Dr. Bradford Lee

• Associate Clinical Professor at the University of Hawaii School of Medicine and private practitioner in Honolulu.

• Chair of the DEI (Diversity, Equity, and Inclusion) Committee for ASOPRS.

Dr. Andrea Kossler

• Associate Professor of Ophthalmology, Stanford University School of Medicine

• Director of Oculofacial Plastic Surgery and Orbital Oncology at Stanford University.

• Board member of the Women in Ophthalmology and LATINOUS.

Dr. Cesar A. Briceño

• Chief of Oculoplastics at Shea Eye Institute, University of Pennsylvania.

• Assistant Dean for Diversity and Cultural Affairs at the Perelman School of Medicine, UPenn.

Dr. Eydie G. Miller-Ellis

• Chief of the Glaucoma Service at the University of Pennsylvania.

• Co-director of the RAB Venable Excellence in Research Project for the NMA.

Dr. John Ng

• Division Chief and Professor of Oculofacial Plastic, Orbital, and Reconstructive Surgery at Casey Eye Institute, Oregon Health & Science University.

• Incoming Vice President of Aesoppers and future President.

Dive into an engaging panel discussion on Diversity, Equity, and Inclusion (DEI) within the sphere of ophthalmology, specifically exploring its role in oculoplastic surgery. Hosted by Dr. Bradford Lee and Dr. Andrea Kossler, this episode of Top offers profound insights into the initiatives promoting more inclusive and equitable practices in ophthalmology associations and medical education institutions. With esteemed panelists like Dr. Cesar Briceño, Dr. Eydie G. Miller-Ellis, and Dr. John Ng, the conversation shifts focus on innovative programs like the DEI Committee for ASOPRS, which prioritizes inclusion, access, and diversity for both practitioners and patients.

The episode explores the intersection of DEI and patient care, highlighting how diverse medical professionals contribute to an enriched healthcare delivery model, thereby mitigating disparities in vision health care. The insightful contributions also touch upon the importance of justice within DEI efforts, as well as the significance of recognizing intersectionality among trainees and patients, which brings emphasis to the unseen and complicated layers impacting healthcare accessibility and delivery.

• The DEI Committee for ASOPRS is actively fostering inclusion and access through travel and research grants, as well as mentorship programs to promote diverse career pathways in ophthalmology.

• Diversity improves patient care outcomes by fostering a workforce that understands and respects varied cultural and socioeconomic backgrounds.

• Institutions must strive to create equitable support systems for trainees from diverse backgrounds to ensure they can excel in specialized fields like oculoplastic surgery.

• Addressing intersectionality is crucial in understanding the multifaceted barriers faced by diverse groups, ensuring a more comprehensive approach in medical research and education.

• Programs like the RAB Venable Excellence in Research Project aim to increase genetic representation in clinical trials, crucial for advancing targeted treatments.

Listeners are encouraged to delve deeper into this vital discussion on DEI within ophthalmology by tuning in to the full episode. Stay connected for more insightful and enlightening conversations from our series.

If you're an ASOPRS Member, Surgeon or Trainee and are interesting in hosting a podcast episode, please submit your idea by visiting: asoprs.memberclicks.net/podcast

• Dr. Donovan Reed: An oculoplastic surgeon serving as the Surgical Director at Wilford Hall Eye Center and Brooke Army Medical Center in San Antonio, Texas.

• Dr. Tanuj Nakra: Associate professor at UT Austin Dell Medical School and at Texas Oculoplastics Consultants. He also serves as the Fellowship Director for the American Academy of Cosmetic Surgery Facial Cosmetic Surgery Fellowship.

• Dr. Catherine Hwang: Specialist at the Cleveland Clinic Cole Eye Institute with a focus on cutting-edge oculoplastic and aesthetic surgical techniques.

• Dr. Daniel Rootman: Esteemed surgeon at the Doheny Eye Institute at UCLA, known for his significant research contributions in oculoplastic surgery.

Welcome to another exciting episode of The Oculofacial Podcast with your host, Dr. Donovan Reed. Joining him in this episode are the esteemed Drs. Tanuj Nakra, Catherine Hwang, and Daniel Rootman. This episode delves into the latest research findings from journals beyond "OPRS" relevant to cosmetic and aesthetic surgery in the field of oculofacial surgery.

In this episode, the panel discusses anatomic insights from the article published in "Plastic and Reconstructive Surgery" including:

• Choi Y, Kim IB. Avoiding Pretarsal Denervation in Lower Blepharoplasty Incisions: Refined Pretarsal Motor Nerve Anatomy. Plast Reconstr Surg. 2024 Jul 1;154(1):81-93.
• Zhang, Yi MD; Li, Mengjuan MD; Lei, Shaorong PhD; Long, Jianhong PhD; Qi, Min PhD. Less Is Better: Full-Incision Double-Eyelid Blepharoplasty with Rapid Recovery. Plastic and Reconstructive Surgery 154(2):p 271e-274e, August 2024. | DOI: 10.1097/PRS.0000000000010700
• Blair J, Fasano M, Georgescu D. Single Barbed Suture Fat Pedicle Fixation for Fat Transposition Lower Blepharoplasty. Facial Plast Surg Aesthet Med. 2024 Jul-Aug;26(4):394-396. doi: 10.1089/fpsam.2023.0332. Epub 2024 Mar 19. PMID: 38502846.

Dr. Tanuj Nakra gives an in-depth summary and sparks a discussion about the practical applications and impacts of these new findings on common surgical techniques. Moving forward, Dr. Catherine Hwang introduces a refined method for double eyelid blepharoplasty from a group in China, emphasizing its potential to reduce postoperative swelling. Dr. Daniel Rootman wraps up with a novel approach using barbed sutures for fat transposition described in "Facial Plastic Surgery and Aesthetic Medicine."

• New Findings on Orbicularis Innervation: The updated anatomical understanding shows the complexity and importance of the lower medial pretarsal branch, impacting lower blepharoplasty techniques.

• Innovative Double Eyelid Surgery: A modified technique introduces less trauma to the orbicularis muscle, aiming for rapid recovery and satisfactory outcomes in patients.

• Barbed Sutures for Efficiency: The single-barb suture method offers an innovative way to internalize fat pedicle fixation, though it needs careful patient selection to avoid complications like dimpling.

• Patient-Centric Techniques: Personalized approaches in aesthetics are crucial, with surgeons adapting techniques based on individual patient needs and anatomical nuances.

• Continuous Learning and Adaptation: Highlighting the importance of staying updated with the latest scientific findings to refine surgical practices and improve patient outcomes.

Resources:

• American Academy of Cosmetic Surgery Facial Cosmetic Surgery Fellowship

• Plastic and Reconstructive Surgery Journal

• Cleveland Clinic Coal Eye Institute

• Doheny Eye Institute at UCLA

Stay tuned for more enlightening discussions from the Oculofacial Podcast. If you found this episode insightful, make sure to listen to the full conversation and catch our next episode for even more professional insights!

If you're an ASOPRS Member, Surgeon or Trainee and are interesting in hosting a podcast episode, please submit your idea by visiting: asoprs.memberclicks.net/podcast

M. Reza Vagefi, M.D.

Dr. Reza Vagefi is a renowned oculofacial plastic surgeon based in Boston at Tufts University School of Medicine. He is recognized for his contributions to the treatment of orbital tumors and infections and has a particular interest in the management of acute invasive fungal rhino-orbital sinusitis.

Daniel Rootman, M.D.

Dr. Daniel Rootman is an accomplished orbital surgeon based in Los Angeles, California, at UCLA. He has significantly contributed to the field through his research, focusing on complex orbital diseases and their management. Dr. Rootman is also an advocate for evidence-based, minimally invasive treatments.

Tarjani Dave, M.D.

Dr. Tarjani Dave is a noted oculofacial surgeon from Hyderabad, India, working at the LV Prasad Eye Institute. She has gained worldwide recognition for her work on mucormycosis, especially during the Covid-19 pandemic, where her research and clinical efforts have made substantial impacts on disease management.

Welcome to the Oculofacial Podcast hosted by Dr. M. Reza Vagefi. In this insightful episode, Dr. Vagefi is joined by Dr. Daniel Rootman from UCLA and Dr. Tarjani Dave from the LV Prasad Eye Institute to discuss the complexities of acute invasive fungal rhino orbital sinusitis, particularly in the context of the Covid-19 pandemic. This episode dives deep into the debates and evolving treatment paradigms surrounding the disease, with the guests sharing their firsthand experiences and clinical insights.

The discussion starts with an exploration of the controversial topic of exenteration in treating mucormycosis. With differing viewpoints, the guests debate whether this aggressive surgical approach is justifiable or if minimally invasive procedures offer equally effective outcomes. Utilizing SEO-focused keywords, Dr. Vagefi and his guests emphasize the importance of MRI imaging in the diagnosis of orbital fungal infections and the clinical decision-making process. They also discuss the significant surge in mucormycosis cases observed in India during the Covid-19 pandemic, sharing personal experiences and clinical strategies that were developed in response to this crisis.

• Role of Exenteration: The efficacy and necessity of exenteration in treating mucormycosis are debated, with a shift towards less invasive methods discussed.

• Imaging Importance: Emphasis on the use of MRI over CT scans for the diagnosis of orbital fungal infections, highlighting MRI’s superior sensitivity.

• Covid-19 Pandemic Impact: Insightful discussion on the surge of mucormycosis cases during the Covid-19 pandemic in India and the treatment strategies adapted.

• Retrobulbar Amphotericin Injections: Exploration of the role and efficacy of retrobulbar amphotericin B injections in sparing ocular structures and preserving the orbital tissues.

• Research Directions: Future research needs, including drug sensitivity, diagnostic techniques, and the impact of systemic advancements in antifungal therapies.

If you're an ASOPRS Member, Surgeon or Trainee and are interesting in hosting a podcast episode, please submit your idea by visiting: asoprs.memberclicks.net/podcast

About the Guests:

Kelsey A. Roelofs, MD - An oculofacial plastic surgeon and Assistant Professor of Ophthalmology at the University of Alberta in Edmonton, Canada.

Catherine J. Hwang, MD - An oculofacial plastic surgeon at Cleveland Clinic Foundation Cole Eye Institute.

Marie B. Somogyi, MD - An oculofacial plastic and reconstructive surgeon in private practice in Austin, Texas at Eyelid and Facial Plastic Surgery, and an affiliate faculty member in Ophthalmology at the University of Texas Dell Medical School.

Jonathan Hoenig, MD - An oculofacial plastic surgeon and Aesoppers fellowship director in private practice in Beverly Hills, California, and an affiliate professor of ophthalmology at the University of California, Los Angeles.

Episode Summery

In this episode of the Oculofacial Podcast, host Dr. Kelsey Roelofs explores a series of insightful discussions with an expert panel on cutting-edge studies in the field of oculofacial plastic surgery, particularly focusing on topics including blepharoplasty complications, orbital implants, and hemorrhage following MMCR.

The conversation kicks off with Dr. Marie B. Somogyi summarizing a study on postoperative hemorrhage following Mueller's muscle conjunctival resection (MMCR). They analyze the implications, risk factors, and offer practical tips for managing such complications. Next, Dr. Catherine J. Hwang sheds light on a robust study from Moorfields Eye Hospital on the efficacy of one-stage orbital volume modification for exposed and non-exposed orbital implants, emphasizing single-stage procedures' advantages.

Continuing on, the discussion shifts to a review of two papers evaluating blepharoplasty complications, led by Dr. Jonathan Hoenig. These papers cover the risk of perforating and penetrating globe injuries during blepharoplasty, underscoring the diverse backgrounds of practitioners and the importance of procedural expertise.

Lastly, the episode delves into a large-scale study on the incidence of strabismus post-blepharoplasty from Massachusetts Eye and Ear, where they explore the potential mechanisms and prevention strategies for diplopia and strabismus following eyelid surgery.

Key Takeaways:

• Postoperative Hemorrhage after MMCR: Hemorrhage occurred on average 4 days postoperatively in around 3% of cases, typically resolving with conservative management without affecting final outcomes.

• Single-Stage Orbital Implant Surgery: Highlighted the success rate and benefits of single-stage surgeries for managing exposed and non-exposed implants and reducing the need for multiple interventions.

• Blepharoplasty Safety - Emphasizing safe practices including the potential complications arising from diverse practitioners performing eyelid surgeries and the necessity of meticulous preoperative planning and procedural caution.

• Strabismus Post-Blepharoplasty: Installation of protocols to identify and mitigate risks related to lower blepharoplasty and its potential impact on extraocular muscles.

• Patient Follow-Up: Importance of close postoperative monitoring to ensure early identification and management of complications, including detailed patient communication and safety briefings.

Produced by Dr. Lilangi Ediriwickrema
Moderator: Dr. Nicole Langelier

Expert Panel Members:
- Dr. Bobby Korn: Incorporating ChatBots into Your Oculofacial Practice
- Dr. Pete Setabutr: Virtual Reality and Surgical Planning
- Dr. Elizabeth Bradley: Facial Reanimation and Face Transplantation

Episode Summary:
Join host Dr. Nicole Langelier in an enlightening episode of the Oculofacial podcast, where leading experts delve into the transformative technologies reshaping oculoplastic surgery. Dr. Bobby Korn introduces the compelling world of large language models and chatbots, illustrating their seamless integration into clinical practice and administration. Dr. Pete Setabutr follows with a discussion on the current and potential applications of virtual and augmented reality in surgical planning and education, painting a futuristic view of surgical training and execution. Dr. Elizabeth Bradley wraps up the podcast by sharing groundbreaking advancements in facial reanimation and face transplantation, highlighting a multidisciplinary collaboration at Mayo Clinic.
.
Key Takeaways:
- AI Integration in Clinical Practice: Dr. Bobby Korn highlights the significant role of AI and chatbots in assisting with
administrative duties and clinical care.
- Virtual Reality for Surgical Training: Dr. Pete Setabutr discusses the implementation of VR and AR technologies in enhancing anatomical understanding and surgical precision, with an emphasis on ophthalmology training and education.
- Facial Reanimation Innovations: Dr. Elizabeth Bradley shares advanced techniques such as using palmate longus tendon to support paralytic lower eyelid retraction and platysma muscle grafts with cross face nerve grafts for managing upper eyelid paralytic lagophthalmos. .Dr - Bradley also shares the role of technology and extensive collaboration among various specialties at Mayo Clinic in handling complex facial transplant cases.
- Future of Oculoplastic Surgery: The speakers collectively forecast significant advancements in personalized AI-assisted surgery, comprehensive virtual reality applications, and envisioning a tech-driven transformation in patient care and surgical education.

If you're an ASOPRS Member, Surgeon or Trainee and are interesting in hosting a podcast episode, please submit your idea by visiting: asoprs.memberclicks.net/podcast

If you're an ASOPRS Member, Surgeon or Trainee and are interesting in hosting a podcast episode, please submit your idea by visiting: asoprs.memberclicks.net/podcast

In the first of the TOP Surgical Battle Series, Dr. Natalie Homer (Stanford) moderates a debate between the frontalis sling (Dr. John Ng, OHSU) and frontalis muscle flap (Dr. Richard Allen, TOC Eye and Face) techniques for correction of myogenic ptosis.

In this episode, Dr. John Ng advocates for the frontalis sling procedure, emphasizing its straightforward nature, time-tested effectiveness, and adaptability. Dr. Ng discusses the various materials used, including silicone and fascia lata, and the procedure’s suitability for teaching and clinical practice. He addresses the potential for infection, material failure, and the cosmetic aspects of the procedure.

Dr. Richard Allen alternatively defends the frontalis muscle flap procedure, making a compelling case for its efficiency and durability. He details his comprehensive technique, incorporating elements such as levator resection. He shares his experience on patient outcomes, complications, and long-term results with this procedure.

Key Takeaways:

• The frontalis sling procedure is known for its straightforward approach and adaptability, particularly useful in teaching environments and varying patient anatomies.
• A variety of materials can be used in the frontalis sling procedure, including silicone and fascia lata. Each material has its pros and cons, such as durability and infection risks.
• The frontalis muscle flap procedure can avoid the use of foreign materials, offering a potentially longer-lasting solution. The technique includes levator resection for optimal eyelid contour and function.
• Post-operative care and complication management, including lagophthalmos and dry eye, are critical regardless of the technique used.
• Both procedures have unique indications and may be chosen based on individual patient needs, anatomical considerations, and potential for future adjustments.

Notable Quotes:

1. “The advantage of the [frontalis] sling is…for teaching at a teaching institute. The anatomy and the procedure is a lot easier to teach and has a...shallower learning curve.” - Dr. John Ng
2. “The beauty of a frontalis flap procedure is that you’re making a single incision across the eyelid, at the eyelid crease.” - Dr. Richard Allen
3. “I think that if you don’t do it,…they’re gonna find someone that does.”- Dr. Richard Allen
4. “It’s…representation of how the materials and techniques have evolved over time, balancing traditional methods with newer innovative practices.” (Regarding the frontalis muscle flap procedure) - Dr. John Ng

This highly engaging episode will give you a comprehensive look at the journey of ASOPRS and the luminaries whose contributions continue to shape the future of this field.

About the Guests:

• Dr. David B. Samimi, MD: An esteemed oculoplastic surgeon based in Los Angeles, Dr. Samimi is driven by his passion for the history and future of oculoplastic surgery. He has trained under many prominent figures in the field and brings a wealth of experience and insightful storytelling to the discussion.

• Dr. Steven C. Dresner, MD: A pioneer in orbital implants and aesthetic surgery, Dr. Dresner is a leading figure in oculoplastic surgery, teaching at USC and known for his captivating stories and deep knowledge of the field’s history. Sadly, Dr Dresner passed away 2 weeks after this recording. We are fortunate to have his animated story telling captured here.

• Dr. Jill A. Foster, MD: Operating out of Ohio, Dr. Foster is renowned for her expertise in both functional and aesthetic surgery. She trained with Bill Katowitz and works at the Ophthalmic Surgery Consultants of Ohio.

• Dr. Michael Hawes, MD: Based in Colorado, Dr. Hawes is celebrated for his innovations in eyelid reconstructive surgeries. He recently retired after a distinguished career, having worked with numerous people and served as a key figure in the field’s development.

• Dr. David M. Reifler, MD: An authority on the history of oculoplastic surgery, Dr. Reifler has documented the evolution of this field via his books. He trained in Manhattan and now enjoys retirement across Austin and Michigan.

Host Dr. David B. Samimi engages with prominent oculoplastic surgeons Drs. Steven C. Dresner, Jill A. Foster, Michael Hawes, and David M. Reifler. They delve into the fascinating history of oculoplastic surgery and its evolution, highlighting the contributions of the founding figures, the development of fellowship training, and the transformative events that have shaped the field today.

Listeners will gain insight into the establishment of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and how its meetings foster collaboration and progress in this specialized area. The discussion covers both the noble beginnings from war and trauma care and the more personal anecdotes from early days, offering a captivating mix of technical evolution and personal stories within the profession.

Key Takeaways:

• Historical Origins: The roots of oculoplastic surgery tie back to trauma and war, with foundational figures such as Wendell Hughes and Byron Smith pushing the field forward.

• Fellowship Training: Evolution from informal observerships to structured fellowship programs marked significant progress in the specialized training of oculoplastic surgeons.

• Influential Figures: Notable mentors like Dr. Henry Baylis and Dr. Richard Dortzbach significantly contributed to oculoplastic surgery’s growth and modern practices.

• Gender Pioneers: Early female surgeons like Dr. Virginia Lubkin and Dr. Bernice Brown played crucial roles in breaking barriers within the specialty.

• Evolving Practices: The panel discusses the importance of maintaining excellence and mentorship while acknowledging shifts in practice dynamics towards aesthetics and broader surgical capabilities.

Resources:

• Dr. David B. Samimi’s Profile on ASOPRS: asoprs.org

• Dr. David M. Reifler’s Books: “ASOPRS: The First 25 Years” and “ASOPRS: The Next 50 Years” available on the ASOPRS website.

• Jeremiah Tao’s Chapter on Mentorship with the ASOPRS Family Tree: Available in the ASOPRS 50th Anniversary book on asoprs.org