Why isn't Ophthalmology an accepted pathway into a Plastics fellowship?

[GuP]

Almost all of the other surgical subspecialties can pursue the plastics fellowship after their initial training. This includes fields such as orthopedics, otolaryngology, oral surgery, urology, etc. One can argue that ophtho has oculoplastics but the breadth of training in oculoplastics is not the same as plastics. Furthermore, I am confident that the surgical skills gained in ophtho residency are adequate to prusue a plastics fellowship. So what gives?

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[7ontheline]

I don't see the issue here. If someone's goal ultimately is plastics then as you have stated there are a number of well-recognized pathways into it. Ophthalmology is a very specialized field with a narrow focus. It even has a plastics path of its own. If someone really wants to do general plastic surgery then they probably wouldn't enter ophthalmology. I'm sure there are a few exceptions, but I would assume not enough to create a demand for entry into regular plastics fellowships.

 

[OMD]

Why?

Because there are accepted paths without need for another pathway. If you want to do it, then choose the route that provides the complete, appropriate training.


Man, that sure sounds familiar.

 

[GuP]

7ontheline - But what if you get interested in doing full blown plastics doing an ophtho residency? I agree that no one should enter ophtho with plastics as their ultimate goal but if your mind sways, then...

OMD - Thanks for the highly regarded info.

 

[7ontheline]

7ontheline - But what if you get interested in doing full blown plastics doing an ophtho residency? I agree that no one should enter ophtho with plastics as their ultimate goal but if your mind sways, then...

Realistically, I would tell someone who changed their mind this way tough luck. Happens to people in all sorts of fields. If you get interested in something else then go do that, don't look for a shortcut. I think that if you wanted to do a general plastics fellowship, you should have done a surgical internship (which most of us did not do) and you should be very comfortable working with skin/blood/non-ocular tissues. This is unfortunately probably not the case for every residency. I would have reservations about allowing just anybody who did ophthalmology to do plastics.

 

[GuP]

Realistically, I would tell someone who changed their mind this way tough luck. Happens to people in all sorts of fields. If you get interested in something else then go do that, don't look for a shortcut. I think that if you wanted to do a general plastics fellowship, you should have done a surgical internship (which most of us did not do) and you should be very comfortable working with skin/blood/non-ocular tissues. This is unfortunately probably not the case for every residency. I would have reservations about allowing anybody who did ophthalmology to do plastics.

Well I really don't see it as a shortcut - just another route. I agree that a certain comfort level with tissue/blood, etc is needed to do plastics and I believe that one year of general surgery does just that. Maybe they should have open plastics to ophtho residents who have done a surgical year or maybe one can do ophtho then ocuoplastics then plastics...

 

[PDT4CNV]

Well I really don't see it as a shortcut - just another route. I agree that a certain comfort level with tissue/blood, etc is needed to do plastics and I believe that one year of general surgery does just that. Maybe they should have open plastics to ophtho residents who have done a surgical year or maybe one can do ophtho then ocuoplastics then plastics...

There are some facial plastics fellowships that accept ophthalmolgy applicants. However, I am not aware of any general plastics fellowships that do. Many oculoplastics fellowships provide a good facial plastics experience for most procedures. There are also some oculoplastics fellows who have gone on to do other fellowships such as craniofacial. Facial plastic surgery is within the realm of the ophthalmologist. General plastic surgery is not without additional training in that area.

 

[GuP]

There are some facial plastics fellowships that accept ophthalmolgy applicants. However, I am not aware of any general plastics fellowships that do. Many oculoplastics fellowships provide a good facial plastics experience for most procedures. There are also some oculoplastics fellows who have gone on to do other fellowships such as craniofacial. Facial plastic surgery is within the realm of the ophthalmologist. General plastic surgery is not without additional training in that area.

Interesting. Do you happen to know any practicing guys who have taken the aforementioned route?

 

[PDT4CNV]

Interesting. Do you happen to know any practicing guys who have taken the aforementioned route?

I don't know of anybody going directly into a facial plastic fellowship out of ophthalmology residency. Most of those require at the minimum, a year of general surgery internship rather than transitional or internal medicine. I know of some folks who have done either facial cosmetic surgery fellowships or craniofacial fellowships after their oculoplastics fellowship.

 

[GuP]

I don't know of anybody going directly into a facial plastic fellowship out of ophthalmology residency. Most of those require at the minimum, a year of general surgery internship rather than transitional or internal medicine. I know of some folks who have done either facial cosmetic surgery fellowships or craniofacial fellowships after their oculoplastics fellowship.

Ya sorry that's what I meant - ophtho -> oculo -> facial/craniofacial. Do you happen to know any more details i.e. what/where was the fellowship, etc. etc. Thanks.

 

[exmike]

There are some facial plastics fellowships that accept ophthalmolgy applicants. However, I am not aware of any general plastics fellowships that do. Many oculoplastics fellowships provide a good facial plastics experience for most procedures. There are also some oculoplastics fellows who have gone on to do other fellowships such as craniofacial. Facial plastic surgery is within the realm of the ophthalmologist. General plastic surgery is not without additional training in that area.

the first time ive heard a convincing arguement for doing a prelim surgery year for ophtho. interesteing...

 

[Pigmentosa]

Who knows an opththalmologist that does nose jobs?

 

[FutureOph123]

if you want to do facial plastics, do a plastic surgery residency or an ENT residency with a fellowship. Do not do oph as a way of getting to do nose jobs, face lifts, or breast enhancements; I think the eye is way too cool for all that other stuff anyway.

 

[cranifacial]

I think we are talking about two different things here. I haven't heard of any oculoplastics guys doing breast augmentation, nose jobs or liposuctions, etc., I maybe wrong...

For what I understand, these guys do periocular stuff (ptosis, eyelidmalpositions) , brows, orbital tumors, lacrimal system, orbital decompressions,etc.

I know a couple of colleagues in the hospital that were trained: OPH ->Oculoplastics, they are good in what they do; we do work together in many cases, especially craniosynostosis with shallow orbits, etc.

What they do, once they finish Ophth is: they get 2 additional years oftraining in periocular stuff. The number of cases that they performed during fellowship seemed to be very high ( I cannot confirm this), apparently theyhave a very solid referral base from Ophthalmology, Optometry and Dermatology.

Last Tuesday we had lunch together, I told them about this blog... Theyasked me a bunch of questions including the training of some of the most prominent figures in facial reconstruction. Specifically Richard Tenzel (TenzelSemicircular Flap), Mustarde ( Mustarde rotational Flap), Fasanella, Smith, Hughes (Hughes flap for eyelidreconstruction), Crowell Beard and some others that I am not sure who they are., well, thanks to Wikipedia and Pubmed!, now I know!, all of them were trained inOphtho…

Very interesting that ENT can do facial plastics but Ophtho can not... especially now that I realize that both specialties used to be American Academy of Ophthalmologyand Oto-Laryngology for many years…

I also think it is amazing that the founder or at least, one of the most prominentf igures in plastic surgery was Dr. Varaztad Kazanjian, a dentist!, considered to be the founder of the modern practice of plastic surgery.

The more I read, the more I understand that facial plastics, especially reconstruction, is not a one or two year training deal…

 

[orbitsurgMD]

There aren't many urologists doing plastics. The largest pathway is GS preliminary, followed by ENT. OMFS has carved its own separate pathway, with apparent success, and most of their graduates have dual professional degrees, DDS/MD. Ophthalmology is sort of an outlier, not requiring 1-2 years of preliminary surgery as do the other surgical fields, and being a fairly specialized discipline by itself, does not really offer common foundation experience in surgery as do the others. One has to have either done a surgery internship and then an oculoplastics fellowship to have comparable experience in surgery as a foundation for other plastics procedures. The typical repertoire of surgery training in ophthalmology does not easily lend itself to extension into general and facial plastic surgery except for the oculoplastics component.

I did a general surgery internship and a couple of plastic surgery rotations. Compared to my residency colleagues, I think that gave me a comfort level by experience those without a surgery year did not have when it came to doing ophthalmic plastic procedures. But I think my background was an exception.