Oculoplastics & Internship

[AGreene80]

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Hi everybody... I'm getting very interested in the oculoplastics. Do you think doing a surgical internship would improve my odds of landing a fellowship in this obscenely competitive subspecialty? Since most surgical interns spend the majority of their time doing floor scut, I doubt it, but I'd like to hear the group's input.

Also, if anyone has any general info about oculoplastics, I'm all ears. Are oculoplastic surgeons generally happy with their career choice? What do fellowship directors base their admission decisions on? Do you really have to apply to accredited fellowships in your second year of ophtho residency, and do most resident feel prepared to make that decision so early in their training? Is it wise to consider non-accreditied programs? What are the bread-and-butter cases like? What are the big cases like?

Any info or advice would be much appreciated. Thanks!

 

[orbitsurgMD]

Hi everybody... I'm getting very interested in the oculoplastics. Do you think doing a surgical internship would improve my odds of landing a fellowship in this obscenely competitive subspecialty? Since most surgical interns spend the majority of their time doing floor scut, I doubt it, but I'd like to hear the group's input.

Also, if anyone has any general info about oculoplastics, I'm all ears. Are oculoplastic surgeons generally happy with their career choice? What do fellowship directors base their admission decisions on? Do you really have to apply to accredited fellowships in your second year of ophtho residency, and do most resident feel prepared to make that decision so early in their training? Is it wise to consider non-accreditied programs? What are the bread-and-butter cases like? What are the big cases like?

Any info or advice would be much appreciated. Thanks!

It is unfortunate, but the applications process in plastics seems to start a full year earlier than other fellowship specialties. Most residents haven't experienced much plastics let alone other ophthalmic surgery to really judge from a reasonable amount of OR and clinical experience.

The fellowships have generally segregated themselves into odd-even start year patterns and are nearly all two years in length. Some have recently sought to dual-credential (board certify) their fellows in facial plastic surgery.

You should see if you can shadow an oculoplastic surgeon if you want to see the case variations. Practices can differ widely; some are highly cosmetic and elective in nature, emphasizing a high-end service approach, others are more academic and mainstream, with a functional surgical emphasis, still others mix plastics and other specialties that interest the practitioner. Just because you do a fellowship doesn't lock you into exclusive activity in that subspecialty. How and what you do is in some ways dependent on your community's needs and capacity to generate referral volume.

Typical mainstream oculoplastics offers sugery for eyelid malpositions: ptosis, entropion, ectropion, dermatochalasis, brow ptosis, lagophthalmos, protractor deficiencies (e.g., Bell's palsy). Orbit and eyelid surgery for treatment of Graves' orbitopathy, evaluation and treatment of orbital disease and tumors, repairs of orbital deformities and orbital trauma,
Reconstruction after primary or secondary (e.g., Mohs) tumor resections,
and lacrimal surgery, DCRs and other lacrimal bypass procedures. Enucleation, eviseration, orbital implant, and revisions and reconstruction of post-enucleation orbits are part of the specialty. Neurological and orbital procedures like nerve-sheath decompression are also part of the scope of practice.Cosmetic procedures done by oculoplastic surgeons can include blepharoplasty, browplasty, forehead lifting, midface and full-face and neck procedures (rhytidectomy), laser and chemical peel surface and subsurface rejuvenating procedures, hair transplantation, collagen replenishment and chemodenervation (Botox).

 

[Surgess]

It is unfortunate, but the applications process in plastics seems to start a full year earlier than other fellowship specialties. Most residents haven't experienced much plastics let alone other ophthalmic surgery to really judge from a reasonable amount of OR and clinical experience.

The fellowships have generally segregated themselves into odd-even start year patterns and are nearly all two years in length. Some have recently sought to dual-credential (board certify) their fellows in facial plastic surgery.

You should see if you can shadow an oculoplastic surgeon if you want to see the case variations. Practices can differ widely; some are highly cosmetic and elective in nature, emphasizing a high-end service approach, others are more academic and mainstream, with a functional surgical emphasis, still others mix plastics and other specialties that interest the practitioner. Just because you do a fellowship doesn't lock you into exclusive activity in that subspecialty. How and what you do is in some ways dependent on your community's needs and capacity to generate referral volume.

Typical mainstream oculoplastics offers sugery for eyelid malpositions: ptosis, entropion, ectropion, dermatochalasis, brow ptosis, lagophthalmos, protractor deficiencies (e.g., Bell's palsy). Orbit and eyelid surgery for treatment of Graves' orbitopathy, evaluation and treatment of orbital disease and tumors, repairs of orbital deformities and orbital trauma,
Reconstruction after primary or secondary (e.g., Mohs) tumor resections,
and lacrimal surgery, DCRs and other lacrimal bypass procedures. Enucleation, eviseration, orbital implant, and revisions and reconstruction of post-enucleation orbits are part of the specialty. Neurological and orbital procedures like nerve-sheath decompression are also part of the scope of practice.Cosmetic procedures done by oculoplastic surgeons can include blepharoplasty, browplasty, forehead lifting, midface and full-face and neck procedures (rhytidectomy), laser and chemical peel surface and subsurface rejuvenating procedures, hair transplantation, collagen replenishment and chemodenervation (Botox).

Do you know which programs specifically are doing the dual credentialing in facial plastics?

 

[orbitsurgMD]

Do you know which programs specifically are doing the dual credentialing in facial plastics?

I spoke with the fellow training at U. Wisconsin under Dr. Lemke (who is now independent, I think); they were doing a dual-certificate program.

 

[PDT4CNV]

Do you know which programs specifically are doing the dual credentialing in facial plastics?

Getting the dual certificate is unnecessary. What is more important is picking a fellowship with the focus you want. If you want to do more cosmetic/gen. facial plastics then train with a preceptor who does more of that. There is one oculoplastics preceptor who is doing boob jobs believe it or not. If you want to do more reconstructive/functional oculoplastics, then train with somebody doing that.

The fact is, oculoplastics is not PRS or ENT/plastics. We have no business doing rhinoplasties, otoplasties, neck lipo/platysmaplasties, and BOOB jobs, just as they have no business doing ptosis, ectropion, DCR's or orbitotomies. That is my feeling anyway. Rhytidectomies, brow lifts, SOOF/midface lifts, mentoplasty, and blepharoplasties fall into that overlap area as far as cosmetic procedures go.

The idea that it is better to have the additional certificate somehow implies that oculoplastics is a weak subspecialty, I think not. And how many PRS and ENT guys do you see applying for membership in ASOPRS?

 

[orbitsurgMD]

The idea that it is better to have the additional certificate somehow implies that oculoplastics is a weak subspecialty, I think not.

Agreed. The dual certificate is beneficial if you want to get privileges at hospitals and surgery centers where facial plastic surgeons have used board certification as a roadblock to oculoplastic surgeons getting privileges to do facial procedures for which they have been adequately trained.

BTW, ASOPRS is a professional organization, despite their ambitions to become a specialty board and a certifying agency. The fact that they test their members doesn't make them a specialty board.

 

[Visioncam]

Do you think doing a surgical internship would improve my odds of landing a fellowship in this obscenely competitive subspecialty? Since most surgical interns spend the majority of their time doing floor scut, I doubt it, but I'd like to hear the group's input.

What do fellowship directors base their admission decisions on?

It would seem that a surgical internship would help though one fellowship program, whose main mentor did not do a surgical internship, says that a surgical internship is a strike against the applicant!

Surgical interns do not necessarily only do scut. There are some programs that are very good as far as surgical experience. You just have to know where to look. One of my fellow resident comrades did a surgical internship and he really could sew, unlike some of my fellow klutzes.

Connections are very important in getting an oculoplastics fellowship though there are some successful applicants who have no connections.

If one likes oculoplastics simply because of cosmetic procedures, particularly if they are still in medical school, oculoplastics is the wrong field. Try ENT or plastics. In fact, it would be very unusual but not a bad idea to do plastics then see if an oculoplastics fellowship will take you. The bargain would be "you teach me eyes and I'll teach you face and breasts". This bargaining has been done at least once before in another subspecialty (not oculoplastics), i.e. not going the traditional route and the fellow teaching the mentor his expertise in exchange for getting into the fellowship.

 

[orbitsurgMD]

It would seem that a surgical internship would help though one fellowship program, whose main mentor did not do a surgical internship, says that a surgical internship is a strike against the applicant!

Surgical interns do not necessarily only do scut. There are some programs that are very good as far as surgical experience. You just have to know where to look. One of my fellow resident comrades did a surgical internship and he really could sew, unlike some of my fellow klutzes.

Connections are very important in getting an oculoplastics fellowship though there are some successful applicants who have no connections.

If one likes oculoplastics simply because of cosmetic procedures, particularly if they are still in medical school, oculoplastics is the wrong field. Try ENT or plastics. In fact, it would be very unusual but not a bad idea to do plastics then see if an oculoplastics fellowship will take you. The bargain would be "you teach me eyes and I'll teach you face and breasts". This bargaining has been done at least once before in another subspecialty (not oculoplastics), i.e. not going the traditional route and the fellow teaching the mentor his expertise in exchange for getting into the fellowship.

I don't think it is essential, but it can be helpful. I did a surgery internship that had general plastics rotations and was pretty good with the sewing bit throughout. I learned there some things that my oculoplastics fellowship didn't include but which have added to my skill base. A lot of that had to do with being at a very "hands-on" internship program that gave interns many opportunities to stitch and do procedures. Not all surgery internships are like that, however.

I agree with the cosmetics observation. I see cosmetic procedures as more of an evolution from the core competencies of oculoplastics, and for nearly all my oculoplastics colleagues it remains a minority of their surgical practice volume. In most American communities, there are only a limited number of candidates for cosmetic procedures who have the resources to afford them, and offering these procedures places you in the pool of other facial plastic surgeons who do the same.

 

[Energon]

A lot of people do facial cosmetic procedures because they are fee for service deals. No insurance involvement and obviously they pay great. However, there are many things that people usually do not consider prior to going into this field. For one, you are limited only to the face. Second, a fair share of the patient population really have body image issues and tend to blame the surgeons if the outcome is not what they percieved it would be. I assisted on a lot of these procedures when I was on my OMFS externship and rotations.... and yea, they are cool procedures, and they make a lot of money and they are highly glorified by the media, but there are also some disadvantages. Also remember you have to fight for your business with PRS, ENTs and OMFS folks who are also getting into the business big time.

 

[jmou123]

what are some of the disadvantages?

 

[EYESURG]

So what other things besides having connections would help you land an oculoplastics fellowship? What if your program is weak in oculoplastics?

 

[PDT4CNV]

So what other things besides having connections would help you land an oculoplastics fellowship? What if your program is weak in oculoplastics?

Connections are important. Meet everyone you can. Go to the next ASOPRS meeting. Next, publications...even if they are just case reports in throw-away journals, as many as possible. Besides that, good LORs, good OKAP scores. Strong interviews.

 

[orbitsurgMD]

So what other things besides having connections would help you land an oculoplastics fellowship? What if your program is weak in oculoplastics?

Some go the double fellowship route, doing a complementary fellowship in neuro or path and then using that as a springboard to a plastics spot. It can help if you come from a program with a weak plastics program and need better quality LORs.

 

[thirtyeight]

do oculoplastics fellowship programs look at step 1 and 2 scores?

 

[orbitsurgMD]

do oculoplastics fellowship programs look at step 1 and 2 scores?

When you speak of "programs", realize that in most cases this means one person or maybe two, at most. So who gets an invite can depend on great scores, or maybe just on an interesting resume. The focus can change from year to year. It is really a very subjective process. Sometimes the prospective interviewee is brought by for an interview with the current fellow present and is invited to scrub in for cases.