how legit is oculoplastics for facial procedures?

[soonmd1]

Hi all
At my university, oculoplastics is pretty much shunned. A plastic surgeon went as far to tell me it's the illegitimate child of plastic surgery...oculoplastics shares trauma call with omfs ent and plastics but they still don't seem that well respected. When I shadowed an oculo guy he was even doing rhinoplasties (with excellent results) and seemed really confident so there was def a discrepancy.


Is this how it is at other institutes at well? If so why?

If you really like just facial plastic procedures is oculoplastics a good way to go? Are there places that train you beyond just the orbit? How far beyond the orbit do most oculo ppl go?

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[Visionary]

Hi all
At my university, oculoplastics is pretty much shunned. A plastic surgeon went as far to tell me it's the illegitimate child of plastic surgery...oculoplastics shares trauma call with omfs ent and plastics but they still don't seem that well respected. When I shadowed an oculo guy he was even doing rhinoplasties (with excellent results) and seemed really confident so there was def a discrepancy.


Is this how it is at other institutes at well? If so why?

If you really like just facial plastic procedures is oculoplastics a good way to go? Are there places that train you beyond just the orbit? How far beyond the orbit do most oculo ppl go?

You're experience is fairly typical. Actually, most institutions don't even have oculoplastics share face call. In my (limited) experience, most oculoplastics docs don't go below the maxilla. They essentially stick to the orbit and surrounding structures. There are some who do mid-face lifts and such, but that's uncommon. The fellowships are variable. Some are mainly cosmetic (e.g., lids, Botox), whereas others involve more orbital trauma and reconstruction. As far as why it's this way, I suspect it has to do with the evolution of the system. Ophthalmology originally arose from EENT. Some practitioners were likely comfortable working on more of the face than others. They trained docs who followed, etc. I know of one ophthalmology-trained oculoplastics doc who essentially shuns his own background and identifies more with plastics and ENT docs. He seems to think ophthalmology residents are ignorant and lazy. Go figure.

 

[MR1]

Ours just stay in the orbit. I have heard there is GREAT variability in fellowship training as Visionary said and have heard of oculoplastics folks that do face lifts, rhinos, etc. They are well respected at my institution also.

I think the question you have to ask yourself is, first what if you don't get a fellowship. Oculoplastics and facial plastics via ENT is super competitive, would you rather do cataracts or PE tubes (obviously more than that but you get what I mean).

Second do you want to do large reconstructions of the face and total facial plastics or do you want to do just eyelid recon (cutler-beard, hughes, etc) and eyelid plastics (lid tightening, blephs, ptosis repair, etc).

I would not go the ophtho\oculoplastics route if you wanted to mainly do facial plastics, I think ENT then facial plastics fellowship is your best option

 

[orbitsurgMD]

Hi all
At my university, oculoplastics is pretty much shunned. A plastic surgeon went as far to tell me it's the illegitimate child of plastic surgery...oculoplastics shares trauma call with omfs ent and plastics but they still don't seem that well respected. When I shadowed an oculo guy he was even doing rhinoplasties (with excellent results) and seemed really confident so there was def a discrepancy.


Is this how it is at other institutes at well? If so why?

If you really like just facial plastic procedures is oculoplastics a good way to go? Are there places that train you beyond just the orbit? How far beyond the orbit do most oculo ppl go?

I don't know many doing rhinoplasties (I don't do them) but there are some who do. Some oculoplastic fellowships are seeking dual facial plastic surgery certification in addition to fulfilling the ASOPRS qualifications. The latter really doesn't open many doors when dealing with hospitals and surgery centers, where demonstrating some kind of qualification to do facial plastics procedures may be necessary for credentialing.

"Core" oculoplastics requires being able to go beyond the orbit. Graft harvests commonly require operating at other non-periocular and non-cranial locations. A complete repertoire of oculoplastic skills requires familiarity in harvesting mucosa, hard palate, auricular cartilage, skin, fascia lata, cutaneous-fat autograft, inferior orbit approaches requiring Caldwell-Luc incision and trans-antral access, orbit reconstruction requiring bone grafting, midface lifts for both functional/reconstructive and cosmetic indications, and forehead flaps for similar reasons. Rhinoplasty requires similar skills, so it shouldn't be beyond the abilities of an oculoplastic surgeon.

Most universities with a strong ophthalmology department and good departmental leadership will not have neglected oculoplastics, and generally most academic oculoplastics specialists will at least make a collegial effort to know their colleagues in general and facial plastics, skull-base, OMFS and neurosurgery, at least that is how things ought to be.

 

[docdoc2012]

I don't know many doing rhinoplasties (I don't do them) but there are some who do. Some oculoplastic fellowships are seeking dual facial plastic surgery certification in addition to fulfilling the ASOPRS qualifications. The latter really doesn't open many doors when dealing with hospitals and surgery centers, where demonstrating some kind of qualification to do facial plastics procedures may be necessary for credentialing.

"Core" oculoplastics requires being able to go beyond the orbit. Graft harvests commonly require operating at other non-periocular and non-cranial locations. A complete repertoire of oculoplastic skills requires familiarity in harvesting mucosa, hard palate, auricular cartilage, skin, fascia lata, cutaneous-fat autograft, inferior orbit approaches requiring Caldwell-Luc incision and trans-antral access, orbit reconstruction requiring bone grafting, midface lifts for both functional/reconstructive and cosmetic indications, and forehead flaps for similar reasons. Rhinoplasty requires similar skills, so it shouldn't be beyond the abilities of an oculoplastic surgeon.

Most universities with a strong ophthalmology department and good departmental leadership will not have neglected oculoplastics, and generally most academic oculoplastics specialists will at least make a collegial effort to know their colleagues in general and facial plastics, skull-base, OMFS and neurosurgery, at least that is how things ought to be.

orbitsurg, is the dual facial plastics certification in the near future for most programs do you think? Also, from what I understand the salary potential with oculoplastics is nowhere near traditional plastics and is only slightly above that of a general ophtho. The field is intriguing regardless of salary, but I was wondering why that is? is it a volume issue or because they just don't do bigger procedures?
also, i guess, just for curiosity, do you mind sharing some of your own most intense procedures 😀 ?thanks!

 

[orbitsurgMD]

orbitsurg, is the dual facial plastics certification in the near future for most programs do you think? Also, from what I understand the salary potential with oculoplastics is nowhere near traditional plastics and is only slightly above that of a general ophtho. The field is intriguing regardless of salary, but I was wondering why that is? is it a volume issue or because they just don't do bigger procedures?
also, i guess, just for curiosity, do you mind sharing some of your own most intense procedures 😀 ?thanks!

There's gold in them there hills.

The breadth of procedures in general plastic surgery is greater and a larger proportion of their practice is devoted to cosmetic surgery away from the face.

Dual certification has really only one purpose: satisfying credentials committees at outpatient surgery centers that you are qualified to perform cases that are not exclusively the domain of ophthalmologists. It is designed to answer the challenge that oculoplastics specialists are not trained to do facial plastic surgery.

 

[Adab]

Has anyone heard of oculoplastics folks having difficulty getting credentialed at surgical centers/hospitals to perform traditionally non-core oculoplastic procedures like face-lifts or rhinoplasties?

 

[rocketbooster]

I'm on my ENT rotation now and the residents told me that they do all the orbital fractures. When I asked about oculoplastics, they said "they can do them but they don't. We do all of them."

 

[MPMD]

I'm on my ENT rotation now and the residents told me that they do all the orbital fractures. When I asked about oculoplastics, they said "they can do them but they don't. We do all of them."

I think this varies from institution to institution. At my school, both ENT's and oculoplastics will do orbital fractures, it just depends on the location. At county it is always the ENT's; at University either ENT or OP takes it; Peds goes either way but it seems like OP is getting greater preference recently. I stay away from the VA but I would assume ENT does most of them there.

We have had more oculoplastics faculty join in recent years, so I think they are capturing more turf. Whether this is the case elsewhere though I can't say.