When Robert M. Kellman, MD, took over as president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) last October, he had one overarching goal. He wanted to make the “R” count as much as the “P.”
Kellman, the professor and chair of the Department of Otolaryngology and Communication Sciences at SUNY Upstate Medical University in Syracuse, NY, is first and foremost a reconstructive surgeon. Unlike many of his colleagues, he would much rather rebuild a lower jaw from scratch than get rid of crow’s feet or excise a double chin.
Simply put, he is a surgeon’s surgeon. He doesn’t have or need a handler or high-powered publicist. All he needs is his scalpel, retractor, dissector, and a complicated case.
And as Kellman looks back on his 1-year term in office, he is characteristically modest about the inroads he has made toward reinvigorating the R. “It’s a work in progress, and it is progressing well.”
This is an understatement. For the first time ever, this year’s Fall AAFPRS meeting in New Orleans boasts an entire reconstructive track, including a “high-powered” session on microvascular surgical techniques for the face and neck. “Just having a reconstructive track running through the meeting is a huge change, and it has some real potential to excite a bunch of people,” he says. “I’d like to see more of the people that count themselves in the reconstructive category feel a sense of attachment and at home in the organization.”
And by all accounts, a groundswell is occurring. The AAFPRS is home to more than 2,700 facial plastic and reconstructive surgeons, and of these, about 15% count themselves in the reconstructive category. This number may increase further as the Affordable Care Act takes hold and more Americans become insured. Surgeons may opt to provide a greater number of reimbursable services to make sure they get a piece of the pie.
Incoming president, Tampa, Florida-based facial plastic surgeon Edward H. Farrior, MD, has more of a cosmetic bent to his practice, but he plans to continue Kellman’s efforts to bolster the reconstructive side of the organization. “His goal was admirable, and we will continue to do it, as reconstructive surgery is the foundation of our training,” he says.
Facial plastic surgeons can’t just move into a community and open up a successful cosmetic practice. “Reconstructive surgery, whether through trauma, the emergency room, or cancer surgery, helps you build a reputation within a community,” he says. “This is the way you build your practice, and as it evolves over time, the people who come to you for cosmetic work are the same ones who you treated as reconstructive patients.”
The R is integral, and you can’t be a facial plastic surgeon without having done a lot of it, he says.
Furthering research and education were also high on Kellman’s agenda, and he has made significant inroads here as well. The development of the LEARN portal on the AAFPRS website ushers the group into the modern age of web education and access to information. “It has really given our members and guests opportunities to access the Academy’s resources as never before,” Kellman says. “It is indeed a wonderful addition to our educational armamentarium.” In addition, the funding of several new research grants will allow members to have access to resources that can advance our field and keep them in the forefront of new scientific developments.
While the beefed-up reconstructive arc will certainly be part of Kellman’s AAFPRS legacy, he may well be remembered for having been president when the Accreditation Council for Graduate Medical Education (ACGME) approved a facial plastic surgery fellowship. This endeavor was started by his predecessor, Tom D. Wang, MD (pronounced Wong), a Portland, Oregon-based plastic and reconstructive surgeon.
The AAFPRS does offer some 47 fellowships, but until now there has not been one that is ACGME-accredited either through plastic surgery or otolaryngology-head and neck surgery. “The objective was successful, but it has carried with it, like all change, some unintended consequences,” Kellman says.
“The most important job, you might say the ‘crowning effort of my presidency,’ will be to make sure that no one ends up feeling disenfranchised as a result of this outcome.”
As to what made the endeavor controversial or difficult to move forward, the short answer is politics. At times, there were too many chefs in the kitchen. To continue with the cooking analogy, the different chefs all had different cooking philosophies.
“It has progressed to a point where the outcome is much more likely than before,” he says. “The devil is in the details, and the current model raises some questions.”
Now, negotiations are taking place in small groups, and soon the final model will be presented to the larger bodies, Kellman says (with his fingers crossed).
“This pathway is not something that everyone will pursue,” he says. “It didn’t exist before, and it will be offered as a new opportunity for fellowship directors,” he says. “It is presumed that some will choose to pursue this pathway, while others will continue to run their fellowships under the current model.”
However, he says, the most important challenge is to assure that the creation of a new pathway does not in any way disadvantage those who choose to continue to work within the current system, and that includes the fellowship directors as well as the trainees who choose their fellowships.
Kellman is a diplomat, Farrior adds. “He has shepherded the association through the controversy surrounding the creation of an ACGME fellowship.”
Kellman adds: “I tried to pave the road for [Farrior] so that when he takes over he is on a pathway that will be the glue that holds everyone together.”
Farrior is ready for whatever this year brings.”My main goals will be to maintain excellence in education and the parallel goal of trying to keep us in the forefront of organized medicine as the best-trained and best-educated providers of facial plastic surgery,” he says.
When Farrior takes the baton in New Orleans, Kellman plans to settle back into his academic practice. As a surgeon, he is best known for putting together faces that have been smashed in car accidents or kicked by horses. The latter is not common, but the damage can be devastating when it does occur. He also does a lot of functional rhinoplasty in older patients. And it can be difficult to balance form and function in these cases. “The key is to have the middle third of the nose wide enough for airflow without making it too wide,” he says.
He is always watching out for new techniques and technologies to help improve upon the results of these cases. “We always try to be on the left side of that curve,” he says. “While we may not necessarily be the inventors, we certainly want to be early adaptors of promising technologies. The trick is to identify these while also being able to recognize the ones that are not really beneficial for our patients.”
To that end, he has his eye on two potential prizes: an investigational radiofrequency device that can alter the shape of the nasal valve, and stem cells, though he remains skeptical about the radiofrequency device until he can see some results. On the other hand, “The possibility that stem cells can allow for wound healing without scars is one of the most exciting things on the horizon,” he says.
One thing is clear: With all of the developments coming down the pike, “I am certainly not ready to retire.”