Perspective: committed to excellence.

Abstract

Archives of Facial Plastic SurgeryVol. 1, No. 1 Society SectionFree AccessPerspective: Committed to ExcellenceRobert L. SimonsRobert L. SimonsNorth Miami Beach, FlaSearch for more papers by this authorPublished Online:1 Jan 1999https://doi.org/10.1001/archfaci.1.1.63AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Today, when facial plastic surgery is recognized universally as a legitimate surgical specialty, it may be hard to imagine that this was not always the case. Thirty-five years ago, few, if any, surgeons limited their practice to facial plastic surgery. Only a few decades before that, the first reference to the term facial plastic surgery appeared. How did we get from there to here in such a short span of time?Commitment is the answer. Commitment to improving standards of patient care, to evolving techniques and technology, and to teaching and leading the next generation of surgeons.Commitment is the common thread that runs through our history and the force that will shape our future. To commitment, then, I would like to dedicate this and future columns so that the surgical advances featured elsewhere in the new journal Archives of Facial Plastic Surgery can be properly showcased among the pioneering efforts and technical contributions of those individuals who set in motion the trends that continue to impart vitality to our specialty today.With education being the raison d'être for this journal, this inaugural column offers a brief survey of the people who imbued our specialty with its passion for ecumenical learning and the events that led to the universal association of our expertise with the term facial plastic surgery. The recognition we enjoy today stems directly from the momentum generated by these people and events.Early Teachers From Many SpecialtiesThe regional specialty of facial plastic surgery has origins in a number of surgical disciplines, as evidenced by reports in 1845 of a nasal reduction by German general surgeon Johann Friedrich Dieffenbach, in 1881 of a procedure to correct protruding ears by US otolaryngologist Edward Talbott Ely, and in 1887 of the first intranasal rhinoplasty by another US otolaryngologist, John Orlando Roe.It was an orthopedic surgeon, however, who appears to have used the term facial plastic surgery for the first time. German by birth, Jacques Joseph (Figure) performed his first otoplasty in Berlin in 1896 and his first nasal reduction in 1898. The work intrigued him sufficiently, and he committed his life to improving techniques and teaching them to others. From 1916 to 1921, Joseph served as director of the Facial Plastic Surgery Division of the Charitè Hospital in Berlin—probably the earliest entity to identify itself in this way. There, during World War I, he treated a multitude of facially injured soldiers. In the 1920s and 1930s, Joseph's innovative skills and vast experience catapulted him to international renown as the premier teacher of facial plastic surgery. His place in history as the father of modern facial plastic surgery was ensured with the 1931 publication of his monumental text, Rhinoplasty and Other Facial Plastic Surgery.How far has facial plastic surgery come? The term may have appeared first in the title of the monumental work of Jacques Joseph (left), father of modern facial plastic surgery. Today, the term's universal recognition is perhaps best illustrated by its appearance in the name of the American Academy of Facial Plastic and Reconstructive Surgery's popular newsletter (right) for patients.Also contributing to facial plastic surgery's early, multidisciplinary growth were surgeons for the Allied forces of World War I. A US dentist, Varaztad Kazanjian, directed the Harvard Unit in France. A New Zealand otolaryngologist, Harold Delf Gilles, headed the renowned facial surgery facility at Queen Mary's Hospital in Sidcup, Kent, England. Assisting Gilles was a US oral surgeon, Vilray P. Blair, who became head of the Section of Oral and Plastic Surgery for the American Expeditionary Forces. Ferris Smith, another US otolaryngologist, also served in England and was perhaps the first surgeon to describe otolaryngology's inherent interest in the emerging specialty of plastic surgery. His article, "Plastic Surgery: Its Interest to Otolaryngologists," was published in 1921 in the Journal of the American Medical Association.When the American Board of Plastic Surgery was established in 1937, it is not surprising that many of these surgeons, together with others from equally diverse backgrounds, were among its founding members.Organizing Facial Plastic Surgery TrainingThe establishment of the American Board of Plastic Surgery did not diminish the ardor of a small number of otolaryngologists for facial plastic surgery. This spark was fanned by an anatomist, Samuel Foman of Chicago, Ill, who late in the 1930s researched facial plastic surgery in Europe and wrote his major treatise, The Surgery of Injury and Plastic Repair. Foman's work built on Joseph's teachings and, in 1940, he began a series of courses that taught Joseph's basic principles of rhinoplasty and otoplasty to otolaryngologists.With Foman's courses, the formal organization of facial plastic surgery training within otolaryngology began. Attendance at Foman's courses was encouraged by George Coats, professor of otolaryngology at the University of Pennsylvania, Philadelphia, ayvnd editor of the prestigious Archives of Otolaryngology. Through Coates, Foman met Dean Lierle, chairman of the Department of Otolaryngology at the University of Iowa, Iowa City, long-time secretary of the American Board of Otolaryngology (ABOto) (founded in 1924), and probably the most powerful man in otolaryngology in the 1950s and 1960s. Lierle's department, said to be one of the finest in the world at that time, was one of the few providing full facial plastic surgery training within the structure of a residency program. He opened the doors of academia to Foman and made his course acceptable to otolaryngologists (sidebar).Meanwhile, in the 1940s, Foman and his followers formed a society devoted to furthering facial plastic surgery training. Two of his students, Irving Goldman and Maurice Cottle, started their own courses and societies in the 1950s. By the early 1960s, with several societies working toward similar goals, talks of amalgamation began. In 1964, the Foman and Goldman groups merged to form the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).The AAFPRS emerged as public interest in facial plastic surgery soared, fueled by the widespread acceptance of all means of self-improvement by a fast-paced, postwar society. The young AAFPRS's educational programs attracted scores of otolaryngologists who understood the necessity of appropriate training for high-quality patient care within the new subspecialty.Shows Depth of Facial Plastic Surgery TrainingA recent survey of 118 US and Canadian otolaryngology training programs shows the depth of facial plastic surgery training in accredited programs. Ninety-four (80%) of the 118 programs responded to the survey.Of respondents, 51% said that their programs have a division specifically designated for facial plastic surgery training. Nearly 18% of those currently without a separate division plan to add one.With or without a separate division, 91.5% respondents reported that their departments have one or more facial plastic surgeons on the faculty. Seventeen percent of all respondents reported plans to add one or more faculty positions.Facial Plastic Surgery Comes of AgeIn the ensuing years, under the AAFPRS's leadership, facial plastic surgery became an integral part of otolaryngology training. As it did, the AAFPRS won recognition for facial plastic surgery within organized medicine and eventually established the American Board of Facial Plastic and Reconstructive Surgery. The addition of the words "facial plastic surgery" to the American Board of Otolaryngology certificate further acknowledged its importance to the specialty.Landmark events that have occurred in the field include the following:Establishment by the AAFPRS of the facial plastic surgery fellowship program (1968), which today includes 43 approved fellowships. Approval from the Accreditation Council for Continuing Medical Education for the AAFPRS to grant credit for its facial plastic surgery courses—the first such approval ever granted outside a university setting (1970). Establishment of the Educational and Research Foundation for the AAFPRS (1972), which today fosters a wide array of educational programs, research opportunities, and charitable programs. Approval by the ABOto, the American Medical Association (AMA), and the American College of Surgeons of a revised edition of Essentials in Otolaryngology, which effectively mandated facial plastic surgery training in approved residency programs and command of the subspecialty for ABOto certification (1975). Recognition from organized medicine with an AAFPRS seat on the new AMA Plastic Surgery Section (1972), another seat on the American College of Surgeons Board of Governors (1974), and representation to the AMA House of Delegates as a national medical specialty society (1978).Establishment of the American Board of Facial Plastic and Reconstructive Surgery (1986), which to date has certified 484 facial plastic surgeons. With publication of the Archives of Facial Plastic Surgery, our subspecialty achieves another long-standing goal. The dissemination of information in a peer-reviewed journal can only enhance the interest and capabilities of young surgeons. Facial plastic surgery has developed into a respected and desired subspecialty. It has come of age, and its growth augurs well for the future care of our patients.FiguresReferencesRelatedDetailsCited byOur Journal, Our Literature, Our Culture, Our Voice David Reiter3 November 2008 | Archives of Facial Plastic Surgery, Vol. 10, No. 6 Volume 1Issue 1Jan 1999 InformationCopyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Robert L. Simons.Perspective: Committed to Excellence.Archives of Facial Plastic Surgery.Jan 1999.63-64.http://doi.org/10.1001/archfaci.1.1.63Published in Volume: 1 Issue 1: January 1, 1999PDF download