ostgraduate medical education, and specifically postgraduate surgical education, encompasses thre... more ostgraduate medical education, and specifically postgraduate surgical education, encompasses three unique domains: fund of knowledge, technical skills, and judgment. Competency in all three of these modalities is required to deliver safe and consistent patient care. Education takes place both inside and outside of the operating room. Within the operating room, residents learn technical skills and surgical decision-making, and outside of the operating room, residents learn clinical diagnosis, bedside manner, the ability to navigate health care delivery systems, and the required fund of knowledge to diagnose and safely treat patients. To achieve comprehensive resident education, both intraoperative and extraoperative components must be present and are required by the American Council for Graduate Medical Education. To maintain a high standard of care, the American Council for Graduate Medical Education
OBJECTIVE A large factor influencing a patient's choice of aesthetic plastic surgeons is onli... more OBJECTIVE A large factor influencing a patient's choice of aesthetic plastic surgeons is online patient reviews. METHODS/TECHNIQUE Plastic surgeons whose practices are located in counties within the New York metro area were included. Selected surgeons were divided into private and academic surgeons (defined as having a residency program). For each surgeon, the quantity and quality of their Google reviews were collected. RESULTS/COMPLICATIONS A total of 145 aesthetic surgeons from the New York area were included in the study, both private (n = 126) and academic (n = 19). Given the small size of the latter cohort, 19 private aesthetic surgeons were randomly selected, and compared with the academic surgeons, it was shown that private surgeons had both higher average quality and quantity of online patient Google reviews (confidence interval, 95%; P = 0.0223). Similar results were found when comparing all private American Society for Aesthetic Plastic Surgery (ASAPS) surgeons (n = 126) with all academic ASAPS surgeons (n = 19); private ASAPS surgeons had a higher average rating and number of reviews when compared with academic surgeons, again representing a statistically significant difference for the quality of online reviews between private and academic surgeons (confidence interval, 95%; P = 0.031975). CONCLUSIONS There is a statistically significant difference in both the quality and quantity of online ratings for private and academic aesthetic surgeons.
Background In efforts to help alleviate the strain placed on healthcare during the COVID-19 pande... more Background In efforts to help alleviate the strain placed on healthcare during the COVID-19 pandemic, the American Society of Plastic Surgery recommended suspending elective procedures on March 19, 2020. When this suspension was enacted, it was unknown when cases would resume. Objectives This analysis aimed to estimate the regional economic impact of the pandemic specifically with regards to elective, aesthetic surgical procedures. As knowledge regarding the effects of the pandemic has grown, the authors then evaluated the accuracy of the projected estimates compared with actual events. Methods Utilizing the American Society of Plastic Surgery 2018 Plastic Surgery Statistics Report, regional case volume and surgeons’ fees were obtained for the top 5 aesthetic procedures. Models developed by the Institute for Health Metrics and Evaluation were employed to estimate the anticipated duration of suspension by utilizing the date that no ventilators would be required for COVID-19 patients....
Transient paraplegia in the immediate postoperative period after lipomyelomeningocele repair is u... more Transient paraplegia in the immediate postoperative period after lipomyelomeningocele repair is uncommon and is not discussed in the literature. We present the unique case of a patient who developed transient paraplegia 48 hours after lipomyelomeningocele repair attributable to the acute development of a thoracic syrinx. At birth, the patient was noted to have a large skin-covered mass in the lumbosacral region. On neurological examination, both iliopsoas and quadriceps exhibited 3/5 motor function, and the plantar flexors and dorsiflexors exhibited 1/5 motor function. Urodynamic studies were normal. Magnetic resonance imaging demonstrated the presence of a lipomyelomeningocele associated with tethering of the spinal cord in the lumbosacral region. At 5 months of age, the patient underwent repair of the lipomyelomeningocele. After surgery, the patient developed progressive paraplegia along with bowel and bladder dysfunction. Given the concern about a postoperative hematoma resulting...
ace lifts are among the most common operations for facial aging and perhaps the procedure most sy... more ace lifts are among the most common operations for facial aging and perhaps the procedure most synonymous with plastic surgery in the minds of the lay public. Nearly 130,000 face lifts were performed in the United States last year. 1 A limited number of studies have attempted to assess patient outcomes after face lifting, 2,3 but the lack of a standardized outcome tool has made assessment of patient satisfaction difficult. Recently, the FACE-Q has been established as a validated tool for evaluating patient satisfaction and outcomes in aesthetic facial surgery. 4-10 Our goal was to use a validated questionnaire to assess patient-reported satisfaction after face lifting. PATIENTS AND METHODS One hundred five patients undergoing a face lift between 2011 and 2014 performed by the senior author (C.H.T.) using a high, extended superficial musculoaponeurotic system (SMAS) technique with submental dissection and platysmaplasty were asked to complete, anonymously, the FACE-Q following the procedure. The FACE-Q is a new patient-reported outcome instrument composed of numerous independently functioning scales designed to measure outcomes among facial aesthetic patients. 4-11 Patients were asked to complete the following FACE-Q scales: 1. Satisfaction with Facial Appearance Overall: Measures patient satisfaction with the overall appearance of their face. 2. Social Function: Has a series of positively worded statements that measure social confidence. 3. Psychological Well-being: Measures psychological well-being in terms of a series of positively worded statements.
The frontal sinuses make an important contribution to normal forehead and glabellar contour. This... more The frontal sinuses make an important contribution to normal forehead and glabellar contour. This study was designed to test our clinical impression that early fronto-orbital ("frontal bone") advancement could have an adverse effect on frontal sinus development and consequently on forehead aesthetics. A retrospective study was conducted on 11 patients who had undergone fronto-orbital advancement and also had a long period of follow-up at the Institute of Reconstructive Plastic Surgery at New York University. The longitudinal cephalometric data were compared with unoperated controls. With one exception, no patient who underwent bilateral fronto-orbital advancement developed a frontal sinus, and all such patients had a flattened brow contour when compared with unoperated patients, of whom 82 percent developed at least one frontal sinus. Of the three patients who underwent unilateral fronto-orbital advancement for plagiocephaly (flattened forehead), two developed a frontal sinus but only on the unoperated side and one developed bilateral frontal sinuses. The two patients with unilateral frontal sinus development had a particularly obvious deformity resulting from normal glabellar projection on the unoperated side and a flattened contour on the operated side. Fronto-orbital advancement affects forehead aesthetics and should be performed only in infant patients with moderate to severe deformities. patients with plagiocephaly whose deformity is sufficiently severe to warrant surgery should preferably undergo bilateral fronto-orbital advancement (by the technique described) rather than unilateral advancement in order to avoid the brow asymmetry that results from unilateral frontal sinus development.
Facelifting is one of the most common operative procedures for facial aging and perhaps the proce... more Facelifting is one of the most common operative procedures for facial aging and perhaps the procedure most synonymous with plastic surgery in the mind of the lay public, but no verifiable documentation of patient satisfaction exists in the literature. This study is the first to examine facelift outcomes and patient satisfaction using a validated questionnaire. 105 patients undergoing a facelift performed by the senior author (CHT) using a high, extended-SMAS with submental platysma approximation technique were asked to complete anonymously the FACE-Q by email. FACE-Q scores were assessed for each domain (range 0 - 100), with higher scores indicating greater satisfaction with appearance or superior quality of life. 53 patients completed the FACE-Q (50.5% response rate). Patients demonstrated high satisfaction with facial appearance (mean 80.7, SD 22.3), and quality of life, including social confidence (mean 90.4, SD 16.6), psychological well-being (mean 92.8, SD 14.3), and early life...
The disadvantages of autogenous bone grafts has prompted a search for a dependable onlay bone gra... more The disadvantages of autogenous bone grafts has prompted a search for a dependable onlay bone graft substitute. A combination of tricalcium phosphate, a resorbable ceramic, and osteogenin, an osteoinductive protein, was evaluated as an onlay bone graft substitute in a rabbit calvarial model. Twenty-eight tricalcium phosphate implants (15 mm diameter x 5 mm; pore size, 100-200 microns) were divided into experimental and control groups and placed on the frontal bone of 14 adult New Zealand White rabbits. In the experimental animals, 185 micrograms of osteogenin was added to each implant. In the control animals, the implants were placed untreated. Implants were harvested at intervals of 1, 3, and 6 months, and evaluated using hematoxylin and eosin histology, microradiography, and histomorphometric scanning electron microscope backscatter image analysis. At 1 month there was minimal bone ingrowth and little tricalcium phosphate resorption in both the osteogenin-treated and control impla...
Cranial vault remodeling procedures are carried out for both syndromic and nonsyndromic craniosyn... more Cranial vault remodeling procedures are carried out for both syndromic and nonsyndromic craniosynostosis as well as to correct some acquired deformities of the cranial vault. These procedures improve not only cosmesis but also neurological symptoms. The purpose of this study was to determine the incidence of "late" cephalohematoma, an underreported complication following these complex procedures. A total of 113 patients underwent 127 cranial vault remodeling procedures using autogenous bone over a 6-year period. All patients who developed a late cephalohematoma 75 days or more after surgery were recorded. The time, size, and location of the cephalohematoma, the treatment performed, and the length of follow-up were also recorded. Ages at initial operation and postoperative follow-up were compared between patient groups for statistical differences. Of the 113 patients, 17 developed 18 late cephalohematomas. The incidence for this complication was 15 percent. The median age at operation for all patients was 10 months, and most late cephalohematomas occurred 208 days later (range, 77 to 1416 days), at 12 to 24 months of age. Fronto-orbital advancement was the most commonly performed procedure, and 83.3 percent of late cephalohematomas occurred in the frontal region. No cephalohematomas became infected or required any operative intervention, but they were aspirated. Surgeons should inform prospective parents of patients undergoing cranial vault remodeling procedures of this potential complication. This will improve parental awareness and possible avoidance strategies in future patients. Further evaluation and follow-up are required to determine the minimum length of postoperative time after which late cephalohematomas do not occur.
It has been demonstrated that distraction osteogenesis is an effective clinical tool with applica... more It has been demonstrated that distraction osteogenesis is an effective clinical tool with applications for the entire human skeleton. Therapeutic exploitation in the correction of the asymmetrical and hypoplastic mandible has been reported previously. However, the main criticism of this technique has been the residual cutaneous scars resulting from the surgical incision and the path of the expansion device. In order to obviate the need for skin incisions, we have developed and demonstrated the feasibility of a miniaturized mandibular bone lengthener that is suitable for intraoral placement. Ten growing mongrel dogs were studied. Under general anesthesia, a buccal mucosal incision was made along the oblique line, and the body and ramus of the mandible were exposed in a supraperiosteal plane. Two 2.0-mm half-pins were placed percutaneously in the area of the angle of the mandible, and two other pins were placed 3.5 cm anteriorly. The clamps of the lengthening device were then attached to the half-pins in an intraoral position. An osteotomy was made by connecting percutaneously made drill holes between the clamps in a line positioned posterior to the third molar. The mucosa was closed loosely over the device. Distraction was commenced on the eighth postoperative day. The results were assessed with pre- and post-lengthening photographs, cephalograms, and CT scans with three-dimensional reconstruction. All animals demonstrated a contralateral cross-bite. The newly developed bone also was examined histologically. The intraoral method of mandibular lengthening offers the same advantages of extraoral lengthening but without the need for a cutaneous incision and resulting scar.
ostgraduate medical education, and specifically postgraduate surgical education, encompasses thre... more ostgraduate medical education, and specifically postgraduate surgical education, encompasses three unique domains: fund of knowledge, technical skills, and judgment. Competency in all three of these modalities is required to deliver safe and consistent patient care. Education takes place both inside and outside of the operating room. Within the operating room, residents learn technical skills and surgical decision-making, and outside of the operating room, residents learn clinical diagnosis, bedside manner, the ability to navigate health care delivery systems, and the required fund of knowledge to diagnose and safely treat patients. To achieve comprehensive resident education, both intraoperative and extraoperative components must be present and are required by the American Council for Graduate Medical Education. To maintain a high standard of care, the American Council for Graduate Medical Education
OBJECTIVE A large factor influencing a patient's choice of aesthetic plastic surgeons is onli... more OBJECTIVE A large factor influencing a patient's choice of aesthetic plastic surgeons is online patient reviews. METHODS/TECHNIQUE Plastic surgeons whose practices are located in counties within the New York metro area were included. Selected surgeons were divided into private and academic surgeons (defined as having a residency program). For each surgeon, the quantity and quality of their Google reviews were collected. RESULTS/COMPLICATIONS A total of 145 aesthetic surgeons from the New York area were included in the study, both private (n = 126) and academic (n = 19). Given the small size of the latter cohort, 19 private aesthetic surgeons were randomly selected, and compared with the academic surgeons, it was shown that private surgeons had both higher average quality and quantity of online patient Google reviews (confidence interval, 95%; P = 0.0223). Similar results were found when comparing all private American Society for Aesthetic Plastic Surgery (ASAPS) surgeons (n = 126) with all academic ASAPS surgeons (n = 19); private ASAPS surgeons had a higher average rating and number of reviews when compared with academic surgeons, again representing a statistically significant difference for the quality of online reviews between private and academic surgeons (confidence interval, 95%; P = 0.031975). CONCLUSIONS There is a statistically significant difference in both the quality and quantity of online ratings for private and academic aesthetic surgeons.
Background In efforts to help alleviate the strain placed on healthcare during the COVID-19 pande... more Background In efforts to help alleviate the strain placed on healthcare during the COVID-19 pandemic, the American Society of Plastic Surgery recommended suspending elective procedures on March 19, 2020. When this suspension was enacted, it was unknown when cases would resume. Objectives This analysis aimed to estimate the regional economic impact of the pandemic specifically with regards to elective, aesthetic surgical procedures. As knowledge regarding the effects of the pandemic has grown, the authors then evaluated the accuracy of the projected estimates compared with actual events. Methods Utilizing the American Society of Plastic Surgery 2018 Plastic Surgery Statistics Report, regional case volume and surgeons’ fees were obtained for the top 5 aesthetic procedures. Models developed by the Institute for Health Metrics and Evaluation were employed to estimate the anticipated duration of suspension by utilizing the date that no ventilators would be required for COVID-19 patients....
Transient paraplegia in the immediate postoperative period after lipomyelomeningocele repair is u... more Transient paraplegia in the immediate postoperative period after lipomyelomeningocele repair is uncommon and is not discussed in the literature. We present the unique case of a patient who developed transient paraplegia 48 hours after lipomyelomeningocele repair attributable to the acute development of a thoracic syrinx. At birth, the patient was noted to have a large skin-covered mass in the lumbosacral region. On neurological examination, both iliopsoas and quadriceps exhibited 3/5 motor function, and the plantar flexors and dorsiflexors exhibited 1/5 motor function. Urodynamic studies were normal. Magnetic resonance imaging demonstrated the presence of a lipomyelomeningocele associated with tethering of the spinal cord in the lumbosacral region. At 5 months of age, the patient underwent repair of the lipomyelomeningocele. After surgery, the patient developed progressive paraplegia along with bowel and bladder dysfunction. Given the concern about a postoperative hematoma resulting...
ace lifts are among the most common operations for facial aging and perhaps the procedure most sy... more ace lifts are among the most common operations for facial aging and perhaps the procedure most synonymous with plastic surgery in the minds of the lay public. Nearly 130,000 face lifts were performed in the United States last year. 1 A limited number of studies have attempted to assess patient outcomes after face lifting, 2,3 but the lack of a standardized outcome tool has made assessment of patient satisfaction difficult. Recently, the FACE-Q has been established as a validated tool for evaluating patient satisfaction and outcomes in aesthetic facial surgery. 4-10 Our goal was to use a validated questionnaire to assess patient-reported satisfaction after face lifting. PATIENTS AND METHODS One hundred five patients undergoing a face lift between 2011 and 2014 performed by the senior author (C.H.T.) using a high, extended superficial musculoaponeurotic system (SMAS) technique with submental dissection and platysmaplasty were asked to complete, anonymously, the FACE-Q following the procedure. The FACE-Q is a new patient-reported outcome instrument composed of numerous independently functioning scales designed to measure outcomes among facial aesthetic patients. 4-11 Patients were asked to complete the following FACE-Q scales: 1. Satisfaction with Facial Appearance Overall: Measures patient satisfaction with the overall appearance of their face. 2. Social Function: Has a series of positively worded statements that measure social confidence. 3. Psychological Well-being: Measures psychological well-being in terms of a series of positively worded statements.
The frontal sinuses make an important contribution to normal forehead and glabellar contour. This... more The frontal sinuses make an important contribution to normal forehead and glabellar contour. This study was designed to test our clinical impression that early fronto-orbital ("frontal bone") advancement could have an adverse effect on frontal sinus development and consequently on forehead aesthetics. A retrospective study was conducted on 11 patients who had undergone fronto-orbital advancement and also had a long period of follow-up at the Institute of Reconstructive Plastic Surgery at New York University. The longitudinal cephalometric data were compared with unoperated controls. With one exception, no patient who underwent bilateral fronto-orbital advancement developed a frontal sinus, and all such patients had a flattened brow contour when compared with unoperated patients, of whom 82 percent developed at least one frontal sinus. Of the three patients who underwent unilateral fronto-orbital advancement for plagiocephaly (flattened forehead), two developed a frontal sinus but only on the unoperated side and one developed bilateral frontal sinuses. The two patients with unilateral frontal sinus development had a particularly obvious deformity resulting from normal glabellar projection on the unoperated side and a flattened contour on the operated side. Fronto-orbital advancement affects forehead aesthetics and should be performed only in infant patients with moderate to severe deformities. patients with plagiocephaly whose deformity is sufficiently severe to warrant surgery should preferably undergo bilateral fronto-orbital advancement (by the technique described) rather than unilateral advancement in order to avoid the brow asymmetry that results from unilateral frontal sinus development.
Facelifting is one of the most common operative procedures for facial aging and perhaps the proce... more Facelifting is one of the most common operative procedures for facial aging and perhaps the procedure most synonymous with plastic surgery in the mind of the lay public, but no verifiable documentation of patient satisfaction exists in the literature. This study is the first to examine facelift outcomes and patient satisfaction using a validated questionnaire. 105 patients undergoing a facelift performed by the senior author (CHT) using a high, extended-SMAS with submental platysma approximation technique were asked to complete anonymously the FACE-Q by email. FACE-Q scores were assessed for each domain (range 0 - 100), with higher scores indicating greater satisfaction with appearance or superior quality of life. 53 patients completed the FACE-Q (50.5% response rate). Patients demonstrated high satisfaction with facial appearance (mean 80.7, SD 22.3), and quality of life, including social confidence (mean 90.4, SD 16.6), psychological well-being (mean 92.8, SD 14.3), and early life...
The disadvantages of autogenous bone grafts has prompted a search for a dependable onlay bone gra... more The disadvantages of autogenous bone grafts has prompted a search for a dependable onlay bone graft substitute. A combination of tricalcium phosphate, a resorbable ceramic, and osteogenin, an osteoinductive protein, was evaluated as an onlay bone graft substitute in a rabbit calvarial model. Twenty-eight tricalcium phosphate implants (15 mm diameter x 5 mm; pore size, 100-200 microns) were divided into experimental and control groups and placed on the frontal bone of 14 adult New Zealand White rabbits. In the experimental animals, 185 micrograms of osteogenin was added to each implant. In the control animals, the implants were placed untreated. Implants were harvested at intervals of 1, 3, and 6 months, and evaluated using hematoxylin and eosin histology, microradiography, and histomorphometric scanning electron microscope backscatter image analysis. At 1 month there was minimal bone ingrowth and little tricalcium phosphate resorption in both the osteogenin-treated and control impla...
Cranial vault remodeling procedures are carried out for both syndromic and nonsyndromic craniosyn... more Cranial vault remodeling procedures are carried out for both syndromic and nonsyndromic craniosynostosis as well as to correct some acquired deformities of the cranial vault. These procedures improve not only cosmesis but also neurological symptoms. The purpose of this study was to determine the incidence of "late" cephalohematoma, an underreported complication following these complex procedures. A total of 113 patients underwent 127 cranial vault remodeling procedures using autogenous bone over a 6-year period. All patients who developed a late cephalohematoma 75 days or more after surgery were recorded. The time, size, and location of the cephalohematoma, the treatment performed, and the length of follow-up were also recorded. Ages at initial operation and postoperative follow-up were compared between patient groups for statistical differences. Of the 113 patients, 17 developed 18 late cephalohematomas. The incidence for this complication was 15 percent. The median age at operation for all patients was 10 months, and most late cephalohematomas occurred 208 days later (range, 77 to 1416 days), at 12 to 24 months of age. Fronto-orbital advancement was the most commonly performed procedure, and 83.3 percent of late cephalohematomas occurred in the frontal region. No cephalohematomas became infected or required any operative intervention, but they were aspirated. Surgeons should inform prospective parents of patients undergoing cranial vault remodeling procedures of this potential complication. This will improve parental awareness and possible avoidance strategies in future patients. Further evaluation and follow-up are required to determine the minimum length of postoperative time after which late cephalohematomas do not occur.
It has been demonstrated that distraction osteogenesis is an effective clinical tool with applica... more It has been demonstrated that distraction osteogenesis is an effective clinical tool with applications for the entire human skeleton. Therapeutic exploitation in the correction of the asymmetrical and hypoplastic mandible has been reported previously. However, the main criticism of this technique has been the residual cutaneous scars resulting from the surgical incision and the path of the expansion device. In order to obviate the need for skin incisions, we have developed and demonstrated the feasibility of a miniaturized mandibular bone lengthener that is suitable for intraoral placement. Ten growing mongrel dogs were studied. Under general anesthesia, a buccal mucosal incision was made along the oblique line, and the body and ramus of the mandible were exposed in a supraperiosteal plane. Two 2.0-mm half-pins were placed percutaneously in the area of the angle of the mandible, and two other pins were placed 3.5 cm anteriorly. The clamps of the lengthening device were then attached to the half-pins in an intraoral position. An osteotomy was made by connecting percutaneously made drill holes between the clamps in a line positioned posterior to the third molar. The mucosa was closed loosely over the device. Distraction was commenced on the eighth postoperative day. The results were assessed with pre- and post-lengthening photographs, cephalograms, and CT scans with three-dimensional reconstruction. All animals demonstrated a contralateral cross-bite. The newly developed bone also was examined histologically. The intraoral method of mandibular lengthening offers the same advantages of extraoral lengthening but without the need for a cutaneous incision and resulting scar.
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Papers by Charles Thorne