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The Chief Resident Aesthetic Surgery Clinic: a Safe Alternative forPatients
Ariel Rad, MD, Kate J. Buretta, BS, Jennifer Im, BA, Paul N. Manson, MD.
Johns Hopkins University, Baltimore, MD, USA.

PURPOSE: Providing comprehensive aesthetic surgery training is a major challenge in residency programs. Supervised chief resident aesthetic surgery clinics offer distinct advantages for both trainees and patients: residents learn by hands-on care, and reduced fees offer patients affordable access to aesthetic procedures. While studies of outcomes from chief resident run clinics have reported resident perception of aesthetics training and assessments of complication rates, there is nonetheless a need for investigation of outcomes. Such data inform educators about safety and effectiveness of the training model. To address this, we conducted an IRB-approved, retrospective analysis of outcomes of aesthetic surgeries performed through the chief resident aesthetic surgery clinic as part of the plastic surgery residency training program at the Johns Hopkins Hospital.

METHODS: We performed a retrospective chart review of consecutive patients undergoing aesthetic surgeries through the Johns Hopkins chief resident aesthetic surgery clinic from July 2009 to July 2011. A single board certified attending surgeon supervised all operations. Breast procedures included augmentation, augmentation-mastopexy, mastopexy, and reduction mammoplasty. Body contouring procedures included liposuction, abdominoplasty with or without liposuction, and belt lipectomy. Facial aesthetic procedures included facelift, browlift, rhinoplasty, facial fat grafting, and blepharoplasty. Out of 196 patient charts reviewed, 28 charts were excluded due to insufficient records or were revisions to procedures performed prior to the study period. The study sample included 115 patients who underwent 132 primary body contouring procedures (48 breast procedures, 84 body contouring procedures), and 53 patients who underwent 84 facial aesthetic procedures (31 facelifts, 26 blepharoplasties, 15 browlifts, 8 rhinoplasties, 4 fat grafting). Major complications were defined as emergent return to the operating room, unplanned hospitalization, pneumothorax, or pulmonary embolus. Minor complications included non-operative hematoma or seroma, delayed wound healing, infection requiring oral antibiotic therapy only, and temporary facial nerve branch dysfunction. Additionally, we tabulated the incidence of hypertrophic scars requiring in-clinic revision.

RESULTS: Amongst 132 primary body contouring procedures, there were no emergent returns to the operating room. Two patients developed infection requiring hospitalization for intravenous antibiotics (major complication, 2.4%). The overall minor complication rate for breast and abdominal procedures was 6.3% and 21.4%, respectively; the overall revision rate was 2.1% and 14.3%, respectively. In-clinic scar revision accounted for 73% of all revisions. The incidence of seroma for breast and abdominal procedures was 1% and 10.2%, respectively; the incidence of non-operative delayed wound healing was 1% and 11.9%, respectively; the incidence of infection requiring oral antibiotics was 1% and 15.3%, respectively. There were no hematomas. The overall rate of minor secondary revision was 2.1% for breast and 23.7% for abdominal procedures, the majority of which were for scar revision. For facial aesthetic cases, 1 patient had temporary frontal branch paresis (6.7%), 1 patient developed pneumothorax (not requiring a chest tube) from rib graft harvest (12.5%), 2 patients had hypertrophic scar (5.8%), and 1 patient had a seroma (2.9%).

CONCLUSION: In this study, we report complication rates comparable to those reported in the literature. As such, our chief resident clinic offers patients safe options with greater accessibility to aesthetic surgery compared to private aesthetic surgery practices. At Johns Hopkins, the chief resident aesthetic surgery
clinic model continues to be an important component of our residency training

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