Fellowships may introduce surgeons to specific techniques they haven’t seen before, though. “I saw zero deep plane facelifts in my residency, and I operated in the biggest medical center in the world,” says Dr. Jalalabadi. The deep plane (an advanced technique that releases and repositions the tissues in a lasting and natural-looking way) was a focus of his fellowship, however, and is now, four years later, a mainstay of his practice. “My fellowship program had a strong clinic built in, where I could book my own cases and I had supervision,” he says. “It’s crazy, the amount of learning that happens when you actually do a technique for the first time.”
Which is precisely the point of a fellows’ clinic: Instead of merely watching or assisting, fellows can devise surgical plans and operate autonomously, but with the safety net of having a mentor nearby. In the clinic, “the co-surgeon model is flipped,” says Tyler Safran, MD, a dual fellowship-trained plastic and reconstructive surgeon in Montreal. “The fellow becomes the primary surgeon of record, and the senior surgeon is assisting or at least available to help.” When Jason Bloom, MD, a double board-certified facial plastic surgeon and co-director of the Facial Plastic & Reconstructive Surgery Fellowship program at the University of Pennsylvania, allows fellows to do aesthetic cases in his private surgery center, he’s “always around in case they have questions,” he says. “I could be in the other room operating, or I could be across the parking lot at my office, but I’m nearby to assist if needed.”
Some residency programs offer similar experiences—what’s known as resident aesthetic clinics or chief cosmetic clinics—enabling plastic surgery residents in their final years of training to perform injectable treatments or surgical procedures on patients for a nominal fee. (Residents’ clinics have been around since the late ’80s; today, upwards of 75% of plastic surgery programs have them.) A critical difference between residents’ clinics and fellows’ clinics is the degree of oversight. Residents require direct supervision, as in a senior surgeon (a.k.a., an attending) in the room with them. When a fellow is operating, however, “there’s not necessarily going to be an experienced surgeon looking over their shoulder,” says Dr. Clark. “Some fellowship directors may do that, but that’s largely going to be the exception rather than the rule.”
How much experience do these surgeons actually have?
Every plastic surgery resident must log a certain number of surgeries across the breadth of the specialty, including a minimum of 150 aesthetic cases. “By your final years of residency, you’re functioning as a surgeon,” says Matthew Farajzadeh, MD, a plastic and reconstructive surgery chief resident at UC Davis. “You still have supervision, and you still have to answer to the attendings, but you’re fully working as a surgeon in the hospital.” Otolaryngology (ENT) residents, who may be training to become facial plastic surgeons, have their own case requirements. In both fields, each five- to eight-year residency affords its own mix of cases and its own unique ratio of reconstructive to cosmetic procedures.
