Commentary on: Aesthetic Surgery in Plastic Surgery Academia

It is no secret that academic aesthetic surgery is somewhat of an oxymoron. Most residents are concerned about their training in aesthetic surgery, always “wishing they could do more.” The paper by Eaves et al¹ provides a needed, evidenced-based perspective on the status of academic aesthetic surgery in the United States. Additionally, it offers suggestions that may be used to strengthen this essential element of every training program in our specialty.

The authors report the results of an exhaustive, 122-question “Audit of Aesthetic Surgery” survey of plastic surgery training. The survey focused on (1) what business practices contribute to a successful aesthetic program, (2) the competence and training of the program’s residents, and (3) necessities and barriers to a successful academic aesthetic practice. Using this 2018 survey’s results, a group of concerned chairs and chiefs of plastic surgery, the Academic Aesthetic Surgery Roundtable (AASR), met to discuss the results and develop a consensus of the data obtained, while adding their own anecdotal experience. Considering the survey’s length, it had a remarkably high 70% response rate.

Academic aesthetic surgery has several barriers to a robust practice in academia; these include a system-wide and frequently unappreciative, unsupportive bureaucracy; limited access to market share; inability to provide an aesthetic “experience” to prospective cosmetic patients; and the inherent stigma of “a resident doing my cosmetic surgery” mindset of the consumer. These combine to make a difficult circumstance almost untenable in some programs. Regardless, this paper provides hope, and good data, for the 28% of “not strong aesthetic surgery training” programs, a category the authors describe that is based on the program’s observation that their residents do not receive adequate exposure and experience in aesthetic surgery. At the same time, over 70% of chairs/chiefs felt that their residents received adequate exposure and experience in aesthetic surgery (defined as “strong aesthetic surgery training”).

Not unsurprisingly, two-thirds of programs responded they do not have a dedicated (>50%) aesthetic practice faculty member, although over 80% of chairs/chiefs had a real desire to increase the aesthetic volume in their programs. About one-third of programs had a dedicated aesthetic center and, surprisingly, 75% of respondents stated their facility fees were “on par with” or “a little higher than” their private practice counterparts. A large majority of programs judged their advertising to be “very bad” or “poor,” even though much of it was self-funded. This was attributed to a lack of information technology support at an institutional level.

As expected, programs with 1 of the 24 aesthetic fellowships with The Aesthetic Society and with overnight surgical facilities had “revenue-positive practices” that were identified as “strong aesthetic surgery training” programs. The most important information from this paper is collated in Figure 7, which ranks the barriers to a strong academic aesthetic practice. A “not strong aesthetic surgery” program could use these challenges as a template to determine the feasibility of expanding their aesthetic surgery volume.

The authors have done a commendable job of collating most of the recent reports on aesthetic surgery in the academic setting. I particularly appreciate the suggestions in the Discussion section regarding faculty and staff support, the necessity of institutional support in growing an aesthetic practice in academic medical centers, and the need for a dedicated aesthetic center that is promoted by effective marketing. A rudimentary resident aesthetic clinic should be a reasonable start for any program.

I would have liked to know whether departmental status influenced the strength of aesthetic surgery and what role institutional support played in those programs. The identities and number of AASR members are not stated. I would also like to see future activity of the AASR. It seems that there is now a groundswell of interest in further improvement in aesthetic training, and this group might be the vehicle to move that forward.

As opposed to most other areas of plastic surgery (eg, congenital, trauma, burn, wounds), anyone with more than a passing interest in aesthetic surgery will continue lifelong learning in aesthetic surgery using the many resources available. Based on 3 decades of training residents, regardless of the quality/quantity of aesthetic surgery in their training, a trainee with an interest in aesthetic surgery will always avail themselves of the wonderful resources available through The Aesthetic Society. These include courses and panels at the annual meeting, as well as 2- and 3-day postgraduate and online courses that cover the scope of aesthetic surgery. Members of The Aesthetic Society regularly produce books that include the entire gamut of aesthetic surgery. Of course, the premier journal for aesthetic surgery is Aesthetic Surgery Journal, which has a multitude of articles, video instruction, continuing medical education courses, and a variety of innovative Internet tools to keep surgeons abreast of developments in aesthetic surgery. Considering these resources and the data presented by the authors, a chair/chief of a plastic surgery program who wants to make his program stronger in aesthetic surgery should be able to do so.

Disclosures

The author declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The author received no financial support for the research, authorship, and publication of this article.

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Author notes