Where Have All the Rhinoplasties Gone? A Call to Action for Academic Plastic Surgeons to Get Back Into the Rhinoplasty Game Before It's Too Late
Ashley Jordan, MD1; Alexis Rothermel, MD2; Katherine Santosa, MD3; Paul Cederna, MD3; Christian A. Kauffman, MD1
1Geisinger Medical Center, Danville, PA; 2Penn State Health, Hershey, PA; 3. University of Michigan Hospital, Ann Arbor, MI
Background: Plastic surgeons operate on patients from head to toe making our array of surgical procedures numerous. Unfortunately, plastic surgeons have been losing portions of their operative domain to other subspecialties for years. Abdominal component separations were once primarily performed by plastic surgeons; however general surgeons learned the technique and now perform the procedure. Oculoplastic surgeons perform blepharoplasties and Otolaryngologists (ENT) have embraced the rhinoplasty market. The number of subspecialties invading our niche is bothersome, but more concerning is the fact that losing the reins of these core procedures results in less surgical exposure and competency for plastic surgery residents. Lately, in academic institutions ENT appears to be performing the majority of rhinoplasty procedures, resulting in fewer surgeries performed by plastic surgeons. Trainees must perform ten rhinoplasties to fulfill graduation requirements but more importantly, residents should graduate feeling competent and confident performing rhinoplasties. The aims of this study were to determine the number of rhinoplasties being performed at academic centers each year and to evaluate the trend in regards to which specialties are performing these procedures.
Methods: Investigators at three academic institutions with plastic surgery and otolaryngology residency programs searched medical records for primary and secondary rhinoplasty CPT codes from 1/1/2009 to 12/31/2019. Total number of rhinoplasties performed each year, by each specialty were tallied.
Results: Growth rate in rhinoplasty volume amongst participating institutions ranged from 27% to 149%. At these institutions, plastic surgeons’ performed less than 1/3rd of all rhinoplasties. In 2009, 10% of rhinoplasties were performed by plastic surgeons at Institution one, 18% at institution two and 22% at Institution three. In 2019, the volume of rhinoplasties performed by plastic surgeons was 5%, 27% and 12%, respectively. The three ENT departments have had statistically significant increasing trends in rhinoplasty volume. Institution one and two’s plastic surgery departments showed negative volume trends however, they were not statistically significant. Institution three’s plastic surgery department has had an increasing trend which was statistically significant.
Conclusion: Otolaryngology is performing the majority of rhinoplasties at several academic institutions. This is concerning for the education of plastic surgery trainees. Academic plastic surgeons must focus on increasing the number of rhinoplasties they perform in order to adequately train residents this core procedure before they enter the workforce as independent practitioners. If we do not make this a priority now, rhinoplasty surgery may become a historic operation instead of a vital skill in plastic surgeons’ armamentarium.
Back to 2022 Posters