By Denise Mann
National and even international plastic surgery society meetings are often home to rah-rah talks, bustling exhibit halls, exciting preclinical research, and motivational keynote speakers (sometimes there’s even a headlining act), but the real action starts on a local and regional level.
“Think globally, act locally” is more than just the catchphrase of the Go Green movement. It’s actually the blueprint for meaningful change in many industries, including plastic and reconstructive surgery.
“It’s so important to get involved in local and regional societies so that you are aware of all the city and state issues that affect our specialty,” says Kiya Movassaghi, MD, DMD, founder and director of Movassaghi Plastic Surgery & Ziba Medical Spa in Eugene, Oregon, and the 2015-2016 president of the Northwest Society of Plastic Surgeons (NWSPS).
This is one of the main reasons that Movassaghi, also a board member of the American Society for Aesthetic Plastic Surgery (ASAPS), got involved with the NWSPS, a group that represents more than 350 plastic surgeons from Washington, Oregon, Idaho, British Columbia, Alaska, and Hawaii. He plans to use his 1-year term to call attention to issues affecting the professional and personal lives of plastic surgeons in the Northwest, with the hope that positive changes resonate and take root on a national and even international level.
“Change always starts locally and then involves the regional society, and from there, has a ripple effect throughout the country,” he says. In particular, Movassaghi intends to focus on physician wellness and burnout prevention during his term. “Because of all the budget cuts, we are working harder and harder for longer hours, and we have no time to breathe and reflect on what life is all about,” he says. “We don’t learn the skills to cope with stress and personal stuff, so as long as things go smoothly, we are on cruise control; but once there is turbulence, we hit a wall,” he says.
“I am trying to bring a focus back to the physicians by advocating for their wellness physically and emotionally,” he says. Regular exercise, healthy eating, as well as mindfulness and other modalities that address the mind and the body, all play a role in burnout prevention, says the avid cyclist and triathlete. “We are not taught these skills, and we often are afraid to ask for help,” he says.
All Politics Is Local
Affecting change, whether behavioral, legislative, or both, is not an easy feat. “Our biggest challenge as leaders is to get people involved in advocacy efforts. People are busy, and it does take resources and energy; and advocacy tends not to yield instant results,” says New York City plastic surgeon Scot Bradley Glasberg, MD, the president of the American Society of Plastic Surgeons (ASPS).
“As the saying goes, ‘All politics is local,’?” he says. ASPS has a network of individuals from all 50 states. “If an issue comes up that we don’t know about, we have sources that have their boots on the ground. In addition, if a local issue pops up, we have a core group of surgeons who we can call on to help us address it.”
ASPS provides resources to these foot soldiers if the need arises. In addition, PlastyPAC, ASPS’s bipartisan national Political Action Committee, is funded by ASPS members to make financial contributions to key Congressional campaigns. “It is a two-way street, but without the network, that two-way street doesn’t work,” he says.
Las Vegas plastic surgeon and ASAPS President Mike Edwards, MD, is also president of the Clark County Medical Society in Nevada. As such, he has an aerial view of this two-way street. Edwards says that there is a great deal that plastic surgeons can do locally to affect positive change throughout the country. This includes supporting efforts to reduce prescription drug abuse without penalizing patients, as well as scope of practice and truth in advertising initiatives.
Restrictions on prescribing opiates to curb abuse and diversion have demonized many pharmacists. “I’ve had breast augmentation patients go to three or four pharmacies for pain medications,” he says. “If you get involved at the local or state levels, you really can make a difference and help set precedents in other states.”
Some local efforts solely benefit the denizens, he says. For example, Edwards is in favor of creating a public medical school in Las Vegas. As its stands, there is presently only one medical school in Nevada. The goal is to keep doctors around after they complete their training so that they can serve the community.
Continuing education is also of paramount importance for surgeons, and ?fostering this is part of Movassaghi’s mission. He developed a preceptorship education program to teach surgeons how to incorporate anatomic breast implants into practice.
As a clinical assistant professor of plastic surgery at Oregon Health and Science University in Portland, chief ?residents often spend time completing a cosmetic rotation in his clinic. “We all only learned how to use smooth round, saline implants in residency, and then in 2006, we all used smooth round, silicone gel,” he says. “This was an easy transition and an upgrade in terms of the quality, but not necessarily outcome.”
The approval of a series of anatomic implants has been a game change, but there is a learning curve. To speed this curve, Movassaghi traveled to Sweden to learn how to place these implants. “When we place round implants, there is a lack of control at the intramammary fold or the lateral pocket,” he says. Textured round and anatomic implants solve this vexing problem. “We now have control at the fold.”
Movassaghi, for one, would not go back to round smooth implants unless a patient wanted that augmented look. “God didn’t create round breasts; they are supposed to be tear-shaped,” he says. “I tell all my breast augmentation patients that this is the most exciting time because our thought process has shifted from volumizing to shaping the breast.”
Still, the uptake of these anatomic implants hasn’t been dramatic yet. “We, as plastic surgeons, are habitual users of certain technologies and techniques that we get accustomed to,” he says. Movassaghi sees himself as an early majority adapter when it comes to new techniques and procedures. While most of the profession has gone gaga over the use of fat for aesthetic procedures, he only calls on fat to define edges of implants in breast reconstructions. Movassaghi is not quite ready to introduce fat to cosmetic breast enhancement. “I want data proving that it is safe and effective in a peer-reviewed article first.”
And he hopes to instill this cautious optimism and thirst for rigorous data in all of the NWSPS members in hopes of improving outcomes and safety.
Denise Mann is the editor of Plastic Surgery Practice. She can be reached at firstname.lastname@example.org.