed Professor and Chair, Department of Plastic Surgery, University of Pittsburgh School of Medicine Current ASPS/PSF Board Position: ASPS President-Elect

Surgery Residency; Chairman, Division of Plastic Surgery, Monmouth Medical Degree: Case Western Reserve University Medical Center Years in Practice: 18 Current ASPS/PSF Board Position: ASPS/PSF Board Vice Presi- ABPS Certification: 2004 dent of Health Policy & Advocacy Past ASPS/PSF Board Position: ASPS/PSF Board Vice President of Health Policy & Advocacy Current ASPS/PSF Committee Work: ADM and Surgical Meshes in Breast Surgery Task Force (Chair); Advocacy Summit Planning Committee; Annual Meeting Educational Program Committee; ASPS PRIDE Forum; ASPS/PSF Board of Directors; Code of Ethics Disciplinary Review Task Force (Chair); Development Committee; Executive Committee; Healthcare Delivery Subcommittee; Legislative Advocacy Committee; Maliniac Lecturer Selection Subcommittee; Patient Safety Subcommittee; PlastyPAC Board of Governors Past ASPS/PSF Committee Work: Advocacy Summit Planning Committee; Annual Meeting Educational Program Committee; ASPS/PSF Board of Directors; Council on State Affairs; Development Committee; Executive Committee; Government Affairs Committee; Health Policy Committee; Legislative Advocacy Committee (Past Federal Chair); Maliniac Lecturer Selection Committee; Northeast COVID-19 Task Force; Patient Safety Subcommittee; PlastyPAC Board of Governors; State Affairs Committee; Young Plastic Surgeons Steering Committee State and Regional Society Involvement: New Jersey Society of Plastic Surgeons (Past President); New York State-Regional Society of Plastic Surgeons; Monmouth Society of Plastic Surgeons Affiliations: AMA; ACS; ASE; Association of Program Directors in Surgery; Monmouth Medical Center Foundation (Board of Di rectors); Visiting N urse Association Health Group (Personal Care Board o f Directors); Tigger House Foundation (Board of Directors)

Past ASPS/PSF Committee Work: Accreditation Work Group; Annual Meeting Educational Program Committee; ASPS Clinical Symposia Committee; ASPS EdNet Editorial Subcommittee; ASPS/ASAPS Post Bariatric Surgery Task Force; ASPS/PSF Audit Committee; ASPS/ PSF Board of Directors; ASPS/PSF Nominating Committee; BRA Fund Appropriations and Review Subcommittee; Clinical Registries Committee; Clinical Research Subcommittee; Clinical Trials Network Subcommittee; Coding and Payment Policy Subcommittee; Compensation Committee; Curriculum Development Subcommittee; Development Committee; Emerging Trends Subcommittee; Executive Committee; Fat Grafting Task Force; Finance & Investment Committee; Gluteal Fat Grafting Task Force; GRAFT Steering Committee (Co-Chair); Instructional Course Committee; Legislative Advocacy Committee (Chair); Maliniac Lecturer Selection Subcommittee; Plastic Surgery Practice Solutions Board of Directors; PlastyPAC Board of Governors; Program Committee; PRS Editorial Board; PRS Global Open Editorial Board; PSF Study Section; Regenerative Medicine Oversight Group (Co-Chair); Regenerative Medicine Subcommittee; Regenerative Medicine Task Force; Research Oversight Council; Researcher Education Subcommittee; Resident Curriculum Development Committee; Symposia Committee State and Regional Society Involvement: Robert H. Ivy Pennsylvania Plastic Surgery Society; The Ohio Valley Society of Plastic Surgeons Affiliations: ASA, ACS, AAPS, SUS, AAS, PSRC, ASAPS, ASERF, TERMIS, IFATS, ISPRES (Board of Directors) Medical Degree: Tufts University Years in Practice: 19 ABPS Certification: 2004

President-Elect GREGORY GRECO, DO Red Bank, N.J.

Academic Position/Title: Clinical Assistant Professor of Surgery – Rutgers-Robert Wood Johnson School of Medicine, Drexel University School of Medicine; General Surgery Program Director, Monmouth Medical Center-Rutgers Robert Wood Johnson/Barnabas Health; Associate Program Director, Robert Wood Johnson General

CLYDE ISHII, MD Honolulu

Academic Position/Title: Assistant Clinical Professor of Surgery, John A. Burns School of Medicine; Chief of Plastic Surgery, Shriner’s Hospital For Children Current ASPS/PSF Board Position: None Past ASPS/PSF Board Position: None Current ASPS/PSF Committee Work: None Past ASPS/PSF Committee Work: Emerging Trends Subcommittee; Exhibits Committee State and Regional Society Involvement: ACS, Hawaii Chapter (Past President and Governor) Affiliations: ACS; ASAPS (Past President) Medical Degree: Jefferson Medical College Years in Practice: 34 ABPS Certification: 1987

Medical Degree: University of Medicine and Dentistry of New Jersey Years in Practice: 19 ABPS Certification: 2003

Past ASPS/PSF Board Position: ASPS/PSF Board Vice President of Finance and Treasurer; ASPS/PSF Board Member-at-Large Current ASPS/PSF Committee Work: Accreditation Work Group; ASPS Emerging Trends Subcommittee; ASPS/PSF Board of Directors; BRA Fund Appropriations and Review Subcommittee; Compensation Committee; Executive Committee; Finance & Investment Committee; Gluteal Fat Grafting Task Force; Legislative Advocacy Committee; Maliniac Lecturer Selection Subcommittee; Regenerative Medicine Subcommittee

Trustee

Judicial Council VICTORIA VASTINE, MD Charlottesville, Va.

Trustee JEFFREY JANIS, MD Columbus, Ohio

Academic Position/Title: Professor, Departments of Plastic Surgery, Neurosurgery, Neurology and Surgery, The Ohio State University Wexner Medical Center; Co-Director, Center for Abdominal Core Health, The Ohio State University, Chief of Plastic Surgery, University Hospital Current ASPS/PSF Board Position: None Past ASPS/PSF Board Position: ASPS President; ASPS President-Elect; ASPS Board Vice President of Education Current ASPS/PSF Committee Work: Academic Affairs Council; Annual Meeting Educational Program Committee; Diversity and Inclusion Committee; Internal Education Strategy Advisory Council; Maliniac Lecturer Selection Subcommittee; PRS Global Open Editorial Board (Editor-in-Chief); PRS Global Open Managing Committee (Chair); PRS Managing Committee; PSF Fundraising Subcommittee; Wellness Subcommittee (Co-Chair) Past ASPS/PSF Committee Work: Academic Affairs Council; Annual Meeting Council (Chair); Annual Meeting Educational Program Committee (Chair); ASPS Clinical Symposia Committee; ASPS Emerging Trends Subcommittee; ASPS Practice Management Education Committee; ASPS/PSF Audit Committee; ASPS/PSF Board of Directors; ASPS/PSF Nominating Committee (Co-Chair); BIA-ALCL Subcommittee; BRA Fund Appropriations and Review Subcommittee; Coding and Payment Policy Subcommittee; Compensation Committee; Conflict of Interest Task Force (Chair); Development Committee; Diversity and Inclusion Committee; Education Strategy Advisory Council; Governance Committee (Co-Chair); In-Service Examination Subcommittee; Instructional Course Committee; International Subcommittee; Leadership Development Committee; Maliniac Lecturer Selection Subcommittee; Membership Committee (Chair); Membership Strategies Committee (Chair); Pathways to Leadership; Product Advisory Committee; Program Committee; Program Evaluation Committee; PRS Editorial Board; PRS Global Open Editorial Board; Regenerative Medicine Subcommittee; Resident Curriculum Development Committee (Co-Chair); Spring Meeting Council (Chair); Symposia Committee (Chair); Visiting Professors Subcommittee; Wellness Subcommittee (Co-Chair); Young Plastic Surgeons Steering Committee State and Regional Society Involvement: Columbus Medical Association (Past President); Columbus Society of Plastic Surgeons; Dallas County Medical Society; Dallas Society of Plastic Surgeons; Ohio State Medical Association; Ohio Valley Society of Plastic Surgeons; Texas Medical Association; Texas Society of Plastic Surgeons Affiliations: AAPS; ABPS; ACAPS (Past President); ACGME (PS RRC Member); ACS (Governor); AHS (President-Elect; Past Governor); ASAPS; Migraine Surgery Society (President); Surgical Pain Consortium

Academic Position/Title: Private Practice Current ASPS/PSF Board Position: None Past ASPS/PSF Board Position: None Current ASPS/PSF Committee Work: Advocacy Summit Planning Committee; Legislative Advocacy Committee; Membership Committee; Women Plastic Surgeons Steering Committee Past ASPS/PSF Committee Work: Advocacy Summit Planning Committee (Co-Chair); Aesthetic Surgery Metrics Design Task Force; ASPS/ PSF Bylaws Committee (Chair); Council on State Affairs; Ethics Committee; Group Practice Task Force; Leadership Development Committee; Legislative Advocacy Committee; Membership Committee; Pathways to Leadership; Women Plastic Surgeons Steering Committee (Chair) State and Regional Society Involvement: Medical Society of Virginia; Southeastern Society of Plastic and Reconstructive Surgeons; Virginia Society of Plastic Surgeons (Past President) Affiliations: ACS; ASAPS Medical Degree: Texas A&M University Years in Practice: 23 ABPS Certification: 2000

Judicial Council CHRISTIAN VERCLER, MD Ann Arbor, Mich.

Academic Position/Title: Associate Professor, Section of Plastic Surgery, University of Michigan Current ASPS/PSF Board Position: None Past ASPS/PSF Board Position: None Current ASPS/PSF Committee Work: Code of Ethics and Disciplinary Process Review Task Force; Ethics Committee (Chair); Essentials of Leadership; Resident Curriculum Development Committee Past ASPS/PSF Committee Work: Ethics Committee; Resident Curriculum Development Committee State and Regional Society Involvement: Michigan State Medical Society Ethics Committee (Chair) Affiliations: AAP; AAPS; ACAPS (Ethics & Professionalism Committee Past Chair); ACS; American Cleft Palate-Craniofacial Association (Ethics Committee); American Society of Bioethics & Humanities; ASCFS; ASMS (Ethics Committee Past Chair); PSRC; Sir Charles Bell Society Medical Degree: University of Illinois Years in Practice: 8 ABPS Certification: 2014

July/August 2021

Ethics Committee – District 3, Midwest Region STEVEN BERNARD, MD Cleveland

Academic Position/Title: Residency Director, Cleveland Clinic Plastic Surgery; Associate Professor of Surgery, Lerner College of Medicine Current ASPS/PSF Board Position: None Past ASPS/PSF Board Position: None Current ASPS/PSF Committee Work: Resident Curriculum Development Committee Past ASPS/PSF Committee Work: ASPS EdNet Editorial Subcommittee; ASPS/PSF Nominating Committee; Computer-Based Education Committee; Coding and Payment Policy Subcommittee; Essentials of Leadership; In-Service Examination Subcommittee; Leadership Development Committee; Resident Curriculum Development Committee; Scientific Program Committee; Volunteers in Plastic Surgery Forum; Young Plastic Surgeons Forum State and Regional Society Involvement: Academy of Medicine of Cleveland and Northern Ohio; Ohio Valley Society of Plastic Surgeons Affiliations: AAPS; ASRM; Association of Academic Chairmen of Plastic Surgery Medical Degree: Case Western Reserve University Years in Practice: 23 ABPS Certification: 1998

Ethics Committee – District 5, Rocky Mountain Region JOYCE AYCOCK, MD Denver

Academic Position/Title: Private Practice Current ASPS/PSF Board Position: None Past ASPS/PSF Board Position: None Current ASPS/PSF Committee Work: None Past ASPS/PSF Committee Work: Continuing Education Committee State and Regional Society Involvement: None Affiliations: ASRM Medical Degree: Columbia University College of Physicians and Surgeons Years in Practice: 13 ABPS Certification: 2008

Conflict of Interest Committee Member-at-Large RAYMOND DUNN, MD

Affiliations: AACPS; AMA; ASRM; AAPS; ACS; NESPS; NESPRS; MSPS Medical Degree: Albany Medical College Years in Practice: 31 ABPS Certification: 1992

July/August 2021

THE

PSF

2022 SLATE OF CANDIDATES

ASPS/PSF Vice President of Education SCOTT HOLLENBECK, MD Durham, N.C.

Academic Position/Title: Associate Professor of Surgery, Vice Chief of Research, Division of Plastic, Maxillofacial and Oral Surgery, Director of Breast Reconstruction, Duke University School of Medicine Current ASPS/PSF Board Position: ASPS/PSF Vice President of Education Past ASPS/PSF Board Position: None Current ASPS/PSF Committee Work: Academic Affairs Council; ASPS/PSF Board of Directors; Education Strategy Advisory Council (Chair); In-Service Examination Subcommittee; Internal Education Strategy Advisory Council (Chair); Online Education Council; PRS Global Open Editorial Board; PRS Global Open Managing Committee; Spring Meeting Council Past ASPS/PSF Committee Work: Academic Affairs Council; ASPS EdNet Editorial Subcommittee; ASPS/PSF Board of Directors; ASPS/PSF Nominating Committee; Education Strategy Advisory Council (Chair); Online Education Council; PSF Study Section; Researcher Education Subcommittee; Resident Curriculum Development Committee (Chair); Spring Meeting Council; Visiting Professors Subcommittee; Wellness Subcommittee State and Regional Society Involvement: Southeastern Society of Plastic and Reconstructive Surgeons (Board of Directors) Affiliations: ACS Medical Degree: Ohio State University College of Medicine

President BERNARD T. LEE, MD, MBA, MPH Boston

Academic Position/Title: Chief, Division of Plastic Surgery, ViceChair of Finance, Department of Surgery Beth Israel Deaconess Medical Center, Professor of Surgery, Harvard Medical School Current ASPS/PSF Board Position: The PSF President-Elect Past ASPS/PSF Board Position: ASPS/PSF Board Vice President of Academic Affairs; ASPS/PSF Vice President of Academic Affairs and Reconstructive Surgery Current ASPS/PSF Committee Work: Academic Affairs Council; Annual Meeting Council; ASPS/PSF Board of Directors; BIA-ALCL Subcommittee; Code of Ethics and Disciplinary Process Review Task Force; Executive Committee; Governance Committee; Healthcare Delivery Subcommittee; Maliniac Lecturer Selection Subcommittee; Quality and Performance Measurement Committee; Research Oversight Council; SHARE Past ASPS/PSF Committee Work: Academic Affairs Council (Chair); Annual Meeting Educational Program Committee; ASPS EdNet Editorial Subcommittee; ASPS/PSEF Young Plastic Surgeons Forum; ASPS/PSF Board of Directors; Autologous Breast Reconstruction Performance Measures Work Group (Co-Chair); Autologous Breast Reconstruction Work Group (Chair); BRA Fund Appropriations and Review Subcommittee; Executive Committee; Health Policy Committee; Healthcare Delivery Subcommittee; In-Service Examination Subcommittee; Instructional Course Committee; Leadership Development Committee; Maliniac Lecturer Selection Subcommittee; Pediatric Task Force; Program Committee; Quality and Performance Measurement Committee; Research Oversight Council; TOPS Steering Committee State and Regional Society Involvement: New England Society of Plastic and Reconstructive Surgeons Leadership (President); Massachusetts Society of Plastic Surgeons; Northeastern Society of Plastic Surgeons (Member-at-Large); Massachusetts Medical Society Affiliations: Journal of Reconstructive Microsurgery (Editor-in-Chief), ASRM, ASLS, ACS, AAPS, PSRC, AAS, World Association for Plastic Surgeons of Chinese Descent, WSRM, AMA, ASA, ABPS (Director) Medical Degree: Tufts University Years in Practice: 18 ABPS Certification: 2004

Years in Practice: 11 ABPS Certification: 2011

President-Elect Vice President of Health Policy & Advocacy LYNN DAMITZ, MD Chapel Hill, N.C.

Worcester, Mass.

Academic Position/Title: Division of Plastic Surgery, University of Massachusetts Medical School; Professor of Surgery, University of Massachusetts Medical School; Professor, Department of Anatomy and Cell Biology, University of Massachusetts Medical Center; Affiliate (Adjunct) Professor of Biomedical Engineering, Worcester Polytechnic Institute Current ASPS/PSF Board Position: None Past ASPS/PSF Board Position: YPS Representative to the ASPS Board of Directors Current ASPS/PSF Committee Work: ASPS/PSF Bylaws Committee Past ASPS/PSF Committee Work: Archives Committee; ASPS Clinical Symposia Committee; ASPS/PSF Board of Directors; ASPS/PSF Bylaws Committee; ASPS/PSF Committee on Maintenance of Certification; CME Committee; Core Surgical Exam Committee; Essentials of Leadership; Ethics Committee; Instructional Course Committee; Judicial Council; Leadership Development Committee; Program Committee; Public Education Committee; Regulatory Evaluation Committee; Research Fellowship Committee; Research Fund Proposals Committee; Research Grants Committee; Scientific Program Committee; Technology Assessment Committee; Young Plastic Surgeons Forum (Chair); Young Plastic Surgeons Steering Committee (Chair) State and Regional Society Involvement: Northeastern Society of Plastic Surgeons (President); New England Society of Plastic Surgeons (President)

2022 SLATE OF CANDIDATES

Academic Position/Title: Chief, Division of Plastic and Reconstructive Surgery, Director of Aesthetic Surgery, Professor of Plastic Surgery, University of North Carolina School of Medicine Current ASPS/PSF Board Position: None Past ASPS/PSF Board Position: None Current ASPS/PSF Committee Work: Accreditation Work Group (Chair); Healthcare Delivery Subcommittee; Membership Committee (Chair); Military Forum Work Group; National Endowment for Plastic Surgery Council of Advisors; Patient Safety Subcommittee; PlastyPAC Board of Governors Past ASPS/PSF Committee Work: Accreditation Work Group (Chair); ASPS Presidential Task Force; ASPS/PSF Nominating Committee; Governance Task Force; Government Affairs Committee; Health Policy Committee; Healthcare Delivery Subcommittee; Legislative Advocacy Committee (Chair); Membership Committee (Chair); Pathways To Leadership; Patient Safety Subcommittee; PlastyPAC Board of Governors; Women Plastic Surgeons Steering Committee (Chair) State and Regional Society Involvement: North Carolina Society of Plastic Surgeons (Vice President); Southeastern Society of Plastic and Reconstructive Surgeons (Board of Directors) Affiliations: ACAPS; ACS (ASPS Representative, ACS National Accreditation Program for Breast Centers Board); ASAPS Medical Degree: Hahnemann University School of Medicine Years in Practice: 20 ABPS Certification: 2001

HOWARD LEVINSON, MD Durham, N.C.

Academic Position/Title: Associate Professor Plastic Surgery, Pa thology, Division of Surgical Sciences, Dermatology, and Surgery, Duke University Medical Center Current ASPS/PSF Board Position: ASPS/PSF Vice President of Research Past ASPS/PSF Board Position: PSRC Representative to the ASPS/ PSF Board of Directors Current ASPS/PSF Committee Work: Academic Affairs Council; Annual Meeting Educational Program Committee; ASPS/PSF Board of Directors; BRA Fund Appropriations and Review Subcommittee; Development Committee; PSF Fundraising Subcommittee; Quality Accreditation Program Investigation Task Force; Research Oversight Council (Chair); Technology, Innovation & Disruption Committee Past ASPS/PSF Committee Work: Academic Affairs Council; Annual Meeting Educational Program Committee; ASPS EdNet Editorial Subcommittee; ASPS/PSF Board of Directors; Basic and Translational Research Committee; BRA Fund Appropriations and Review Subcommittee; Clinical Trials Network Subcommittee; Clinical Registries Committee; Clinical Research Subcommittee; Development Committee; Leadership Development Committee; PSF Study Section; Research Development Subcommittee; Research Oversight Council; Researcher Education Subcommittee (Chair); Resident Curriculum Development Committee; Technology, Innovation & Disruption Committee State and Regional Society Involvement: Southeastern Society of Plastic Surgeons; North Carolina Society of Plastic Surgeons; Duke Hand Society Affiliations: AAPS; AAS; ACAPS; ACS; AHS; ASRM; EPSRC; PSRC; SBM; WSSS; WHS Medical Degree: University of Texas, Medical Branch at Galveston Years in Practice: 13 ABPS Certification: 2009

Vice President of Development SCOT BRADLEY GLASBERG, MD New York

Academic Position/Title: Private Practice Current ASPS/PSF Board Position: ASPS/PSF Vice President of Development Past ASPS/PSF Board Position: ASPS President; ASPS PresidentElect; Vice President of Health Policy & Advocacy; Vice President of Finance & Treasurer; Council of State Affairs in Plastic Surgery Representative to the ASPS/PSF Board of Directors; Parliamentarian Current ASPS/PSF Committee Work: ASPS/PSF Board of Directors; BIA-ALCL Subcommittee; BIA-ALCL Surgeon-to-Surgeon Network; BRA Fund Appropriations and Review Subcommittee; Code of Ethics and Disciplinary Process Review Task Force; Executive Committee; Legislative Advocacy Committee; Plastic Surgery Practice Solutions Board of Directors; PRS & PRS Global Open Managing Committee; PRS Editorial Board; PRS Global Open Editorial Board; PRS Managing Committee; PSN Editorial Board; Publications Committee; Regenerative Medicine Subcommittee; Research Oversight Council Past ASPS/PSF Committee Work: ACS Board of Governors Appointments; Annual Meeting Educational Program Committee; ASPS Clinical Symposia Committee; ASPS Emerging Trends Subcommittee; ASPS Past Presidents; ASPS/ASAPS Scope of Practice Task Force; ASPS/PSEF Bylaws Committee; ASPS/PSEF Young Plastic Surgeons Forum Steering Committee; ASPS/PSEF Young Plastic Surgeons Forum; ASPS/PSF Audit Committee; ASPS/PSF Board of Directors; ASPS/PSF Bylaws Committee; ASPS/PSF Nominating Committee (Co-Chair); BIA-ALCL Subcommittee; BIA-ALCL Surgeon-to-Surgeon Network; BRA Fund Appropriations and Review Subcommittee; Clinical Trials Network Subcommittee; CME Committee; Coding and Payment Policy Subcommittee; Compensation Committee (Chair); Conflict of Interest Work Group (Chair); Corporate Leadership Council; Cosmetic Surgery Alliance; Council on State Affairs (Chair); CPT/RUC Committee; Curriculum Development Subcommittee; Development Committee (Chair); Ethics Committee; Executive Committee; Exhibits Committee; FDA Affairs Committee; Federal Affairs Committee; Finance & Investment Committee; Governance Advisory Task Force; Governance Task Force (Chair); Government Affairs Committee; Government Affairs Council (Chair); Government Relations Committee; Health Policy Committee; In-Service Examination Committee; International Scholar Subcommittee; International Subcommittee; Inter-Specialty Work Group; Journal Business Operations Committee; Judicial Council; Leadership Development Committee; Leadership Tomorrow Fellows Activity; Legislative Advocacy Committee; Membership Strategies Committee; Northeast COVID-19 Task Force; Office Based Surgery Task Force; Pathways to Leadership Alumni; Patient Safety Subcommittee; Plastic Surgery Caucus; Plastic Surgery Informatics Collaborative Action Task Force; Plastic Surgery Practice Solutions Board of Directors (President); PlastyPAC Board of Governors (Chair); Practice Management Committee; Professional Liability Insurance Committee; PRS & PRS Global Open Managing Committee; PRS Editorial Board; PRS Global Open Editorial Board; PSEF Board of Directors; PSEF/ASPS Committee on Maintenance of Certification; PSF Board of Directors; PSF Volunteers in Plastic Surgery Steering Committee; PSN Editorial Board; Public Education Committee; Publications Committee; Quality and Performance Measurement Committee; Regenerative Medicine Advisory Group; Regenerative Medicine Subcommittee; Regenerative Medicine Task Force; Research Development Subcommittee; Research Oversight Council; Researcher Education Subcommittee; Resident Information Committee; Risk Retention Group Exploratory Task Force; Spring Meeting Council (Vice Chair); State Affairs Committee; TOPS Committee; Visiting Professors Subcommittee; Women Plastic Surgeons Steering Committee; Young Plastic Surgeons Steering Committee State and Regional Society Involvement: New York County Medical Society (Past President, Trustee); New York Regional Society of Plastic Surgeons (Past President, Trustee); New York State Society of Plastic Surgeons (Past President, Trustee) Affiliations: ACS (Governor), AAPS Medical Degree: New York University Years in Practice: 22

Current ASPS/PSF Committee Work: ASPS/PSF Board of Directors; Diversity and Inclusion Committee; Emerging Trends Subcommittee; Executive Committee; Plastic Surgery Practice Solutions Board of Directors; PRS Global Open Editorial Board; PRS Global Open Managing Committee; Social Media Subcommittee; Technology, Innovation & Disruption Committee Past ASPS/PSF Committee Work: Accreditation Work Group (Chair); ASPS Emerging Trends Subcommittee; ASPS/PSF Board of Directors; Diversity and Inclusion Committee (Chair); Essentials of Leadership; Executive Committee; Leadership Development Committee; Membership Committee (Chair); Plastic Surgery Practice Solutions Board of Directors; Social Media Subcommittee; Technology, Innovation & Disruption Committee State and Regional Society Involvement: San Joaquin Medical Society; Medical Board of California; California Medical Society; California Society of Plastic Surgeons; California Medical Board (Expert Reviewer) Affiliations: ASAPS, ACAPS Medical Degree: Yale University Years in Practice: 15 ABPS Certification: 2008

STEVEN WILLIAMS, MD Dublin, Calif.

Academic Position/Title: Private Practice Current ASPS/PSF Board Position: ASPS/PSF Vice President of Membership Past ASPS/PSF Board Position: ASPS/PSF Vice President of Private Practice and Aesthetic Surgery

ABPS Certification: 2008

AAHS Representative to the ASPS/PSF Board of Directors KYLE EBERLIN, MD Boston

Vice President of Research PETER TAUB, MD New York

Academic Position/Title: Professor of Surgery, Pediatrics, Dentistry, Neurosurgery and Medical Education, Icahn School of Medicine at Mount Sinai; Attending Plastic and Reconstructive Surgeon, Mount Sinai Medical Center, Elmhurst Hospital Center; Program Director, Plastic and Reconstructive Surgery Current ASPS/PSF Board Position: None Past ASPS/PSF Board Position: None Current ASPS/PSF Committee Work: Annual Meeting Educational Program Committee; Development Committee; Education Strategy Advisory Council (Vice Chair); Essentials of Leadership; In-Service Examination Subcommittee; Internal Education Strategy Advisory Council (Vice Chair); PSF Fundraising Subcommittee Past ASPS/PSF Committee Work: Academic Affairs Council; Annual Meeting Council; Annual Meeting Educational Program Committee; ASPS EdNet Editorial Subcommittee; ASPS/PSF Audit Committee; ASPS/PSF Nominating Committee; Development Committee; Education Strategy Advisory Council; Finance & Investment Committee; In-Service Examination Subcommittee (Past Chair); Instructional Course Committee; Northeast COVID-19 Task Force; Online Education Council (Chair); Pathways to Leadership; Program Committee; Public Education Committee; Research Oversight Council; Resident Curriculum Development Committee; Young Plastic Surgeons Steering Committee State and Regional Society Involvement: New York Regional Society of Plastic Surgeons; Northeastern Society of Plastic Surgeons Affiliations: PSRC (Past President); ACAPS; AAPPS (Past President); ABPS; ASMS (Past President); ACS (Advisory Council Chair) Medical Degree: Albert Einstein College of Medicine Years in Practice: 20 ABPS Certification: 2003

Member-at-Large MICHELE MANAHAN, MD Baltimore

ABPS Certification: 2000

Vice President of Membership

Editorial Subcommittee; ASPS/PSF Bylaws Committee; ASPS/PSF Nominating Committee; Clinical Research Subcommittee; Conflict of Interest Committee; Essentials of Leadership; Exhibits Committee; Health Policy Committee; In-Service Examination Subcommittee; Judicial Council (Chair); Legislative Advocacy Committee; Patient Safety Subcommittee (Chair); PRS & PRS Global Open Managing Committee; PRS Editorial Board; Quality and Performance Measurement Committee (Vice Chair); Resident Curriculum Development Committee; Young Plastic Surgeons Steering Committee State and Regional Society Involvement: Baltimore City Medical Society; Maryland State Medical Society Affiliations: AAPS; ACS; AMA; ASAPS; ASRM Medical Degree: Johns Hopkins School of Medicine Years in Practice: 14

Academic Position/Title: Associate Professor, Vice Chair of Faculty and Staff Development and Well-Being, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital Current ASPS/PSF Board Position: None Past ASPS/PSF Board Position: None Current ASPS/PSF Committee Work: Annual Meeting Educational Program Committee; Conflict of Interest Committee (Chair); Essentials of Leadership; In-Service Examination Subcommittee; Patient Safety Subcommittee; PRS & PRS Global Open Managing Committee; PRS Managing Committee; Quality and Performance Measurement Committee (Vice Chair); Resident Curriculum Development Committee Past ASPS/PSF Committee Work: Accreditation Work Group; Annual Meeting Educational Program Committee; ASPS EdNet

Academic Position/Title: Associate Professor of Surgery, Massachusetts General Hospital Current ASPS/PSF Board Position: AAHS Representative to the ASPS/PSF Board of Directors Past ASPS/PSF Board Position: None Current ASPS/PSF Committee Work: Annual Meeting Educational Program Committee; ASPS University Strategic Council; Curriculum Development Subcommittee; Healthcare Delivery Subcommittee; In-Service Examination Committee; Patient Safety Subcommittee Past ASPS/PSF Committee Work: Annual Meeting Educational Program Committee; ASPS EdNet Editorial Subcommittee; ASPS University Strategic Council (Vice Chair); Curriculum Development Subcommittee; Health Policy Committee; Healthcare Delivery Subcommittee; In-Service Examination Committee; Patient Safety Subcommittee State and Regional Society Involvement: None Affiliations: AAHS, ASSH, ASPN, ASRM Medical Degree: Boston University Years in Practice: 6 ABPS Certification: 2015

ACAPS Representative to the ASPS/PSF Board of Directors VU NGUYEN, MD Pittsburgh

Academic Position/Title: Associate Professor, Residency Program Director, University of Pittsburgh Department of Plastic Surgery; Co-Chair, UPMC GME WELL Subcommittee Current ASPS/PSF Board Position: ACAPS Representative to the ASPS/PSF Board of Directors Past ASPS/PSF Board Position: ACAPS Representative to the ASPS/PSF Board of Directors Current ASPS/PSF Committee Work: ACAPS/ASPS Boot Camp Committee; ASPS/PSF Board of Directors; Resident Curriculum Development Subcommittee (Vice Chair); Wellness Subcommittee Past ASPS/PSF Committee Work: ASPS/ACAPS Professionalism Committee; ASPS EdNet Editorial Subcommittee; ASPS/PSEF Young Plastic Surgeons Forum; ASPS/PSF Board of Directors; Essentials of Leadership; PSF Study Section; Resident Curriculum Development Subcommittee; Wellness Subcommittee State and Regional Society Involvement: Greater Pittsburgh Plastic Surgery Society (Past President); Robert H. Ivy Pennsylvania Society of Plastic Surgeons (Past President); Ohio Valley Society of Plastic Surgeons (Past President); Northeastern Society of Plastic Surgeons (Past Scientific Program Chair) Affiliations: ACAPS Medical Degree: University of Nebraska Years in Practice: 13 ABPS Certification: 2008

July/August 2021

ASMS Representative to the ASPS/PSF Board of Directors ANAND KUMAR, MD Cleveland

Academic Position/Title: Dewayne Greenwood Richey II Endowed Professor of Plastic Surgery and Pediatrics at the Case Western Reserve University School of Medicine Current ASPS/PSF Board Position: ASMS Representative to the ASPS/PSF Board of Directors Past ASPS/PSF Board Position: ASMS Representative to the ASPS/PSF Board of Directors Current ASPS/PSF Committee Work: Annual Meeting Educational Program Committee; ASPS/PSF Board of Directors; Development Committee; In-Service Examination Committee; Military Forum Work Group; Resident Curriculum Development Committee Past ASPS/PSF Committee Work: Annual Meeting Educational Program Committee; ASPS/PSF Board of Directors; Development Committee; In-Service Examination Committee; PRS Global Open Editorial Board; PSF Study Section; Resident Curriculum Development Committee; Visiting Professors Subcommittee State and Regional Society Involvement: University Hospitals Cleveland Medical Center (Lisa and Vasu Pandrangi Endowed Chair, Division of Plastic Surgery), Rainbow Babies Children’s Hospital (Director, Cleft & Craniofacial Center, Vascular Anomalies Center) Affiliations: ASMS (Assistant Secretary), AAPPS (President-Elect) Medical Degree: Albert Einstein College of Medicine Years in Practice: 17 ABPS Certification: 2005

ASPN Representative to the ASPS/PSF Board of Directors CATHERINE CURTIN, MD Palo Alto, Calif.

Academic Position/Title: Professor of Plastic and Reconstructive Surgery, Stanford Medicine; Chief of Hand Surgery, Palo Alto VA Current ASPS/PSF Board Position: None Past ASPS/PSF Board Position: None

July/August 2021

Current ASPS/PSF Committee Work: None Past ASPS/PSF Committee Work: Resident Curriculum Development PSRC Representative to the Committee ASPS/PSF Board of Directors State and Regional Society Involvement: Palo Alto VA (Director of Hand Surgery); CDMRP Study Section TIMOTHY KING, MD, PhD Chicago Affiliations: ASPN (Past Program Chair); ASSH; AAHS; Journal of Hand Surgery (Past Associate Editor); National VA Surgical Advisory Board Medical Degree: Yale School of Medicine Academic Position/Title: Professor of Surgery, Stuteville Division Years in Practice: 13 Chief of Plastic Surgery, Loyola University Medical Center ABPS Certification: 2008 Current ASPS/PSF Board Position: PSRC Representative to the ASPS/PSF Board of Directors Past ASPS/PSF Board Position: PSRC Representative to the ASRM Representative to the ASPS/PSF Board of Directors Current ASPS/PSF Committee Work: ASPS/PSF Board of DirecASPS/PSF Board of Directors tors; PSF Study Section; Quality and Performance Measurement Committee; Research Oversight Council; Researcher Education SubJOSEPH DISA, MD committee New York Past ASPS/PSF Committee Work: ASPS/PSF Board of Directors; Academic Position/Title: Vice Chair of Clinical Activities, Depart PSF Study Section; Research Development Subcommittee; Research ment of Surgery; Benno C. Schmidt Chair in Surigcal Oncology, Me Oversight Council; Researcher Education Subcommittee morial Sloan Kettering Cancer Center State and Regional Society Involvement: Southeastern Society Current ASPS/PSF Board Position: ASRM Representative to the of Plastic Surgeons; Alabama Society of Plastic Surgeons ASPS/PSF Board of Directors Affiliations: PSRC (Past President); Wound Healing Society (Execu Past ASPS/PSF Board Position: ASRM Representative to the tive Board); AAPPS (Past President); International Society for Pediatric Wound Care (Vice President); Journal of Surgical Research (Past As ASPS/PSF Board of Directors Current ASPS/PSF Committee Work: ASPS/PSF Board of Direc- sociate Editor); ASMS; ASRM; ACS; AAPS; ACAPS; SUS; AAS; AAP tors; PRS & PRS Global Open Managing Committee; PRS Editorial SOPS (Past Chair); ACPA; BMES; AONA:CMF; SAAS; AWS; AOA; Sigma Xi; SBC II; FACE Journal (Section Editor); ACS-COT; Craniofacial Board; PRS Managing Committees Trauma and Reconstruction (Editorial Board) Past ASPS/PSF Committee Work: ASPS/PSEF Young Plastic Sur geons Forum; ASPS/PSF Audit Committee; ASPS/PSF Board of Direc- Medical Degree: University of Texas-Houston tors; Group Practice Task Force; Judicial Council; Nominating Commit- Years in Practice: 13 tee; Oncoplastic Breast Surgery Task Force; Pathways To Leadership; ABPS Certification: 2009 PRS & PRS Global Open Managing Committee; PRS Editorial Board; PRS Global Open Editorial Board; PSEF Volunteers in Plastic Surgery Forum; PSF Study Section; Resident Curriculum Development Committee; Scientific Program Committee State and Regional Society Involvement: Northeastern Society of Plastic Surgeons (Past President); New York Regional Society of Plastic Surgeons Affiliations: ACS; ASRM (Past President); NESPS; PSRC; SSO; AHNS; ASMS; ASPS; AAPS; ASA; ABPS (Past Director) Medical Degree: University of Massachusetts Years in Practice: 25 ABPS Certification: 1999

ADA compliance

Continued from page 7

Increase your awareness of digital accessibility standards: • Title III of the ADA prohibits discrimination based on disability, requiring websites to be designed to ensure those with disabilities can use them. Standards encompass all disabilities that affect access to the Web, including physical, cognitive, vision and hearing disabilities. The Department of Justice (DOJ) has made it clear that websites are expected to comply with the ADA under Title III (businesses open to the public). • The Web Content and Accessibility Guideline (WCAG) is the de facto standard for digital accessibility. It was established and is managed by the World Wide Web Consortium(W3C). If you want to avoid litigation and make your website maximally accessible, the working standard for digital accessibility is WCAG 2.1 A, AA in the United States. Identify resources for your practice: • W3C’s YouTube channel offers several instructional video playlists, including • Introduction to Web Accessibility and W3C Standards • Evaluating Web Accessibility

Editor’s Message

Continued from page 6

as some community specialty practices, such as dermatology), truly represent a for-profit motivation: investment in a business in return for equity and a substantial return on that investment. This can potentially be all about the money, which may not mix fully with healthcare. Perhaps a prime example of how this relationship can get ugly is the demise of Hahnemann Hospital in Philadelphia. Based on a story titled “The Death of Hahnemann Hospital” that was published in The New Yorker in June, my understanding of what happened is as follows: A private-equity

On Legal Grounds Continued from page 12

Some descriptions about patients and their care could be deemed offensive (e.g., words such as “obese,” “needy,” “demanding” or “difficult”) and inflame an already tenuous doctor-patient relationship. ASPS past President Mark Gorney, MD, developed the “GorneyGram,” which attempts to better define expectations.

Example of the “GorneyGram” Patients with a minimal deformity and great concern (top left) might have issues with results, while those in the bottom-right of the scale do better. How would you chart that designation? The most appropriate way might

group took ownership and control of the hospital. The group enjoyed success with other hospitals that were under-performing financially. However, unlike Hahnemann, the other systems with which they had success were not safety-net hospitals, taking care of the poor, uninsured and underinsured. As time went on, there were increased cost-cutting measures, which affected the delivery of healthcare. The losses continued to mount, which led to the private-equity group closing the hospital, leaving a community dependent on the hospital and its doctors without good options. The private-equity company retained ownership of the real estate, however, which is now being considered for commercial and residential development. Cynics have sug-

Patient-centered language

gested that this was the end-game from the beginning. I certainly hope not. So, what are the lessons learned? Clearly, medicine and healthcare is a business. That’s how we make our livings, as do all those around us in our offices, surgery centers and hospitals. We need to operationalize our practices with good, solid business models. Unlike other businesses, however, we need to remember the people we are treating are our patients – not clients or customers. Our interaction with our patients is not transactional. It’s about helping and caring. The doctor-patient relationship is at the heart of what we do. When that tie is lost, we truly commoditize medicine. Not only will the patients suffer, but so will the doctors. PSN

Negative connotation

Sought reassurance

Needy

Did not adhere to the post-op plan

Noncompliant

The patient reported…

The patient complains of…

Patient made repeated requests

Patient was demanding

Talkative

Jabbering

BMI > 30

Obese, Fat

be to use only marks rather than words. Avoid descriptors such as “demanding,” “unreasonable,” “difficult” or “problematic” now that this chart will be available to patients. I have reviewed litigation cases in which negative side notes on the medical record become a problem in depicting the doctor as uncaring and sarcastic. There are many examples that could prove offensive to patients, and it will be helpful to use objective terms rather than those with negative connotations. The more factual the description, the safer the dialogue.

The book Tongue Fu, by Sam Horn, describes word choices that generate empathy and compassion rather than confrontation. See the table above for some further examples. The 21st Century Cures Act is now enforceable, and practices should adapt to the required changes. Patient record accessibility, along with honest disclosures in an affable and empathetic manner, are recommended. I would encourage ASPS members to continue to add to the above list and share it with all members of the office team. PSN

• Excerpts from the Digital Accessibility Foundations online course • As part of their Web Accessibility Initiative (WAI), W3C also offers a free Digital Accessibility Foundations online course (approximately 16 hours) covering the basics of digital accessibility, including a section on principles, standards and checks. • The U.S. General Services Administration offers additional web accessibility design tools. • A December 2019 Bloomberg Law article, “How Businesses Can Defeat Website Accessibility Lawsuits,” provides perspective on how others across the country are fighting these lawsuits. Consider selecting a knowledgeable partner to support you: • ASPS recommends members work with a reputable company that can verify your website conforms with state/federal standards. • Several websites offer tools, resources and services to gauge website compliance: • ADA Compliance Professionals • Criterion Web Accessibility Compliance • Bureau of Internet Accessibility Members are encouraged to share their own experiences and tips on the ASPS Members Discussion Forum located on the “Directories and Networking” page of the Medical Professionals section of plasticsurgery.org. PSN

July/August 2021

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1 mm

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July/August 2021 Collagen Matrix for So Tissue Reconstruction

PRS

Legislative Update Continued from page 14

[a PA’s] role in patient care” as their training, “is in no way equivalent to that of physicians, who offer essential diagnostic and medical expertise to patients.” ASPS also advocated alongside the Northwest Society of Plastic Surgeons (NWSPS) in opposition to an Oregon bill that would allow PAs to have collaborative practice agreements with their primary practice location, instead of with a physician. Despite opposition from organized plastic surgery, HB 3036 was signed into law by Gov. Kate Brown. Additionally, Utah this session passed scope expansion legislation that allows PAs to practice independently upon reaching 10,000 hours of collaborative practice. Conversely, ASPS and the Florida Society of Plastic Surgeons successfully blocked the Florida Legislature’s attempts to expand the scope of PAs there.

Physicians respond Following the AAPA announcement, both the AMA and the American Osteopathic Association (AOA) issued statements expressing concerns with the change in title to “physician associate.” AMA President Susan Bailey, MD, said the change will “only serve to further confuse patients about who is providing their care.” Dr. Bailey further stressed that “given the existing difficulty many patients experience in identifying who is or is not a physician, it’s important to provide patients with more transparency and clarity in who is providing their care, not more confusion.” Among other points, the AOA noted in its statement the value and contributions of non-physician clinicians and their struggle to achieve professional parity but emphasized that these efforts “must not be at the expense

of the truth-in-advertising and clarity of roles in our healthcare system.” The AOA concluded its statement with a call for action to peers in the healthcare community to “join together with policymakers to support policies that recognize the importance of the physician-led medical team model, ensuring that physicians, the only professionals with comprehensive medical education and training, are appropriately distinguished from non-physicians and are adequately involved in the care of this nation’s sick and injured.”

ASPS position This most recent move by the AAPA ultimately reflects just one step in longstanding efforts by PAs to distance themselves from their status as midlevel practitioners and further infringe upon the scope of physicians. Although not new in its character, a change of this magnitude represents a major shift in the lengths to which PAs will go to expand their scope and blur the line between midlevel practitioner and physician. ASPS supports the physician-led, teambased model of care and recognizes the vital role all providers play in the healthcare delivery system, but the Society also firmly believes that patients deserve transparency – and it’s been a longtime advocate of such. ASPS firmly opposes AAPA’s title change from “physician assistant” to “physician associate” as a move that will be counterproductive to efforts toward greater transparency and will lead to a more confusing, opaque healthcare landscape. ASPS on June 18 joined 11 other specialty organizations – representing nearly 350,000 physicians – in opposing the proposed title change. In their letter of concern, the organizations stated that “ambiguous provider nomenclature, misleading advertisements and the myriad of individuals one encounters at each point of service exacerbates patient

uncertainty.” The organizations stressed that simply changing one’s title to “physician associate” without completing accredited medical school education and training “will further mislead the public.” In addition to collaborative efforts, ASPS is also engaging in its own campaign to persuade the policymakers that will ultimately determine whether or not a legal title change is enacted into law. In comments to the National Conference of State Legislatures and the National Governors Association, ASPS articulated its opposition to the AAPA’s title change and characterized the move as an “irresponsible act of naked self-interest.” The Society also noted that the change does nothing to assist patients in making informed decisions about who is providing their medical care, combat the serious issue of truth in healthcare marketing or clarify the scope and capabilities of a physician assistant. Rather, ASPS pointed out, the title change will ultimately prove to be counterproductive to patient care and outcomes, thus undermining “the physician-led, team-based healthcare delivery model by degrading the vital relationship between physicians and other members of the healthcare team.”

Practice implications The AAPA’s name change represents not only a shift toward a more aggressive approach to scope expansion efforts, but it also has the po-

tential to set a dangerous precedent for other non-physician providers. In recent years, ASPS has actively tracked and responded to a wave of bills attempting to expand the scope of practice for a variety of healthcare roles in addition to PAs, including optometrists, dentists, nurse practitioners and estheticians. The implications of this effort cannot be overstated, as its success could signal an opening for these and other healthcare specialties to follow suit and similarly attempt to circumvent standard legislative and regulatory processes in order to force a change that benefits their practice, but further erodes the care process and blurs the line between midlevel practitioners and physicians. ASPS remains committed to opposing AAPA’s title change effort, as well as any other scope expansion efforts that potentially mislead and endanger patients and threaten the practice of plastic surgery. The Society’s commitment to transparency and the highest-quality patient care is guiding this work. The next steps in the Society’s advocacy on this issue will be to reach out to other 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. These groups expressed reservations about the title change and are responsible for knowing and validating exactly what is the appropriate role for PAs, and our hope is that they will work with the AAPA to set the planned title change aside. As the Society works to convey the dangers of this recent action and long-term implications for both patients and providers, surgeons will be crucial in communicating the practice’s concerns to lawmakers and regulators. Watch for updates from ASPS and grassroots alerts as this issue develops and be prepared to take action to protect the specialty. PSN

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

July/August 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.

J UL Y

What do more than

11,000

Plastic Surgeons have in common?

24-25

ACAPS/ASPS Plastic Surgery Virtual Boot Camp Online Contact: (800) 766-4955 Web: plasticsurgery.org Sponsored by ACAPS, ASPS

AUGUST 7-15

Oral Board Preparation Course Virtual Contact: (800) 766-4955 Web: plasticsurgery.org Directly provided by ASPS

13-14

Singapore 2021 Plastic Aesthetic Surgery Meeting Virtual Contact: (+65) 3941150 Web: pasm2021.com

18-19

ASPS Hot Topics

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

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

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

Indie Aesthetic Surgery Summit

ASPS and PRS

Virtual Contact: (435) 602-1329 Web: indieaestheticsurgerysummit.com Endorsed by ASPS

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

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.

Email: Membership@PlasticSurgery.org

International: +1-847-228-9900

July/August 2021

5-7

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

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

23-25

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

O CTO B ER 12-14

AEC 4.7 Facial Aesthetics Virtual Contact: (020) 7831 5161 Web: bapras.org.uk

ASPS/MSS Migraine Surgery Virtual Symposium

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

NOVEMBER

18-20

11-12

PRS is a member benefit of ASPS

CALENDAR

28-29

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

DECEMBER 3-5

Cutting Edge Livestream

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

9-12

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

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

CLASSIFIEDS

OPPORTUNITIES

San Francisco Cosmetic Practice Searching For Successor Beautifully furnished, 2,000 sq. ft. office in Nob Hill, the preeminent high-end neighborhood of San Francisco. Modern, nonmedical building with curb appeal and valet parking. Perfect for surgicenter, office or med-spa. Much included. Doctor will assist in transition. Timing flexible. Contact helendaniellmpc@gmail.com. 770.856.5673. 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.

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. 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 Plastic Surgery Opportunity-Central New Jersey Board Certified/Board Eligible plastic surgeon looking to join a thriving practice in Central New Jersey. Unlimited potential with three offices located in Monmouth and Ocean County, including the recent opening of an office/Medspa at the Metroburb Bell Works, Holmdel, NJ. Interested applicates, please submit a letter and resume to DRSLTIORIO@MSN.COM.

Resume to: BPS500@aol.com

Seeking Plastic Surgeon Newark, Del.

ChristianaCare is searching for an experienced BC/BE Plastic Surgeon to join Stephanie A. Caterson, MD and the expanding Plastic Surgery team located at its Helen F. Graham Cancer Center in Newark, Del. The ideal candidate will have a primary interest in reconstructive surgery with an emphasis on breast surgery. Fellowship training and proficiency in microsurgery is strongly preferred. Clinical opportunities include the full range of breast reconstruction (free flaps, implant-based procedures, oncoplastic), complex head and neck reconstruction, lymphatic procedures, and other oncologic or traumatic complex reconstruction procedures. Full clinical support with physician extenders and staff will be provided. Additionally, the candidate will participate in the education and training of medical students, general surgery residents and a breast oncology fellow with an available clinical appointment at Thomas Jefferson University. ChristianaCare is a not-for-profit teaching hospital affiliated with Sidney Kimmel Medical College at Thomas Jefferson University, one of the country’s largest health systems, ranking as the 24th leading hospital in the nation and 15th on the East Coast in admissions. Featuring three hospitals with 1,200 beds, ChristianaCare is home to Delaware’s only dedicated Cancer Center and adult Level I Trauma Center. The location is ideally situated between Philadelphia and Baltimore. Living in the Delaware Valley offers a wealth of housing options in urban, suburban, and beautiful rural settings. The region boasts excellent school districts, private schools and some of the nation’s best colleges and universities. Travel is easy with four international airports and Amtrak in the region. The area is rich in diversity and within 1-3 hours you can take advantage of all of the cultural, entertainment and recreational events in Philadelphia, New York City, and Washington, D.C., as well as the popular beach resorts in Delaware, New Jersey and Maryland. Please reach out to Senior Physician Recruiter Frank Gallagher at francis.w.gallagher@christianacare.org. https://careers.christianacare.org/jobs/Plastic_Surgeon_-_Microsurgeon/Newark_Delaware/104/237385/

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. For Sale Southwest Louisiana practice in medical zone with 3 general hospitals in area, one in walking distance, another 16 miles away. Drawing area in excess of 250K and there are two additional plastic surgeons. Price for the practice, good will, office, and lot is the appraised value of the physical plant. I can be available for 6-12 months, for any assistance, if needed. Office contains: waiting room, receptionist’s office, secretary’s office, kitchen and utility rooms, doctor’s office, an additional office, 3 restrooms (one with shower), operating room, scrub room, and recovery room. There are 3 ½ storage rooms. Also under roof, an additional storage area, and a carport (which could be converted to another office). There is an unattached boat shed/storage building which also houses the generator for the operating room. Usual surgical and endoscopic instruments, gas and steam sterilizers, and office furnishings are available at a discount. Contact (985) 868-2320 or apsc615@outlook.com.

Carolina Plastic Surgery Practice For Sale Over 4,000 sf well-appointed office with AAAASF accredited OR and aesthetician suite. 90% cosmetic. Physician willing to assist with transition. Great location with proximity to the coast. Please submit inquiry to LindsayandEvans@aol.com North Carolina Well established aesthetic surgery practice seeking a BC/BE Plastic Surgeon to practice in major metropolitan area in NC. Ideal candidate would be 100% cosmetic focused with proficiency in face, breast and body. Practice has fully accredited on site surgical suites. Candidate will receive a competitive compensation package, bonuses, benefits, and vacation. Please submit resume and communication to: cosmeticsurgeryhrdept@gmail.com Long Island Busy plastic surgery practice on Long Island seeking a BE/BC plastic surgeon to join our practice. We are looking for a talented, energetic and personable individual to join our group. The practice currently treats a variety of cosmetic, reconstructive and hand surgical patients. Competitive salary and benefits package with partnership opportunity. Contact KHPSOffice@gmail.com for additional information. Seeking Plastic Surgeon, Georgia Our office is in Sandy Springs. We are conveniently located across the street from NSH-main. Our practice offers the latest surgical and non-surgical procedures and equipment. We are seeking a board-certified plastic surgeon to join our team and build the practice. Please email CV to: officemanager@drmarisalawrence.com

Plastic Surgeon The Division of Plastic Surgery MetroHealth System The Division of Plastic Surgery at the MetroHealth System, a major teaching affiliate of Case Western Reserve University, seeks a BC/BE Plastic Surgeon to join a busy academic practice as a full-time provider. The Division of Plastic Surgery cares for a broad range of patients in the reconstructive, aesthetic, and congenital spheres. This established position involves the management of all aspects of plastic surgery including breast reconstruction, hand surgery, skin cancer reconstruction, extremity salvage, head and neck reconstruction, and cosmetic surgery. Candidates must have a commitment to academic surgery, with an interest in the teaching of medical students, residents, and fellows. Fellowship training or expertise in Microsurgery is preferred but all qualified applicants will be considered. The MetroHealth System is a county-owned, nationally recognized academic medical center and tertiary referral center with 731 licensed beds. The System includes a Level One Trauma Center, the regional Burn Center, 19 satellite offices, and 3 ambulatory surgery centers. Plastic Surgery has a presence at 5 of the outpatient offices and laser facilities are available at three locations. MetroHealth will complete a new, state-of-the-art hospital in 2021. Position Requirements & Benefits: • Applicants must be board-certified and eligible for licensure in Ohio • Participate in academic and administrative activities and department The MetroHealth System offers a competitive compensation package, health insurance, paid time off, disability insurance, an academic appointment to the Case Western Reserve School of Medicine faculty at a rank commensurate with experience, CME opportunities, malpractice coverage, an impressive pension program with a generous employer match through the Ohio Public Employees Retirement System (OPERS), and an excellent environment for faculty members to develop strong clinical, research (basic and clinical), and quality improvement programs. As a Plastic Surgeon, you have a number of opportunities to consider. However, few will offer you the personal and professional satisfaction and the opportunity to work in a safety-net academic medical system that is leading the way to a healthier community through service, teaching, discovery, and teamwork. We have exceptional clinicians with extraordinary hearts, and we are looking for more to join us. Interested candidates should e-mail their cover letter and CV to: Bram Kaufman, MD, Director, Division of Plastic Surgery, The MetroHealth System, c/o Eloy Vazquez, Provider Recruitment, evazquez@metrohealth.org The MetroHealth System and Case Western Reserve University does not discriminate in recruitment, employment, or policy administration on the basis of race, religion, age, sex, color, disability, sexual orientation or gender identity or expression, national or ethnic origin, political affiliation, or status as a disabled veteran or other protected veteran under U.S. federal law.

July/August 2021

CLASSIFIEDS

Plastic Surgery Career Opportunities At Geisinger – Pennsylvania At Geisinger, our established plastic surgery team works with advanced practitioners, specialty staff, and collaborates with peers and other multidisciplinary providers. Grow your career by joining our established, innovative team: Microsurgery experience or fellowship training preferred. Must be adept at performing these cases including autologous breast reconstruction. • Provide a broad range of services including general plastic surgery, cosmetic surgery (breast augmentation, breast lift, abdominoplasty, body contouring, face lift, liposuction, eyelid lift, brow lift), microsurgical and implant-based breast reconstruction, maxillofacial trauma, and cancer/trauma reconstruction. • Participate in teaching, research, and program development – integrated Residency program • Benefit from an established reconstructive and cosmetic referral base, generated from Geisinger and private practice physicians and surgeons. Geisinger contact: Christian Kauffman, Chair Plastic Surgery – Geisinger, c/o Sarah Lipka, Physician Recruiter, at slipka1@geisinger.edu or 570-271-5406, or visit whygeisinger.org AA/EOE: disability/vet 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

Established Practice Seeking Plastic Surgeon North Atlanta Area Leading cosmetic and reconstructive plastic surgeon practice seeks a dynamic BC/BE surgeon. Expanding to a new location and need an energetic young plastic surgeon to take the lead in this new market while relying on an established and successful nearby office.

Metro-Atlanta Plastic Surgery Opportunity Busy 4 physician practice servicing the MetroAtlanta market with a AAAASF certified surgery center. Our practice is broad based, performing a wide variety of cosmetic and reconstructive cases. We are seeking a motivated BE/BC plastic surgeon to help continue our steady growth as part of a partnership track opportunity.

Located in the north Atlanta metro area, our offices are ideally located in areas that boast amazing schools, excellent housing options, great family-friendly communities, and access to a thriving cultural community.

Our practice includes a fully appointed team including administrative, nursing/MA and patient coordinator staff, as well as billing and surgical support staff, in our 14,000 sq. foot state of the art facility.

As a busy and growing practice, we are focused on finding a plastic surgeon with an entrepreneurial spirit, and a “Patient First” approach. This position has a strong and established referral base while also offering the applicant autonomy. We offer a competitive financial package that includes bonus, health insurance, paid vacation, and participation in the retirement program.

We are offering a very competitive package including base salary, productivity bonus, health and 401-K benefits, paid vacation and malpractice insurance coverage.

Must be able to start position by July 2022, but preferably earlier.

Send CV to j.cannell@plasticsurgerycorner.com.

Please email cover letter and CV for consideration to: KCPS.career@gmail.com Partnership Track, Plastic Surgeon Green Bay, Wisconsin BayCare Clinic is replacing a retiring Plastic Surgeon. Join a high-volume practice with a builtin referral base. BayCare is a physician-owned multi-specialty clinic based in Green Bay, WI. Practice is located in a new, state-of-the-art facility with ownership opportunity. This is a multidisciplinary group offering plastics, aesthetics and dermatology. Weekend call is 1 in 7. Green Bay is a family-friendly community located less than 2 hours from Milwaukee. Please contact Pam Seidl to learn more, pseidl@baycare.net.

Our suburban based practice, located minutes from Atlanta, offers an incredible opportunity, excellent quality of life, and is a tennis/golfer’s dream location.

Southern California/Long Beach Area Practice and equipment for sale. Retiring plastic surgeon. 80% cosmetic 20% reconstructive and hand. Established 1979. Fully equipped AAAASF OR. Medical Spa in building. Great potential for growth will assist in introductions and medical staff in medical staff privileges. michelle@face-doctor.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

LONG ISLAND PLASTIC SURGICAL GROUP, PC

SEEKING A BURN FELLOWSHIP TRAINED PLASTIC SURGEON TO JOIN OUR PRIVATE PRACTICE!

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 July/August 2021

Long Island Plastic Surgical Group (LIPSG) is the nation’s largest private academic plastic surgery practice serving Long Island and the New York metro area. Established in 1948, LIPSG has treated over a half a million patients and in addition, developed many of the region’s specialty centers including hand surgery, microsurgery, burn surgery, wound care, facial reanimation, peripheral nerve reconstruction, and cleft care. The practice maintains a well-established and strong local and regional referral base. The practice has contributed to resident education since 1954. LIPSG currently directs both an Independent and an Integrated ACGME accredited plastic surgery residency program, with 3 graduates per year. Our 22 plastic surgeons practice out of 8 affiliated offices, ambulatory surgery centers, and 25 primary hospitals covering a 100-mile radius. An average of 76,000 patient visits are completed annually. We are looking for an additional Board Certified/Board Eligible Plastic Surgeon that is burn fellowship trained with an interest in wound care to join this private academic practice. The applicant must have an interest in working within a private academic environment that allows flexibility. Our practice offers a full comprehensive benefit program and a competitive salary. Our main office is within 30 minutes of the best beaches, school systems, and the world class art and culture of New York City. Learn more about us at lipsg.com. If interested, please email resumes/CV to Gary Blank, DPM, MBA, at gblank@lipsg.com.

Thriving Plastic & Reconstructive Surgery Practice in Houston, Texas - Immediate Opportunity Memorial Plastic Surgery (MPS) is seeking a Board Certified/Board Eligible Plastic Surgeon to join their busy aesthetic and reconstructive plastic surgery group in Houston, Texas. This private practice offers a ready-made patient base with the opportunity to perform a broad spectrum of surgical procedures, including DIEP flap breast reconstruction and cosmetic surgery of the face, breast, and body inside a newly built medical facility with modern decor, private physician offices, office based surgical suites, and an on-site multispecialty Ambulatory Surgery Center. MPS is located in a premier location, within close proximity to downtown Houston and the Texas Medical Center (TMC), and offers diverse cultural dining, entertainment options, and excellent neighborhoods to raise a family. Competitive compensation models, investment opportunities, and partnership track offered to selected individual. Email an updated CV, cover letter, and headshot photo to: contact@memorialplasticsurgery.com to apply. 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. Atlanta Metro Area, Georgia Marietta Plastic Surgery is seeking an associate for their busy, thriving practice. The practice owns two office locations. One in Marietta and the other in Woodstock. There is a AAASF certified surgery center in their Marietta location with two OR’s. The practice offers the latest non-invasive, State of the Art aesthetic services. This is a robust aesthetic practice that a new associate can immediately start building their cosmetic practice and has a strong reconstructive referral base to get a new physician busy quickly. Our team consists of exceptional front and back office staff. Our ideal candidate would have first-rate educational credentials, fellowship trained, and a minimum of two years in practice. We are looking for a well-trained, highly qualified surgeon. The practice offers Health Insurance, Malpractice Insurance, 401K, and the opportunity for partnership. Interested applicants can submit an updated CV and cover letter to: Cathy@mariettaplasticsurgery.com NYC/Long Island Busy and growing NYC/Long Island aesthetic/ reconstructive practice seeking board eligible plastic surgeon w/hand Fellowship preferred, to join the practice. Two fully equipped and accredited AAAASF O.R.’s and Medical Spa. Competitive salary and benefits. To apply, forward CV to: huntingtonmanagementgroup@google.com Chicago Area Rush University and Copley Medical Centers in Chicago, Oak Brook and Aurora, IL, invite applications for a Plastic and Reconstructive Surgeon. Qualified candidates should possess Board Certification by the American Board of Plastic Surgery. Interested candidates can view the full job description by visiting https://www.joinrush. org/jobs/Plastic_and_Reconstructive_Surgery_-_ Clinical_Faculty/Aurora_Illinois/100/245165/. You may also visit www.joinrush.org.

CLASSIFIEDS

Plastic and Reconstructive Surgeon Swedish Medical Group is seeking a full-time, board-eligible/board-certified plastic and reconstructive surgeon to join an experienced plastic surgery team at Swedish Cancer Institute in Seattle, WA. In this role, you will have the opportunity to work closely with 3 other highly skilled plastic surgeons as you provide microvascular surgery for breast and body reconstruction, lymphedema treatment, and general plastic and reconstructive surgery. Swedish Cancer Institute is a comprehensive cancer center delivering personalized medicine and care. Come join a strong, dedicated, and dynamic team who is expanding our geographic footprint within a high tech and high touch patient environment at a state-of-theart facility in the beautiful bustling city of Seattle. • Microvascular Surgery Fellowship Trained • Board Certified/Eligible in Plastic Surgery • Work with subspecialty groups at Swedish within a multidisciplinary environment • At least 2 years of experience preferred If interested, contact Cindy Corson at Cindy. Corson@psdrecruit.org or call (425) 525-5873 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 our website at: 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. 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 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

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. Candidate must be a graduate of an accredited Plastic Surgery training program and an accredited Hand Fellowship. Must be board certified/ eligible in Plastic Surgery and eligible for a CAQ in Hand Surgery. Research experience which enables procurement of outside funding 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 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 #74165. 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 preference, status as a qualified individual with a disability, or status as a protected veteran. Busy Atlanta Plastic Surgery Practice Breast Body Beauty Plastic & Reconstructive Surgery is seeking BC/BE Plastic Surgeon to join our busy cosmetic & breast reconstructive practice in Atlanta, GA. Our practice has a strong reputation & referral sources to provide a range of breast reconstruction & cosmetic surgeries for the face, breast, & body. We are conveniently located between the suburbs & the city, allowing for an easy commute from multiple areas of metro-Atlanta. We present competitive compensation models & benefits. A partnership or investment track will be offered to our chosen candidate who desires a long-term relationship. Please send CV/cover letter to Gina@breastbodybeauty.com. Plastic Surgery Opportunity – Virginia Beach, VA Hubbard Plastic Surgery is a busy established 100% aesthetic private practice with over 20 years’ experience. Accredited in-office OR suite with an excellent reputation and 30% patient referral rate is looking to add a board-certified plastic surgeon associate to join the practice. This is an attractive opportunity for someone seeking to make a long term move and join the prestige and stability this practice has to offer. All interested candidates are encouraged to submit a cover letter along with resume to suzanne@hubbardplastic.com.

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 Surgeon for NY/NJ Private Practice Rowe Plastic Surgery, a well-established private practice with three busy, full-time plastic surgeons, is looking to hire a fourth surgeon for our northern NJ and NY offices. We currently perform a broad range of reconstructive and cosmetic work, including facial, breast, body and hand surgery, and are willing to expand further to support interests of fourth surgeon. New hire will be busy from day one, with full complement of office and clinical staff. Excellent balance of independent work and co-surgeon practice with strong web and PR support. Accepting BE/ BC candidates, micro training a must. Hand fellowship training a plus. Send CV and cover letter to mia@roweplasticsurgery.com and rissa@roweplasticsurgery.com

TRAINING 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, hands-on exposure to comprehensive facial surgery (customized face-lifting and rhinoplasty), primary and revisionary aesthetic breast surgery, breast reconstruction, body contouring surgery as well as independent operating experience. It also encompasses exciting and cutting edge non-invasive and minimally invasive technologies treatments including hair restoration and skin resurfacing.

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, implantbased 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.

The Fellow will be exposed to our full medical spa with a wide range of technologies, including skin tightening, body contouring and light and laser technologies. The clinical setting is a rewarding experience that emphasizes a full scale approach including patient management, assessment training, practice management, business strategy and leadership. There will also be formal injectable training with hands on experience during the fellow clinic. This Fellowship also has a strong mentorship component with monthly formal lectures/journal clubs. Educational engagement and research are expected with all expenses covered for accepted papers at the annual ASAPS meeting. There will also be opportunities to enhance education and training via nationally organized meetings, webinars and local preceptorships. Applicants to the Fellowship program must have completed a residency in a plastic surgery program accredited by the ACGME and be broad eligible or board certified in plastic surgery by the Fellowship start date and have or obtain an Oregon medical license prior to the start date. Competitive salary & optional call stipend. Health insurance and malpractice insurance are provided.

Do you have an idea for a PSN article?

The best stories in Plastic Surgery News often spring from a conversation with a plastic surgeon who says, “You know what would be a good story for PSN?” Whether it’s a trend you see among patients, a challenge you see in your practice or simply a topic you’d like to know more about – we encourage you to share it with the editors of PSN for a potential article. We’re also always on the lookout for interesting hobbies that help you unwind outside the O.R.; unusual ways you earned money during medical school; or accomplishments. If you’re an ASPS member with an idea for a good story in PSN, please contact Assistant Editor Jim Leonardo at jleonardo@plasticsurgery.org or by phone at (847) 981-5484.

For inquiries, contact niloo@drmovassaghi.com.

July/August 2021

CLASSIFIEDS Pediatric Hand and Microsurgery Fellowship Texas Children’s Hospital (TCH) in Houston Texas is offering a Fellowship in Pediatric Hand Surgery and Microsurgery beginning August 1, 2021. This Fellowship can be arranged as a six month to one year time period based on the applicant’s interest. Texas Children’s Hospital serves Houston and the surrounding area as a primary hospital and a tertiary referral center. The prerequisites for this Fellowship are successful completion of an ACGME-accredited residency in Plastic Surgery and an ACGMEaccredited fellowship in Hand Surgery. Applicants who have completed a similarly accredited residency in Orthopedic Surgery and Hand Surgery will be considered based on interest and interview. The Fellow will be appointed as an Instructor in Surgery at Baylor College of Medicine and will be compensated accordingly. Contact: William C Pederson, MD, FACS, FAAP, Head of Hand Surgery and Microsurgery, Texas Children’s Hospital. Email: wcpeders@texaschildrens.org

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

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. Ad Rates ■ 1 to 50 words: $165 ■ 51 to 100 words: $305 ■ 101 to 150 words: $440 ■ 151 to 200 words: $555 ■ 201 to 250 words: $763 ■ More than 250 words: Contact jembrey@plasticsurgery.org for “designed” ad options Designed Ad Rates ■ ■ ■ ■

1/8 page: $930 1/4 page: $1,440 1/2 page: $2,175 Full page: $3,195

To place a classified ad, email: Jeanne Embrey Advertising Coordinator jembrey@plasticsurgery.org Visit the Job Opportunity Board plasticsurgery.org/job.

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

eNLIGHTEN e-brochures also available!

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July/August 2021

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.

B I RTH DAY G I FT SPU RS AN O BSESSI O N WITH SCALE M O D ELS

ichael Diaz, MD, Melbourne, Fla., was in training when he was first told, “It’s easy to do plastic surgery, but it’s hard to do it well.” It’s a stance he relates to his hobby after straining for hours at a time to complete the increasingly rare scale-model kits he’s tracked down.

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.

If I had to start my career over, I would... Be just as focused, but I wish I would have thought more broadly about how patients are treated to achieve better outcomes. It wasn’t until my 12th year in practice that I did a surgical breast oncology Fellowship – which has changed the way I practice and improved my patients’ outcomes with regard to surgical complications and satisfaction.

“Anybody can build a model kit,” Dr. Diaz says. “Doing a good job is hard, but the hardest part is determining its final appearance: What colors will I give it, and do I want it to look like a factory reproduction or something that was never produced by the auto manufacturer? My focus is on vintage, large-scale endurance race cars and muscle cars – and during the pandemic shutdown, I completed my favorite project so far: a 1/16th scale of the 1979 Porsche 928 featured in Risky Business with Tom Cruise – down to the same color schemes and factory-matched colors, including the two-tone interior. I executed it just as I wanted.” Dr. Diaz has completed five scale model kits since renewing the interest that began when he was a boy and revived by the recent birthday gift from his wife of an airbrush. “I’d build model kits as best I could, but they never came out that good,” he recalls. “When I got the airbrush, I figured I could revisit that hobby and do good work this time. It became an obsession.”

The best thing I ever purchased for my office was... Custom-made chairs, tuffet and mirrored cabinet. I’d been at the University of Pennsylvania for more than a decade and hadn’t put any effort into my office. When we moved into our current offices on the 14th floor of one of the newer buildings, I wanted an office that I enjoyed going to every day. The chairs are pink velvet and tufted, with nailhead trim and a matching tuffet. The piece de resistance is my mirrored bar cabinet.

Building a scale model, like plastic surgery, relies Dr. Diaz last year completed a 1/16th scale of the 1979 heavily upon dexterity, the Porsche 928 featured in Risky Business with Tom Cruise – final appearance and the tools down to the same color schemes and factory-matched colors. required. The gap between the two isn’t as large as people might think. “With aesthetic plastic surgery, you create a plan regarding what you’ll do in the O.R., then you execute it,” he says. “Little details add up to a lot. Most patients end up with a good result and don’t appreciate the small details, but as plastic surgeons, we do. Little things mean a lot in surgery and with scale models. “My techniques have improved in the O.R. because I’m better at foreseeing how something will turn out,” Dr. Diaz adds. “For instance, after I make a breast-lift mark, I can foresee the final contour and adjust as needed. Like scale modeling, I pre-test it before I commit – and sure enough it tends to come out better. That could be due to experience, but because I’m executing these techniques on scale models and in my free time, the concepts translate better into the O.R. There’s no way to separate those.” Those threads are drawn tighter through tools. “The instruments I use in the O.R. are very similar to those for building a scale model,” he says. “I use bent pickups, needle holders and bulldog clamps but different sets of blades – in modeling and the O.R., there’s a different blade for every step.” Dr. Diaz estimates that a properly built-and-painted scale model requires about 40 hours of work – but finding the kits also can be challenging. “When I locate one I’ve wanted, it’s a score – so it’s fun just to find them. I’m trying to accumulate all the cars I want to build, but I still have more kits than I could possibly finish. It’s fun to have them and imagine that I’ll eventually build them all.” In the long run, Dr. Diaz’s scale models still can amount to more than challenges overcome and rare kits found. They may actually help keep the peace on the domestic front. “By doing this, I get to ‘own’ all the cars I wanted as a kid,” he says. “It’s a lot cheaper – which has kept me out of trouble at home.” PSN

25 YEARS AGO IN PSN The ASPRS Board of Directors, during its summer meeting in Washtngton, D.C., voted to launch the Plastic Surgery Education Campaign as a way “to promote the cosmetic sides of members’ practices in the coming years.” A preliminary look at the campaign was printed in the August 1996 issue of PSN: “We’ve put out an excellent program to cope with managed care, but in spite of that, our members continue to say they have diminishing income, problems with managed care and that they need to reinforce their practices in cosmetic surgery... We need to brand ASPRS membership to the public as representing the highest quality of cosmetic surgeons.” – 1996 ASPRS President-Elect Ronald Iverson, MD Danville, Calif. PSN

In this issue, we present ASPS member Liza Wu, MD, MBA, Philadelphia, director of Microsurgery Fellowship and professor of Surgery at the Hospital of the University of Pennsylvania and Children’s Hospital of Philadelphia. Dr. Wu is a member of the ASPS Annual Meeting Educational Program Committee and co-chair of the Annual Meeting Council, has served on several Society panels and committees – and she recently completed studies in the Wharton Executive MBA Program. Between trying to figure out how to keep office plants alive and hitting the tennis courts, Dr. Wu found time to answer the following questions for PSN:

Liza Wu, MD, MBA

The worst thing I ever purchased for my office was... Plants. I’ve somehow managed to kill every one of them. I even had one stolen from me.

An operation that I no longer perform is... Fat-grafting lumpectomy defects. The results are modest and seem to deteriorate over time. It can also lead to scar and fat necroses that result in palpable masses and changes in mammograms that cause anxiety for the patient. My all-time favorite movie is... The Princess Bride. Murder, mystery, love, comedy – what more could you want? The last book I read was... The Power of One by Bryce Courtenay. It’s about a boy growing up in the 1930s and 1940s in South Africa. Peekay, the protagonist, tells his coming-of-age story about struggle and hardship, and how perseverance and resilience allowed him to overcome his greatest enemies. The book is actually 30 years old; it just took me awhile and a pandemic to get around to reading it. The best vacation I (Above) Dr. Wu poses with her daughters, ever took was... To Brooklynn, 8 (left), and Kendall, 7, and her husJordan and Israel. We band, Brad Hartwell, during stop at the Grand hiked Petra, swam in the Canyon this past spring; and (left) with Brad at a wedding in New York in 2020. Dead Sea, went to a bat mitzvah in Masada and visited Jerusalem. I remember being profoundly affected when visiting the Western Wall, Church of the Holy Sepulchre, the Temple Mount and the al-Aqsa Mosque. During the shutdown, something outside of medicine that I worked on was... Taking time for my health. I started to run every day and play tennis. I realized how much I deprioritized my own wants and needs for work and family. I couldn’t operate without my... Loupes and headlight. I perform all my flap dissections and anastomoses with loupes – and as my eyes get older, I need both that and a headlight. The best part of next weekend will be... Taking some time off to spend the Fourth of July with my family. The biggest surprise I ever had in the O.R. was... When I cut through the perforator on a one-vessel DIEP in my 15th year of practice. Having done thousands of flaps, very little surprises me. This was a reminder that you should never become complacent in your work when you’re given the responsibility to help patients through your skills as a surgeon. The words I try to live by are... “Live your life in a way that you will regret nothing.” PSN July/August 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.

July/August 2021

MENTOR Silicone Gel 1 Implants Are Safe and Effective ®

Your Trusted Partner Then, Now & Into the Future

NEARLY

OVER

Patients highly satisfied at 10 years with MemoryGel® Breast Implants3

YEARS

in Breast Aesthetics

Clinical Studies

200K Women

Participated 4-13

MILLION

Women with MENTOR® Breast Implants

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

Plastic Surgery News, July/August 2021

Articles inside

Q&A with HHS Assistant Secretary for Health Rachel Levine, MD

COVER: Live from Atlanta

Getting involved in World Plastic Surgery Day

PRS raises its own bar – again

A unique kind of training experience