OMFS->Plastics

[dentmass]

Is there any stigma in the field for OMFS to pursuing the independent pathway? Is it harder because they don't see you as a traditional general surgery applicant? I'm curious. I've only found one independent pathway from OMFS and he's at UTSW.

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[PiBond]

I don't think there is any stigma at all. I can think of several faculty at my program (all in leadership positions) who pursed PRS through different tracks. One began as OMFS, the other as ENT, and there was even a guy who did Ortho first. They each have a unique perspective to add to our education, and there are quite a few transferable skillsets that OMFS has to PRS (particular in head/neck reconstruction).

 

[droliver]

I think a lot of programs would be skeptical of taking an OMFS resident. While there's a little overlap on the facial fracture/craniofacial side, there's a pretty big experience gap with such a large % of the field that they'd really have to stand out over a surgery or ENT resident to be a preferred choice.

 

[SterlingMaloryArcher]

I think OMFS bring a lot to the table. Osteotomies are f-ing cool. I wonder how many plastic surgeons know their way around the head well enough to be confident they can do a LeFort III or Orbital Box. Or even know the facial bone structure by heart so well that they can appreciate what will truly look "aesthetic" albeit "easy"/"safe" procedures. General Plastic Surgeons who do boobs and buttocks all day have botched so many technically simple procedures like chin implants (overcorrection, accentuating mentolabial fold, suturing it in instead of using screw fixation, etc etc etc) There are many more examples. I friend recently told me a story how he walked into a run-of-the-mill general plastic surgeons office and asked if they thought he had a recessed maxilla. He said she was stunned, looked at him like he had 3 heads and said "excuse me?"

I thought I wanted to be a cardiologist or maybe ER doctor. I took a little sabbatical down plastic surgery, especially craniofacial, and lets just say I have gained a lot of respect for Dentists, Orthodontists, and OMFS I never had before.

There are a surprising amount of Plastic Surgeons who have an OMFS background, they just don't advertise it as much because the public has only been trained to care about "Only go to a Board Certified Plastic Surgeon" which ABPS shoves down everyones throat in an aggressive marketing scheme. If you just want to do Facial Cosmetic Surgey and never venture below the neck you technically don't need it. Look up Joe Niamtu. Although as stated above with the Plastic Surgery turf war it would probably make things a whole lot easier to do a plastics residency. I feel Plastic Surgery doesn't and shouldn't own cosmetic surgery and they especially dont own the face and especially especially don't own oculoplastics.

Obviously this pathway requires you enter a 6-Year OMFS residency. You could consider pursuing Board Certification by a "rogue" board like The American Board of Facial Plastic Surgery or ABof Cosmetic Surgery as secondary options. The latter has somewhat low standards though.

Anyway..........

Barry Eppley is my favorite OMFS Plastic Surgeon. Worship him and Yaremchuk.

 

[malacia]

Are ENT trained applicants at a disadvantage compared to General Surgery trained applicants? Are there certain Plastic Surgery fellowship (Independent Pathway) programs that have a history of taking ENT trained applicants?

 

[droliver]

I think OMFS bring a lot to the table. Osteotomies are f-ing cool. I wonder how many plastic surgeons know their way around the head well enough to be confident they can do a LeFort III or Orbital Box.

Almost no one in practice actually does those tertiary craniofacial procedures outside a very small group of people. It is a very peripheral part of the field at large. OMFS certainly does bring a different skill set and perspective to the field historically on reconstructive bony facial surgery, but they have significantly less experience with literally 99% of the rest of the field then general surgery. It is pretty much conventional wisdom for traditional residency programs that the relative knowledge deficits and experience that a fully trained general surgery background brings to day 1 plastic surgery residency are much easier to manage within a training program then those from ENT, Orthopedics, OMFS, Neurosurgery, Gynecology (probably in that order) in the general sense. Diversity of experience has been a traditional strength of the field, but it causes issues on the residency side incorporating such experience gaps into a workable model for programs.

 

[TheLesPaul]

The longer I am in this field, the more I appreciate what the different fields bring to facial cosmetics. OMFS truly are masters of bone and V-line surgeries and mandibular recontouring are strengths of theirs. Oculoplastic surgeons (my field) really know the eyelids and orbit at a much deeper level than any other surgeon. ENT facial plastics are superb at rhino. PRS have their own niche with body work and what that brings to the head/neck.

We all do primary procedures well (bleph, face/neck, etc.). I would trust a complicated revisional case to the specialty of choice. Of course, individual surgeons can learn and transcend their initial specialty and I think we should all work together...the field will be richer for it.

 

[SterlingMaloryArcher]

The longer I am in this field, the more I appreciate what the different fields bring to facial cosmetics. OMFS truly are masters of bone and V-line surgeries and mandibular recontouring are strengths of theirs. Oculoplastic surgeons (my field) really know the eyelids and orbit at a much deeper level than any other surgeon. ENT facial plastics are superb at rhino. PRS have their own niche with body work and what that brings to the head/neck.

We all do primary procedures well (bleph, face/neck, etc.). I would trust a complicated revisional case to the specialty of choice. Of course, individual surgeons can learn and transcend their initial specialty and I think we should all work together...the field will be richer for it.

Such a great attitude and great post.

In my town there is no oculoplast. Do you do more cosmetic elective work or recon cases if you don't mind me asking?

Also I can't find a definitive answer on what is the difference between a canthoplasty and canthopexy. Don't want to waste your time though if you don't feel like explaining I understand. I found 2 oculoplastic guys on YT I like watching and I'm sure you are well aware of who they are as small as the field is. One is the famed "Almond Eye Surgery" expert lol. One thing I notice is two surgeons do the "same procedure" a lot differently, as if the only thing truly the same is what they call it... (and before anyone accuses me of asking for myself, I already have a nice positive canthal tilt, thank you.)

 

[TheLesPaul]

Such a great attitude and great post.

In my town there is no oculoplast. Do you do more cosmetic elective work or recon cases if you don't mind me asking?

Also I can't find a definitive answer on what is the difference between a canthoplasty and canthopexy. Don't want to waste your time though if you don't feel like explaining I understand. I found 2 oculoplastic guys on YT I like watching and I'm sure you are well aware of who they are as small as the field is. One is the famed "Almond Eye Surgery" expert lol. One thing I notice is two surgeons do the "same procedure" a lot differently, as if the only thing truly the same is what they call it... (and before anyone accuses me of asking for myself, I already have a nice positive canthal tilt, thank you.)

I do 33/33/33 bread and butter functional/orbit/cosmetic (clavicle up).

I don't know that the two words mean much specifically. Canthoplasty traditionally means a surgery incising and splitting the canthus, while the canthus is preserved in canthopexy. I don't think there is a "same procedure" in facial plastics, which is what makes it interesting. Everyone has a different philosophy. The key is to be a thoughtful surgeon.

 

[SterlingMaloryArcher]

I do 33/33/33 bread and butter functional/orbit/cosmetic (clavicle up). And I'm working on a YouTube oculoplastics channel in 4K, I just haven't had time to narrate all the videos yet so stay tuned!

I don't know that the two words mean much specifically. Canthoplasty traditionally means a surgery incising and splitting the canthus, while the canthus is preserved in canthopexy. I don't think there is a "same procedure" in facial plastics, which is what makes it interesting. Everyone has a different philosophy. The key is to be a thoughtful surgeon.

ty

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