AMA Plastic Surgery Resident

[caffeinemia]

It's Saturday morning and I am in the regret phase of the work-drink-regret cycle. So ask away, if you're curious about this small but awesome specialty.

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[Womb Raider]

Do most people who want to do plastics try to get into one of the integrated residency programs? What are the pros/cons for the GS route?

 

[C@lidoc]

Can you give us a run down on how you did in med school? Any specific research projects in plastics? What advice can you give to someone that's entering med school and might be interested in plastics?

 

[Psai]

what year are you

 

[fancymylotus]

Can I take over your thread and turn into the FML show?

 

[drmak89]

How early in medical school did you realize you wanted to do plastics?

I am afraid of finding out that want to do a speciality (competitive or not) in say 3rd year & I wouldn't have enough time to tailor my app for it.

 

[mcloaf]

What's your favorite procedure and why?

 

[Rainbow Zebra]

It's Saturday morning and I am in the regret phase of the work-drink-regret cycle. So ask away, if you're curious about this small but awesome specialty.

When I review the Plastic Surgery faculty at various institutions, it is surprising the dearth of female faculty. When I look at the academic institutions residents, there appears to be more gender diversity at the resident/fellow level. Why was it such a male dominated profession 15-20 years ago? Has the profession changed to make it more female friendly, or just a cultural shift "requiring" more gender balance?? Will I be counseled to "freeze my eggs" if I pursue a plastic surgery career? Looking at other surgical specialties, there is still a male majority, but seems particularly striking in Plastics. What is your opinion on this.

Also, I have done my research on the genetics of cleft palate, so I have an interest in learning more about plastic surgery and how this works with ENT and Maxo/facial surgeons. What would you recommend as a way to learn more about this, as I haven't been successful in getting a shadowing opportunity at my academic institution. Many thanks in advance for your advice.

 

[caffeinemia]

Do most people who want to do plastics try to get into one of the integrated residency programs? What are the pros/cons for the GS route?

It's my opinion that if you know you want to be a plastic surgeon by the third year of medical school, you should pursue an integrated residency program.
It has the following advantages over the GS-->fellowship path:
- Shorter length of training (6 or 7 years PRS + 1-2 year subspecialty fellowship versus 5-7 years GS residency + 3 year plastics fellowship +/- 1-2 year sub specialty fellowship).
- Quicker exposure to operative experience in plastic surgery. (In other words, you may get bored spending 5 years learning how to do endoscopic cholecystectomies, which won't really make you a more competent plastic surgeon)

The disadvantages are:
- More difficult match process -- typical match rate is about 40-50%; versus the GS->fellowships, which typically have a 70-90% success rate.
- Poor GS know how, poor ICU know how, because of shorter experiences in both these realms. I gladly accept that I will never ever be competent in the abdomen or thorax. I will also never be able to care for anything beyond a free-flap in the SICU. That said, I hate the SICU, so some people might see this as an advantage.

Can you give us a run down on how you did in med school? Any specific research projects in plastics? What advice can you give to someone that's entering med school and might be interested in plastics?

I was not an AOA candidate. I also did not honor medicine or surgery... or any other rotation. I was just too much of a jackass to tow the typical med student subservience without a reason. For example, I didn't stay late to deliver an extra baby because it would get the ObGyn resident to like me more (unless she/he was hot). I did the required amount of work and learning when I wasn't interested and no more. I knew what my exact interests were and could always find better use of my time... which leads me to the following:

I scored above 250 on step I and did a dedicated year of clinical + basic science research, which continued in my clinical years. I had 10+ publications, presentations, etc. My mentors in research wrote excellent letters. PRS, like most subspecialty surgical communities, is very tight knit, and LORs are probably the most important deciding factor at the end of the day IMHO. Attendings call each other and talk about you too!

Advice - if you want to do plastics, start looking into it early. Try to get clinical research opportunities early. Take Step I seriously. Get attendings to like you. They really are the power brokers in the world of academic plastics.

what year are you

I'm living in 2015. What year are you in?

You can skip the regret phase if you cycle quickly enough

I will have to experiment. Hard to speed-sip bourbon.

Can I take over your thread and turn into the FML show?

I'm not sure what the FML show is, but is it hot?

Not a plastics resident, but yes, most people go the integrated route.

The number of positions available in the general surgery route are dwindling.

Pros to general surgery:
-Easier to get a residency slot compared to plastics

Cons to general surgery:
-Everything else (signed, a proud general surgery resident)

Get out of my thread, foo. JK. You can stay....if you're hot.

How early in medical school did you realize you wanted to do plastics?

I am afraid of finding out that want to do a speciality (competitive or not) in say 3rd year & I wouldn't have enough time to tailor my app for it.

I started reaching out to faculty, researching, studying for Step I after my first year summer. I learned about plastics early and got hooked up early. It's hard to get hooked up in the middle of your third or fourth year. That usually requires a year off to make it happen. I do recommend committing early. You may say... what if I change my mind? But I counter that as you get older, you will find that you will experience the opportunity costs of each choice more intensely. In other words, too bad.

What's your favorite procedure and why?

I love breasts. I think a well done TUG or DIEP is super cool. However, I think a paramedian forehead flap to reconstruct a nasal dorsum/tip is pretty schweet too. That brings me to another wonderful thing about plastics -- we do all sorts of ridiculous things, and it's great variety. You really never get bored... at least in residency you don't. But if you become an attending and specialize in labiaplasties, then that's your thing.

 

[fancymylotus]

I love breasts.

 

[ridethecliche]

VRAM flap brah.

Do you even plastics?

 

[caffeinemia]

When I review the Plastic Surgery faculty at various institutions, it is surprising the dearth of female faculty. When I look at the academic institutions residents, there appears to be more gender diversity at the resident/fellow level. Why was it such a male dominated profession 15-20 years ago? Has the profession changed to make it more female friendly, or just a cultural shift "requiring" more gender balance?? Will I be counseled to "freeze my eggs" if I pursue a plastic surgery career? Looking at other surgical specialties, there is still a male majority, but seems particularly striking in Plastics. What is your opinion on this.

Also, I have done my research on the genetics of cleft palate, so I have an interest in learning more about plastic surgery and how this works with ENT and Maxo/facial surgeons. What would you recommend as a way to learn more about this, as I haven't been successful in getting a shadowing opportunity at my academic institution. Many thanks in advance for your advice.

To be honest, I think surgery was very much another old boy's club 20-30 years ago. However, all of surgery, not just plastics, is moving towards being more inclusive of women. I am happy that we are taking this direction. I think it may be cultural and the realization that it's actually advantageous to have intelligent and able women in the workplace. Why would we want to leave 1/2 the Millards of the world at home? If anyone tells you to freeze your eggs, I'd kindly tell them to f*** off.

I can think of a number of major academic centers who routinely take female residents who are married and plan to start families during residency. I know a couple of residents who had 2 kids in residency. I think that being sexist is falling out of fashion in the plastics world -- or at least the plastics world that I know.

And on a side note, our female chiefs are some of the most capable chiefs at conflict resolution and surgical technique that I've met. These seemingly disparate traits are huge assets in a residency. It can be a testy time.

I think the major issue with residents taking time off during pregnancies is the issue of coverage. Most programs are actually underpowered and do not have enough residents to cover the tremendous plastics volume out there. Therefore, if you do plan on starting a family, it will be critical to find a supportive program director and co-residents. It will also be important for you to be reasonable and continue to do your fair share of the duties. For example -- it's simply narcissistic to think that because you have a child at home, that you should take less call.

Regarding your cleft interest -- most cleft cases are not treated by your run of the mill plastics practice. It usually requires a children's hospital with a cleft center and pediatric or craniofacial trained plastic surgeons. I would look for those faculty specifically and email them. If you have time to do aways, I would look into centers with pediatric craniofacial centers of excellence. ENT and OMFS will typically be involved in cleft centers because clefts can involve the dentition/alveolus and cause eustachian tube dysfunction. Some ENT and OMFS surgeons may be able to do clefts by themselves, but in my experience, plastics takes the majority of the cleft volume.

However, plastics is a big wide world. Though you have a specific research background, I would advise exploring everything else that your local program can offer in plastics as well.

I knew you would love that.

 

[caffeinemia]

VRAM flap brah.

Do you even plastics?

Indication? Or do you just spout random flaps for status? In that case, fibula osteocutaneous free flap, radial forearm fasciocutaneous free flap, superior gluteal artery perforator fasciocutaneous free flap, innervated gracilis free flap, anterolateral thigh fasciocutaneous free flap. You want more?

 

[JPA178]

Indication? Or do you just spout random flaps for status? In that case, fibula osteocutaneous free flap, radial forearm fasciocutaneous free flap, superior gluteal artery perforator fasciocutaneous free flap, innervated gracilis free flap, anterolateral thigh fasciocutaneous free flap. You want more?

Dat VRAM doe. Nothing like a good VRAM for complex pelvic defect closure.

 

[caffeinemia]

Dat VRAM doe. Nothing like a good VRAM for complex pelvic defect closure.

Well glad you have an indication! Some authors have advocated ORAM for extended reach. Care to elaborate?

 

[JPA178]

As a plastics resident, do you see yourself doing a micro or aesthetic fellowship in the future? I think micro is awesome but it almost seems to me that if you want to do the interesting, complex cases and lots of different free flaps, you end up having to work in an academic setting. Is that pretty much the case?

 

[caffeinemia]

As a plastics resident, do you see yourself doing a micro or aesthetic fellowship in the future? I think micro is awesome but it almost seems to me that if you want to do the interesting, complex cases and lots of different free flaps, you end up having to work in an academic setting. Is that pretty much the case?

I can pretty much guarantee you that anyone coming out of my program will not need an aesthetic fellowship. But it may differ from programs with less exposure and volume. Aesthetics is definitely not the most challenging set of surgeries in plastics, IMHO. Granted, rhinos scare me and I hate/love them.

Regarding micro, working in an academic setting may help with getting privileges and referral base which can help start up a complex recon practice. It's hard to say - oh I want an elective lower extremity flap practice. However, some centers are very idiosyncratic and still rely on private doctors who are consulted to provide specialty care for inpatients/intraop patients. In that case, a hybrid situation may still work out. And finally, if you are one of two or three plastic surgeons out in podunk Alaskabama or whatever, you may be doing everything, whether you like it or not.

 

[JPA178]

Well glad you have an indication! Some authors have advocated ORAM for extended reach. Care to elaborate?

Hah, well I worked on a systematic review of pelvic defect reconstruction that included a number of studies, the majority of which discussed the VRAM in those cases with complex closure of pelvic defects (following anal cancers, sacrectomy, etc). It's been a little while though and I'm not a resident like you! ORAM = oblique rectus abdominus, right?

 

[Make Or Break]

Indication? Or do you just spout random flaps for status? In that case, fibula osteocutaneous free flap, radial forearm fasciocutaneous free flap, superior gluteal artery perforator fasciocutaneous free flap, innervated gracilis free flap, anterolateral thigh fasciocutaneous free flap. You want more?

Yes please.

 

[Make Or Break]

Do you get more women now than before?

 

[caffeinemia]

Do you get more women now than before?

Understanding women is only a minor part of the plastic surgery curriculum.

 

[Make Or Break]

Understanding women is only a minor part of the plastic surgery curriculum.

What is usually the reaction when you say you are a plastic surgeon?

 

[fancymylotus]

What is usually the reaction when you say you are a plastic surgeon?

 

[Slack3r]

Thoughts on "facial plastic surgeons" trained through ENT +fellowship (1 yr FPRS)?

Also sent you a pm.

 

[ridethecliche]

Dat VRAM doe. Nothing like a good VRAM for complex pelvic defect closure.

Hell yes

Well glad you have an indication! Some authors have advocated ORAM for extended reach. Care to elaborate?

I mean I like all sorts of this stuff and I think I've seen some orams as well as hamstrings (forget what those are called).

Mostly for pelvic and sacral tumor reconstruction. Gnarly.

I wish all flaps could be free.

FREE THE FLAPS!

 

[caffeinemia]

Thoughts on "facial plastic surgeons" trained through ENT +fellowship (1 yr FPRS)?

Also sent you a pm.

Replied to your PM.

Generally: injectables, rhinoseptos, blephs and brows all day. Can be fun if you like it. ENT is its own unique discipline and has lots to offer too.

 

[caffeinemia]

Hell yes



I mean I like all sorts of this stuff and I think I've seen some orams as well as hamstrings (forget what those are called).

Mostly for pelvic and sacral tumor reconstruction. Gnarly.

I wish all flaps could be free.

FREE THE FLAPS!

The vascularly leashed ones can be quite sexy too. Not everything should hang freely.

 

[ridethecliche]

The vascularly leashed ones can be quite sexy too. Not everything should hang freely.

Next time we have one of these cases, I'm going to see if I can watch the majority of the VRAM/Complex Closure. Might as well see it while I can.

(I was just talking out my ass about the free flaps.)

 

[Psai]

if that's the kind of woman that plastic surgeons pull i think i'll take my chances on something else

 

[caffeinemia]

Next time we have one of these cases, I'm going to see if I can watch the majority of the VRAM/Complex Closure. Might as well see it while I can.

(I was just talking out my ass about the free flaps.)

Consider seeing some aesthetic, breast, hand procedures as well. You may find them very interesting. A well done reduction/pexy can change a life. It's actually a procedure with one of the highest satisfaction rates in our profession.

 

[username456789]

How much hands on injectable cosmetics do you guys do in residency (Botox, fillers, etc), and do residents perform it at a discounted cost?

Curiously mostly because many of my colleagues at other programs (in Derm) have wildly varying answers to this. Some institutions don't allow discounting these services. Some also seem to view obtaining product from the companies as "sampling" and have a strict no samples policy, effectively barring residents from meeting ACGME cosmetic requirements without seeking it in private practice.

 

[ridethecliche]

Consider seeing some aesthetic, breast, hand procedures as well. You may find them very interesting. A well done reduction/pexy can change a life. It's actually a procedure with one of the highest satisfaction rates in our profession.

Pexy?

I actually had some facial restorative work done at UPenn in college after an accident in college broke bones/teeth and lacerated my face. Good times.

 

[caffeinemia]

Our residents run several cosmetic and general plastics clinics where they do have experience with injectables. We also have a huge network of private attendings who often invite us to learn from them. Nurses love when this happens. We are introduced to fillers and injectables from very early in our training.

Every institution and residency has different policies as you have stated, so I cannot speak to how much Derm residents are allowed to do. I know we have no issue with injectables.

How much hands on injectable cosmetics do you guys do in residency (Botox, fillers, etc), and do residents perform it at a discounted cost?

Curiously mostly because many of my colleagues at other programs (in Derm) have wildly varying answers to this. Some institutions don't allow discounting these services. Some also seem to view obtaining product from the companies as "sampling" and have a strict no samples policy, effectively barring residents from meeting ACGME cosmetic requirements without seeking it in private practice.

Pexy?

I actually had some facial restorative work done at UPenn in college after an accident in college broke bones/teeth and lacerated my face. Good times.

Cool, that should inspire you to be a plastic surgeon 😀

Pexy = lift/pinning; therefore, mastopexy = breast lift.

 

[caffeinemia]

What is usually the reaction when you say you are a plastic surgeon?

"So you don't take care of real problems, right?"

 

[Guero]

Thanks for taking the time to start this thread @caffeinemia. It's so helpful to read perspectives and have an opportunity to ask questions early.

 

[caffeinemia]

Hah, well I worked on a systematic review of pelvic defect reconstruction that included a number of studies, the majority of which discussed the VRAM in those cases with complex closure of pelvic defects (following anal cancers, sacrectomy, etc). It's been a little while though and I'm not a resident like you! ORAM = oblique rectus abdominus, right?

You're pretty much right. Are you looking to match PRS? If so, congratulations on a great career choice!

 

[The Buff OP]

Can I take over your thread and turn into the FML show?

I see that you are here on the pre-med and medical forums frequently, nothing wrong with that 😉. Do you wish you would of gone to medical school instead?

 

[caffeinemia]

Thanks for taking the time to start this thread @caffeinemia. It's so helpful to read perspectives and have an opportunity to ask questions early.

You're welcome. Enjoy!

 

[ridethecliche]

I see that you are here on the pre-med and medical forums frequently, nothing wrong with that 😉. Do you wish you would of gone to medical school instead?

HAHAHHA BURNNNNNN!!!

 

[Make Or Break]

I see that you are here on the pre-med and medical forums frequently, nothing wrong with that 😉. Do you wish you would of gone to medical school instead?

The med school crowd turns her on

 

[Make Or Break]

You're welcome. Enjoy!

Please stay cool and don't become jaded like some of the other residents who frequented the pre allo board 🙂

 

[fancymylotus]

I see that you are here on the pre-med and medical forums frequently, nothing wrong with that 😉. Do you wish you would of gone to medical school instead?

totes!

 

[caffeinemia]

Please stay cool and don't become jaded like some of the other residents who frequented the pre allo board 🙂

I'm already jaded, but I'm still trying to be cool. Trying too hard.

 

[Make Or Break]

I'm already jaded, but I'm still trying to be cool. Trying too hard.

More dad jokes! You need more dad jokes!!

 

[The Buff OP]

totes!

Go for it. There's this plastic surgeon who was a dentist and then went back to medical school and he finish his residency in his 40s.

 

[fancymylotus]

Go for it. There's this plastic surgeon who was a dentist and then went back to medical school and he finish his residency in his 40s.

That was sarcasm. Guess it didn't translate well over the internets. I had/have 0 interest in going to medical school(I graduated and joined the family business), but a lot of my SDN friends post in pre allo and allo, and the teeth forums are mostly super boring.

 

[The Buff OP]

That was sarcasm. Guess it didn't translate well over the internets. I had/have 0 interest in going to medical school(I graduated and joined the family business), but a lot of my SDN friends post in pre allo and allo, and the teeth forums are mostly super boring.

Oh, don't play games with me, girl. 😵😉 That's cool, a family dentistry place. 👍

 

[The Buff OP]

HAHAHHA BURNNNNNN!!!

 

[caffeinemia]

LOL. escharotomies and STSG. Plastics has an answer for everything.

 

[JPA178]

You're pretty much right. Are you looking to match PRS? If so, congratulations on a great career choice!

I'm glad you like it, it seems like you really enjoy it! I've thought about doing PRS for sure. I've got some time though - I'll be an MS1 in the fall, but I worked with a plastics research group at another institution for over a year. I'm also interested in Urology, so if I don't go that route, I will probably start with Gen Surg and look at doing a plastics fellowship if the interest is still there. However, I'm very interested in minimally invasive surgeries (hence my interest in Uro), and you don't really get that in plastics. In fact, I've heard that's what draws a lot of people toward plastics. But of course, my experiences in med school may change my mind. I'm definitely planning on doing some sort of surgery at this point, though, because I really enjoy being in the OR.

Thanks for taking the time to answer questions today!