Fellowship in Cosmetic (Aesthetic) Surgery
Many people have questions about the fellowship, so Dr. Ryan decided to answer some of the most commonly-asked questions:
Q: What exactly was the Aesthetic Surgery Fellowship?
A: The Aesthetic Surgery Fellowship was an intensive, year long program that focused exclusively aesthetic (or cosmetic) surgery. After completing seven years of general surgery and plastic surgery residencies, I was thrilled to have been chosen from among hundreds of applicants for the fellowship.
Q: Don’t all doctors do a fellowship?
A: No. A fellowship is purely elective. It is for those doctors who want to specialize even further in one particular area, like cosmetic surgery.
Q: Are there fellowships in other areas of plastic surgery?
A: Yes. There are also fellowships in hand surgery, craniofacial surgery, burn surgery, and microvascular surgery.
Q: What was the main advantage of doing the Aesthetic Surgery Fellowship?
A: For one thing, I spent the entire year focusing exclusively on cosmetic surgery. I participated in literally hundreds of surgeries, including breast surgery, body contouring surgery and facial surgery. In one year’s time, I performed more cosmetic surgery than most surgeons perform during their first several years in practice. Because it takes most young plastic surgeons a few years to build up a cosmetic surgery practice, those first few years in practice are spent doing reconstructive cases, instead of cosmetic surgery cases.
In fact, one well-known Beverly Hills plastic surgeon did not do a single facelift for the first seven years of his practice – he was too busy doing reconstructive cases. Through the fellowship, I was able to hone my cosmetic surgery skills in just one year at UCLA, and then I hit the ground running when I entered private practice in Beverly Hills.
Q: Were there other advantages to completing the Fellowship?
A: There were many advantages to doing the fellowship. One was the opportunity to perform basic scientific research in the field of cosmetic surgery. I spent the entire year studying the anatomy of the face, knowledge that is crucial for a surgeon performing complex facial procedures, where every millimeter can make the difference. My thesis, “The Anatomy of the Malar Region and Its Significance in Rhytidectomy”, delved into the complex anatomy of the cheek region, where a complex tangle of muscle, nerves, arteries and veins must be thoroughly understood by any surgeon attempting to perform facial cosmetic surgery. In fact, after completing this research, I became convinced that
lifting the cheek, not just the skin, was essential in many patients in order to achieve optimal facelift results. I became an early proponent of the midface lift, which became quite popular in subsequent years. My research into the facial anatomy during the fellowship placed me in a unique position to truly understand the benefits of performing an effective, safe midface lift.
Q: Were there any other research projects?
A: I also participated in various research projects with many members of the UCLA faculty. One project was helping a colleague write a book on rhinoplasty. It focused my attention on the nose – the anatomy of the nose, the function of the nose, the notion of what makes a “perfect” nose, the effects excessive surgery on the nose – and helped me better understand what most surgeons agree is the most challenging procedure in the entire field of cosmetic surgery (i.e., rhinoplasty).
Q: What else did the fellowship consist of?
A: I was fortunate to be to do what few plastic surgeons will ever have the opportunity to do: I was able to observe dozens of top Los Angeles plastic surgeons in the operating room and I was able to glean from them the best techniques and combine them into a surgical technique that I could call my own. Those UCLA surgeons who participated in the fellowship and who opened their doors to me could not have been more honest and helpful. Observing them “in action” was really a huge part of the fellowship.
Q: Are these cosmetic fellowships common?
A: There are many informal arrangements that many surgeons call “fellowships”, but these are not academic, university-based year long intensive fellowships. Many of these arrangements involve the “fellow” watching another surgeon perform surgery for a few months – not exactly rigorous training. The only other fellowship that is comparable to UCLA’s is the fellowship at NYU.
The UCLA Aesthetic Surgery Fellowship was simply one of a kind. For a young surgeon to have the opportunity to participate in hundreds of cosmetic cases, perform research
projects in cosmetic surgery and observe dozens of Beverly Hills’ finest surgeons in the operating room – it was simply a once-in-a-lifetime experience!
Fellowship in Breast Surgery
Q: Dr. Ryan, tell us a little bit about this fellowship.
A: From July 1990 until June 1991, I spent the entire year in a research lab at Harbor/UCLA focusing on breast augmentation. To start the year off, I did a literature review, where I read virtually every scientific paper ever written on the topic of breast augmentation. There were literally hundreds of publications that I read.
Q: What did you do after the literature review?
A: After the literature review, I sat down in the lab and began looking into the possible causes of scar tissue formation around breast implants, since the phenomenon of capsular contracture was – and is -- one of the most common complications of breast augmentation surgery. Our thinking at the time was that if we could pinpoint a specific cause of capsular contracture, we may be able to find a way to prevent capsular contracture.
Q: What did you find?
A: After a short time, it became apparent that there were many possible causes of capsular contracture, including excess blood around the implant, bacterial contamination and infection.
Q: How did you try to prevent capsular contracture?
A: After completing my literature review on breast augmentation, I conducted a similar literature review on a substance known as fibrin glue. Since fibrin glue was already being used successfully in various fields of medicine to decrease bleeding and help with tissue adhesion, we wondered if fibrin glue could somehow play a role in preventing – or at least minimizing – capsular contracture.
Q: Isn’t fibrin glue being used by some cosmetic surgeons today?
A: Yes, some surgeons routinely use fibrin glue during various plastic surgery procedures like facelifts, because they feel that it decreases bleeding after surgery and helps the healing tissues stick together better, thereby speeding up the healing process.
Q: Did you find that fibrin glue helped to decrease the rate of capsular contracture?
A: After looking at a year’s worth of data, we concluded that fibrin glue may have helped minimize capsular contracture early on in the healing process, but it seemed to offer less and less benefit as the healing process continued. Because the fibrin glue may have minimized bleeding around the implant, a scar capsule didn’t form initially. Eventually, however, a scar capsule began to form around most of the implants. Since the benefits of fibrin glue on long-term capsular contracture were minimal, we could not recommend it be used routinely in breast augmentation surgery.
Q: What was your favorite part of the fellowship?
A: I especially enjoyed the fact that I was able to spend almost every waking hour for an entire year studying and researching the topics of breast augmentation, breast implants and capsular contracture. After that year, I felt that I knew as much about the world’s scientific literature on breast augmentation and capsular contracture as anyone on the planet. It was satisfying to have felt like I mastered the world’s literature on the subject.
Q: How did the fellowship help you in your career?
A: When I began my plastic surgery residency in 1991, I was extremely comfortable with performing breast augmentation surgery from Day One. Then, when I went into private practice in 1994, I was able to build a substantial breast augmentation practice almost immediately.
Q: Do you think you still benefit from the fellowship at this stage of your career?
A: Absolutely. The aesthetic judgment that I developed during that fellowship helps me to this day. The vast majority of my breast augmentation patients want natural results, since my patients include not only actresses, singers and models, but also judges, dentists, doctors and lawyers. These women would be horrified if they woke up from surgery with enormous, artificial-looking implants.
I often look back at that year spent focusing on breast augmentation and realize that it was a crucial time in the development of my “eye” for natural breast augmentation.
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