Patents for the Plastic Surgeon: A Primer.

ABSTRACT: Although innovation and entrepreneurship are complementary in the process of creating new products, plastic surgeons are frequently discouraged by the challenges associated with the regulatory and administrative environments in patent filing. The following primer provides a step-by-step guide for understanding patents and outlines the steps and costs involved in patent filing. To improve opportunities for successful patent filing, we elaborate on some of the common pitfalls in the process, including the timing of public disclosure, conducting a private art search, selecting a patent attorney or agent, determining the level of inventor involvement, and navigating academic and employment contracts. The innovative drive in plastic surgery provides a strong impetus for strengthening knowledge about patents and patent filing in order to support efforts for providing high-value patient care.

Full-Thickness Facial Pressure Injury and Buried Dentition from Prone Positioning in a Patient with COVID-19.

ABSTRACT: Prone positioning is recognized for its efficacy in the treatment of acute respiratory distress syndrome related to COVID-19. Here the authors present a case of a facial pressure injury and buried dentition that occurred as a result of prolonged prone positioning in a patient who was COVID-19 positive. The patient was treated with primary closure of the injury and pressure offloading.

The Five Ds for Safe and Effective Buccal Fat Removal.

SUMMARY: An aesthetically sculpted malar, cheek, and jawline contour is a desirable feature sought out by many adults with central facial adiposity. This fullness, anterior to the masseter, can be attributed to underlying buccal lipodystrophy. An attractive central facial concavity can be delivered by performing buccal fat pad excision in conjunction with malar fat pad augmentation and mandibular contouring if indicated. Appropriate patient selection is critical for preventing an aged or unnatural appearance. The authors present a safe and reliable five-step technique for buccal fat pad excision: the Five Ds.

The 10-7 Facial Analysis Method for Facelifting and Facial Rejuvenation.

SUMMARY: Proper facial analysis is the first step toward delivering an excellent result in any facelifting or facial rejuvenating operation/procedure. Every case should be approached in a systematic and comprehensive manner, ensuring proper assessment of specific anatomic regions contributing to facial aging as well as the global facial aesthetic. Failure to do so may result in an unnatural/partially rejuvenated face. The senior author's approach entails ten key anatomic regions on the frontal view and seven on the lateral view. The 10-7 facial analysis method allows the surgeon to reliably assess every patient in a detailed, top down, structural approach when considering facelifting and facial rejuvenation.

The Key to a Straight Nose Is a Straight Septum: 10 Essential Steps.

SUMMARY: The deviated nose derives from underlying skeletal and soft-tissue deformities in the upper, middle, and/or lower third of the nose. Although deviation may stem from several intrinsic and extrinsic elements, the septum is most often the primary contributor. Attempts to straighten the nose without properly addressing the septum invariably result in a persistently deviated nose. The goal of this article is to review the 10 key steps for a reliable, methodical approach to correcting the deviated septum in primary rhinoplasty.

Lip Lifting: The Missing Link in Central Facial Rejuvenation.

The lip lift is a powerful yet finesse operation in the realm of facial rejuvenation. In an era of booming non-surgical lip augmentation, the astute plastic surgeon must identify which patients will end up with a dreaded unnatural appearance should they receive volume enhancement alone in pursuit of central facial and perioral rejuvenation. In this paper, we review the ideal youthful lips, the characteristics of the aged lip and indications for lifting. We present our preferred surgical technique, the underlying principles that it respects, and adjunct procedures to optimize results in central facial rejuvenation.

Sirenomelia: Review of a Rare Syndrome with Case Report, Review of Anatomy, and Thoughts on Management.

BACKGROUND: Sirenomelia is a rare syndrome in which the infant is born with the legs fused from the pelvis to the feet. Sirenomelia is often fatal in the neonatal period because of multiple other anomalies. The feet may be absent; if present, they are often splayed outward or face backward. There are no case reports of any patient with this syndrome who has been able to walk after separation of the legs. METHODS: The authors report on their patient with sirenomelia who was born with the feet facing backward but otherwise normal-appearing hips and thighs and no other anomalies that would lead to fatality in the near future. After preoperative tissue expansion, the authors performed separation of the legs with through-knee amputations, utilizing a vascularized flap from the lower part of the legs based on the sciatic vessels for coverage of the perineum. There was no need for skin grafts or dermal matrices and the patient was referred to physical therapy after recovery from surgery in an attempt to allow her to ambulate. RESULTS: The patient began to ambulate on her stumps early after surgical repair and is now walking with stubby prostheses. Her other medical issues have remained stable and nonproblematic. CONCLUSIONS: Selected patients with sirenomelia may be able to walk after separation of the legs, depending on the status of other congenital differences as well as the status of the legs when separated. Careful workup with multidisciplinary planning of overall care as well as surgical care is essential.

Plastic Surgeons as Medical Directors: A Natural Transition into Medical Leadership.

With the growing complexity of the U.S. health care system, highly motivated medical directors with strong leadership skills are vital to the success of health care facilities. Presently, there are no articles assessing a plastic surgeon's qualifications for the role of medical director. In addition, there is a paucity of literature comparing the responsibilities of medical directors across various types of health care institutions. Herein, we outline why plastic surgeons have the unique skillset to succeed in this role and highlight the differences between medical director positions across the vast landscape of health care. While the intricacies of this position vary greatly across different landscapes of the health care industry, successful medical directors lead by following a set of universal principles predisposing them for success. Plastic surgeons innately exhibit a subset of particular traits deeming them suitable candidates for the medical director position. While transitioning from the role of a surgeon to that of a medical director does require some show of adaptation, plastic surgeons are ultimately highly likely to find intrinsic benefit from serving as a medical director.

Breast Implant Utilization Trends in USA versus Europe and the Impact of BIA-ALCL Publications.

BACKGROUND: The goals of this study were to analyze and compare breast implant preferences between US and European surgeons in terms of size, shape, and surface texturing. Furthermore, we set out to investigate the impact of BIA-ALCL scientific publications on surgeon practice patterns. METHODS: Breast implant sales data from the USA and Europe dating from June 2013 to September 2018 were provided by one of the world's leading breast implant manufactures (Mentor Worldwide LLC). Change-point analysis was used to identify when significant changes in sales trends occurred. These changes were compared with dates of government announcements and publications of landmark scientific articles regarding BIA-ALCL. RESULTS: Our data demonstrate that US surgeons tend to prefer larger, smooth round implants compared with European surgeons, who prefer smaller, textured round implants. Despite these differences, medium-sized implants were still the most common size used between both regions. Sales trends illustrate an increase in smooth implants and a decrease in textured implants for both regions. Significant changes in trends align with publication dates of announcements and landmark scientific articles. CONCLUSIONS: We demonstrate definitive differences in implant preferences between the USA and Europe. We encourage physicians to continue their pursuit of publishing because it seems these publications affect medical device selection.

The Impact of Political Advocacy on the Plastic Surgeon: A Data-Driven Analysis.

BACKGROUND: Despite successful legislative efforts by the American Society of Plastic Surgeons (ASPS), the Plastic Surgery Political Action Committee remains underused. Participation in advocacy and financial contributions of ASPS members fall below those of similar surgical subspecialties. This study aims to perform a data-driven investigation into the impact of Plastic Surgery Political Action Committee efforts on the practicing plastic surgeon. METHODS: A retrospective review of the ASPS procedural database from 1992 to 2018 and Plastic Surgery Political Action Committee contributions from 2012 to 2018 was performed. Postmastectomy breast and congenital anomaly reconstructions were analyzed. To determine significant variations in trends, change-point analyses were conducted. Changes in surgical volume were correlated to implementation of federal legislative efforts. RESULTS: Three significant trends of increased breast reconstruction volume were detected with associations to three specific legislative changes: 1992 to 1998, which correlates with the Women's Health and Cancer Rights Act; 2006 to 2009, which correlates with the U.S. Food and Drug Administration's approval of silicone breast implant use; and 2013 to 2015, which correlates with the Breast Cancer Patient Education Act. During the study period, breast reconstruction procedures increased substantially compared with all reconstructive procedures (146.6 percent versus 3.6 percent). There were no significant trends detected for birth defect reconstructions. Although contributions were relatively stagnant, resident member contributions increased after 2015, correlating with formation of the Political Action Committee's Resident's Club. CONCLUSIONS: This study demonstrates a correlation in timing between Plastic Surgery Political Action Committee legislative accomplishments and the resulting case volume increase in some areas of plastic surgery. The data highlight the importance of political advocacy and how political action committee activities can directly impact patient access to care and the practice of plastic surgery.

Product Development: From Concept to Market.

Plastic surgery has origins that date back to 3,000 BC and although some devices and techniques have withstood the test of time, the field has made much advancement through the use of modern day technology and innovation. The combination of the two has led to an array of advanced products we use in our offices and operating rooms on a daily basis. These products may be used by the surgeon or the patient, may be small scale, or sold en masse. The surgeon stands in a position of power, able to guide the progress of the field as a whole, through new product development. Ideas for advancement are just that-a thought-until put in the hands of an end user. This paper discusses the steps that may aid you in doing so: idea generation, design feasibility, testing and prototyping, pricing, distribution channels, marketing and sales, and seeking enablers.

Creating Value in Plastic Surgery.

Value is defined as the worth, utility, or importance something holds. It can be derived from a variety of goods and services and is relative to a given industry or population. This article will discuss elements of plastic surgery that hold value as to how it pertains to the key players in a medical transaction. It will also discuss strategies for identifying and generating value. Roles of the different members in a plastic surgery transaction were analyzed, specifically the patient, the surgeon, and the facility. Different factors that generated value for all parties were identified throughout the literature. Factors identified that created value included the following: the surgeon's knowledge, experience, and decision-making ability; and technical skill/speed, restoration of life, restoration of form and function, restoration of psychological deficit, instant surgical results, convenience of access, outcomes, cost accounting, research, compassion, and bedside manner. Plastic surgeons can gear their practice to provide the system and their patients with services that hold value. We present several factors that can generate value for the patient, surgeon, and hospital system.

Strategy Assessment for the Medical Professional.

While medical professionals are superbly trained in treating patients, they are not often trained in quality improvement principles. In this article, the authors present a framework for strategy assessment commonly used in the business sector to identify areas for improvement and measure the improvement of interventions. This framework can be adapted to the medical field and used to improve the delivery of health care at a systems level.

Bootstrapping Your Telehealth Program.

Telehealth is a proven modality to better patient care, reduce health care cost, and increase provider efficiency. This article outlines the necessary steps for starting a telehealth program at a medical center or practice. A review of the current literature and health care-related laws was undertaken to identify the necessary steps and considerations for starting a telehealth program. Bootstrapping a telehealth program starts with the creation of concept and identification of need. Generation of a hotbed of support, from providers and patients, is key in gaining executive interest and idea investment. Development of a defined plan of implementation with the utilization of already available technologic assets facilitates ease of execution. Creation of a televisit platform, a patient portal for enrollment, and dedicated provider time for televisits to occur are the next steps in plan realization. Measuring results of patient satisfaction, number of visits, cost reduction, and scheduled procedures are powerful tools in support of the multifaceted expansion of a telehealth program. The authors believe that telehealth programs are critical to advancing patient care, reduction of costs, and increased productivity in the future of medicine.

The Nonprofit Sector: Navigating its Waters from a Surgery Vantage.

The nonprofit sector is a vibrant, dynamic, and expanding portion of the United States' economy. Its growth over the past two decades has opened up many avenues for entrepreneurs wishing to create corporations that are community- and need-driven, particularly in the health services industry. The fertility of this sector has not been maximized by physicians in particular due to the tortuous path of nonprofit incorporation and accreditation. This article focuses on reviewing the structure of nonprofits and streamlining the establishment process.

Entrepreneurial Strategies to Seek Venture Capital Funding.

Innovation is vital for progress in any industry. Evolving technology, paired with human ingenuity, brings ideas for prototypes and business models. Many physicians conceptualize platforms to serve their patients; however, many struggle and ultimately fail to bring their product or service to market. Financing is often the limiting factor. Studies have proven venture capital (VC) funding to be a pivotal source for helping a business survive in its early stages. Plastic surgeons can benefit from learning how to seek out VC funding. In this presentation, common terminology and key players will be defined, from seed capital to angel investors. Doing recommended "homework" will help the plastic surgeon identify a financier tailored to their specific needs-ideally one with a focus in the medical space. A clear-cut approach to assembling a "pitch deck" presentation will be outlined to prepare the plastic surgeon for their first meeting. Insider pearls will be presented from the VC perspective. The plastic surgeon should be prepared to answer fundamental questions expected at different stages of the process. Nevertheless, each meeting also serves as an opportunity for the plastic surgeon to probe the VC firm and their intentions. The role of background checks, social media, and electronic profiles will be discussed. Transparency from both parties at all times can help establish a successful relationship, even if it ends in a referral to a better suited VC firm. Between January and September of 2017, $12.1 billion of seed and VC was invested into life science companies in the United States. Growth is exponential. The surgeon is at the frontier of developing ideas and cutting-edge products that help us serve our patients with enhanced care and improved outcomes. In seeking out the proper financier, your product or service can become a reality in the market, contributing to the betterment of medicine and plastic surgery.

Deploying Your Telehealth Platform.

Telemedicine is a burgeoning industry with potential to enhance patient care and physician outreach. A review of the current literature and legislative laws was conducted along with knowledge from the experience gathered at starting a telehealth platform at Texas Children's Hospital to find the necessary steps for starting a telehealth program. The authors propose their pearls to deploying a capable telehealth platform for the large hospital system. Doing so properly can increase capacity within hospital operations and improve health care economics. Select use-cases can be focused to leverage stakeholder need, while maximizing potential return. Successful deployment of a telehealth platform can be done on a small margin and accrued revenue can be reinvested as the basis for growth. Risk management considerations upfront will help navigate hurdles in the evolving legislative and regulatory landscape. This article presents the authors' stepwise approach for arranging and conducting a teleconsultation between patient and physician along with pearls for risk management considerations to be aware of throughout the process.

Initiating Telehealth in a Complex Organization.

Medicine has been praised for breakthroughs that improve the quality and longevity of human life. In the setting of today's fast-paced, tech-savvy society in combination with increased patient volume entering hospital doors, telemedicine proves an effective tool to enable the industry to adapt to the changing world around us. A review of the current literature and legislative laws was conducted along with knowledge from the experience gathered at starting a telehealth platform at Texas Children's Hospital to find the necessary steps for starting a telehealth program. Through digital platform, telemedicine offers remote delivery of medical services to all parts of the country, urban and rural, while enhancing interprofessional referral patterns in the local setting. Telemedicine sets to preemptively triage and guide patients through their appropriate phases of care all the meanwhile, bringing the patient and physician closer together. This discussion delves into the further added benefits to large hospital systems, breaks down the basics of the technological platform, and addresses current barriers to entry in the telehealth industry. This article serves as an introduction to a series regarding effective implementation of telemedicine into the hospital system.

Activity-Based Costing.

Cost allocation for health care professionals can be an enigma within the health care system. Activity-based costing (ABC) is an accounting tool that allocates costs incurred through a company's practice of providing goods and services to the consumer. ABC can provide insight into inefficiencies across the supply chain and unlock excess capacity. This, in turn, can drive services provided toward generating more value for the hospital system. ABC can be tailored to focus upon a unit of measurement that holds value as it pertains to production. With time-driven ABC (Td-ABC), we look to use the advantages of both the fee-for-service and capitation model to transition to a value-based system. Providers are rewarded based on efficiencies and successful outcomes in patient care while disincentivizing poor outcomes and superfluous volume/expenditures. ABC, however, does not come without its own risks and disadvantages, and the user must exercise caution in applying this cost-allocating tool to avoid detriment to its practice. A review of the literature was conducted to analyze the implementation, medical application, and advantages and disadvantages of Td-ABC.

Treatment of Infected Cardiac Implantable Electronic Devices.

With their rising benefits, cardiac implantable electronic devices (CIEDs) such as pacemakers and left ventricular assist devices (LVADs) have witnessed a sharp rise in use over the past 50 years. As indications for use broaden, so too does their widespread employment with its attendant rise of CIED infections. Such large numbers of infections have inspired various algorithms mandating treatment. Early diagnosis of inciting organisms is crucial to tailoring appropriate antibiotic and or antifungal treatment. In addition, surgical debridement and explant of the device have been a longstanding modality of care. More novel therapies focus on salvage of the device by way of serial washouts and instilling drug-eluting antibiotic impregnated beads into the wound. The wound is then serially debrided until clean and closed. This technique is better suited to patients whose device cannot be removed, patients who are poor candidates for cardiac surgery, or patients who have failed conventional prior treatments.