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The Chief Resident Aesthetic Surgery Clinic: a Safe Alternative for Patients
Kate J. Buretta, BS, Jennifer Im, BA, Gedge D. Rosson, MD, Paul N. Manson, MD, Ariel N. Rad, MD, PhD.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.

BACKGROUND:
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 have reported on resident perception of aesthetics training and assessments of complication rates, there is nonetheless a need for a more thorough investigation of outcomes. We conducted an IRB-approved, retrospective analysis of outcomes of aesthetic surgeries performed through the chief resident aesthetic surgery clinic (CRASC) as part of the plastic surgery residency training program at the Johns Hopkins Hospital.
METHODS:
The medical records of all patients who underwent procedures from July 2009 to August 2011 were retrospectively reviewed. Data on patient age, gender, BMI, smoking status, medical comorbidities, prior surgeries, type of procedure, outcomes, and follow-up time were collected. Most procedures (70%) were supervised by a single attending surgeon. The study sample included 146 patients who underwent 221 procedures: 48 breast procedures (29 breast augmentations, 7 breast augmentation-mastopexies, 9 mastopexies, and 3 reduction mammoplasties), 84 body contouring procedures (20 pure liposuction cases, 43 abdominoplasties with liposuction, 13 abdominoplasties without liposuction, 3 belt lipectomies, 2 brachioplasties, and 3 other body lifts), and 89 facial aesthetic procedures (27 rhytidectomies, 24 blepharoplasties, 12 browlifts, 8 rhinoplasties, 5 neck lifts, 4 facial fat grafting procedures, and 9 other facial procedures). All procedures were considered as separate events. Complications were categorized as either major or minor. In-clinic and operative revision rates were calculated for each procedure.
RESULTS:
There were no emergent returns to the operating room. One patient developed an infection requiring hospitalization for intravenous antibiotics after undergoing abdominoplasty (major complication, 1.5%). The overall minor complication rate for breast and body contouring procedures was 4.2% and 22.6%, respectively; the overall revision rate was 2.1% and 15.5%, respectively, the majority of which were for scar revision. For facial aesthetic cases, one patient developed a pneumothorax (not requiring a chest tube) from rib graft harvest, representing an overall major complication rate of 1.1%. The overall minor complication rate was 9.0%. One patient experienced transient facial nerve paresis, 1 patient had a hematoma drained in clinic, 2 had ectropion, and 4 had non-operative delayed wound healing. The overall revision rate was 11.2%. Three patients underwent in-clinic revision, 3 underwent operative scar revision (3.3%), and 4 patients underwent revision for 5 procedures due to dissatisfaction with the primary outcome (5.6%). The complication and revision rates were comparable to those published in the peer-reviewed literature.

CONCLUSION:
Complication rates for patients treated through the Johns Hopkins CRASC are comparable to those reported in the literature. As such, our CRASC offers patients safe options with greater accessibility to aesthetic surgery compared to private aesthetic surgery practices. At Johns Hopkins, the CRASC model continues to be an important component of our residency training program.


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