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Overall, surgery of the general face was identified most frequently (44.8%) as the surgery in which most individuals would be interested. Younger participants tended to be most interested in cosmetic breast surgery (mean age, 30.6 years), while older participants tended to be most interested in cosmetic surgery of the face (mean age, 35.4 years; P = .02). Subjects were least interested in cosmetic surgery for the extremity or neck (n = 0 and n = 4, respectively; Figure 2A). Fear of a poor result (51%) was the most common reason given for not undergoing plastic surgery. Other reasons were cost (40.6%), fear of the recovery process (25%), fear of anesthesia/surgery (14.6%), and no interest (20.8%). No respondents identified fear of what others might think as a reason not to pursue plastic surgery (Figure 2B). When compared with unmarried individuals, subjects who were married were more likely to choose a more expensive surgery with longer lasting results over a less invasive procedure offering more temporary benefits. There was no statistically significant correlation between preference for a permanent or temporary procedure and age, sex, or income. Factors Influencing Selection Average score for factors viewed by respondents as most important when considering a plastic surgeon are illustrated in Figure 3. Surgeon reputation (9.21 on a scale of 0-10) and board certification (9.20) were the most important factors indicated by subjects. Age (5.49) and advertisement (2.63) were identified as least important. Those with no history of prior surgery tended to value referral from a friend more highly than those with a history of prior surgery (Figure 3A). Most respondents (60.4%) would choose a private practice surgicenter for the site of their surgery followed by a university medical center (36.5%) and a community hospital (4.1%). The rate of preference for surgery location (surgicenter vs university medical center) was significantly different for those individuals who had undergone prior plastic surgery versus those who had not (83.3% vs 56%, respectively; P = .03). There was no statistically significant correlation between preference for surgery location and age, sex, or income (Figure 3B). Table 1. Respondent demographics. Age, y, mean (range) 34.5 (18-67) Income,a $, mean (range) 91 298 (0-500 000) Sex Male 15 (15.6) Female 81 (84.4) Marital status Yes 54 (56.3) No 42 (43.8) Previous plastic surgery Yes 16 (16.7) No 80 (83.3) Values are presented as No. (%) unless otherwise indicated. a Adjusted mean ± SD, without participants who reported an annual income of $0: $106 886 ± $9067. Figure 1. (A) Responses to the question, “Do you draw a distinction between a plastic surgeon and a cosmetic surgeon?” (B) Responses to the question, “Which of the following training paths can produce a cosmetic surgeon?” Anes, anesthesiologist; Derm, dermatologist; OB-Gyn, obstetrician/gynecologist. Downloaded from n 20 May 2021 588 Aesthetic Surgery Journal 33(4) Discussion Demand for cosmetic surgery in the United States continues to rise even with the backdrop of economic recession. Different techniques of implantation (types of incisions and placement, minimally invasive techniques) e. Techniques of nipple/areola reconstruction § Discuss medical and cosmetic indications and techniques for breast alteration surgery (enlargement, reduction, repair of size difference and ptosis, etc.) Complex hernias § Discuss the role of the Plastic Surgeon in the evaluation, planning and execution of surgical therapy of complex abdominal wall hernias a. abdominal wall component release/separation b. component rectus fascia closure, use of tensor fascia lata c. use of artificial materials (mesh) Lymphangioma / Hemangioma § Understand the basic etiology, histology, natural progression of (extremity) lymphangioma; describe the principles of medical and surgical therapeutic options § Understand the basic etiology, histology, natural progression of hemangioma and related lesions (child type I – V vs. adult); describe the principles of medical and surgical therapeutic options (laser / phototherapy, injection therapy, resection, etc.) Chronic wounds: § Describe the etiology and contributing factors for common chronic/non-healing wounds: a. Pressure ulcers (sacral, extremity, head, etc.) b. Wounds related to vascular disease (arterial insufficiency, venostasis) c. Diabetic wounds d. Wounds due to radiation e. Calciphylaxis f. Vasculitis and other connective tissue disorders, pyoderma gangrenosum, chronic lymphedema g, Actinomycosis, Yaws, mucormycosis, cutaneous Anthrax and other chromic infectious wounds § Understand options for medical/conservative therapy (bedside debridement vs. debriding-type dressings [enzymatic vs. mechanical], V.A.C. therapy, etc.) § Describe options indications and contra-indications for surgical reconstruction: (composite-) flaps, etc., vs. amputation (extremity) § Understand options for supportive therapy and prevention including devices to reduce pressure, restoration of blood flow, nutritional therapy, antibiotic therapy, hyperbaric oxygen therapy, etc. § Discuss the potential systemic (long-term) complications of chronic non-healing and/or infected wounds, including: (recurrent) bacteria and endocarditis, osteomyelitis, progressive cellulitis, heterotopic bone formation, pain, amyloidosis, complications related to immobility/loss of function, etc. Congenital anomalies of the head and neck: § Describe the most common congenital anomalies including classifications a. first through fourth branchial arch anomalies b. cleft lip and palate c. micro- (Pierre Robin, Treacher Collins' syndromes, etc.) and macrognathia d. craniosynostosis (turricephalus, trigonocephalus, brachycephalus, etc.) § Understand the basic principles of corrective surgery for these disorders including indication and timing for surgery Soft tissue/skin tumors § Understand and describe the characteristics for the most common differential diagnoses for tumors of the skin, including: Actinic Keratosis Bowen Disease, Fibrous Papule of the Face, Keratoacanthoma, Nevi, Melanocytic Sebaceous Hyperplasia, Seborrheic Keratosis, Squamous Cell Carcinoma, Trichoepithelioma, warts, atypical Fibroxanthoma, Pyoderma, etc. § Understand the etiology, age and anatomic distribution, and staging of basal cell carcinoma (BCC); describe the use of (punch) biopsy in the diagnosis; describe surgical options for therapy (curettage, excision with margin examination and Mohs microsurgery, radiotherapy and cryotherapy); describe the indications, limitations and potential problems with medical therapy (5-Fluorouracil, Interferon alfa-2b); describe the prognosis and risks for subsequent lesions in patients with BCC § Understand the etiology, age and anatomic distribution and staging of squamous cell carcinoma of the skin (SCC); describe the TNM classification, modes of spread and implications for therapy; describe the options for (adjunct) medical therapy (5-FU +/- Radiation therapy, Aminolevulinic acid and Photodynamic therapy – mainly for actinic Keratosis), and options for surgical therapy (curettage and electrosurgery, cryosurgery, excision); describe optimal margins for well-differentiated and high risk tumors and recurrence rates related to stage and tumor biology § Understand the etiology, age and anatomic distribution and staging of Melanoma; discuss different histologic types (superficial spreading, Nodular, Lentigo maligna, acral lentiginous, desmoplastic) and TMN vs. Clark vs. Breslow staging and AJCC groupings; describe stage-directed surgical therapy and (neo-) adjuvant therapy options; describe prognosis/ outcomes in different stages of the disease § Describe options for reconstruction in anatomically difficult regions, i.e., face/ hand, etc. Head and Neck Cancer § Understand the etiology, age, anatomic distribution and staging of head and neck cancer; describe TNM staging and common pathways of metastasis, depending on location; understand the fundamentals of medical (chemo-, photosensitizing-, § immune-, gene-), radio- and surgical therapy § Develop basic understanding of principles of resection and reconstruction of head and neck tumors in various locations Objectives – General: § Complete the reading assignment (see literature list) § Attend all (³
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