Current Trends of Cosmetic Surgical Procedures

The American Journal of Cosmetic Surgery
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This retrospective study was performed to publish the current trends of major surgical procedures from the General Cosmetic Surgery fellowship programs offered by the American Academy of Cosmetic Surgery from July 1, 2015, to June 30, 2018. Data were obtained from the American Academy of Cosmetic Surgery. Fellowship data and the surgical procedures reported by fellow surgeons were analyzed from July 1, 2015, to June 30, 2018. Averages, trends, correlation coefficient, and coefficient of determination were calculated using Microsoft Excel. From July 1, 2015, to June 30, 2018, the number of fellowship programs increased by 26.3%, and the fellows completed 633.3 procedures on average during their 1 year training. The most common procedures performed averaged per fellow were liposuction (215.1), breast augmentation (79.7), abdominoplasty (44.8), breast reduction/lift (38.9), and eyelid surgery (33.7). Strongest increasing trends in surgical procedures included circumferential abdominoplasty and breast re-augmentation. Strongest decreasing trends included body implants and vein procedures. The study demonstrated increasing, decreasing, and neutral trends over the academic years from July 1, 2015, to June 30, 2018. Further studies can analyze causative or correlative factors.

Since 2012 to 2017, the top 5 cosmetic procedures has increased according to the American Society for Aesthetic Plastic Surgery (ASAPS); breast augmentation procedures increased by 4.1%, liposuction by 58%, eyelid surgery by 33.5%, breast lift by 57.5%, and tummy tuck by 27.8%.1 Surgery remains the gold standard for long-term aesthetic results, and surgical procedures continue to increase.1 Americans have spent $6.6 billion on cosmetic surgical procedures in 2017.1 Women tend to be more interested and have undergone cosmetic surgical procedures.1,2 Social network, social norms, body image, self-esteem, certain personality traits, and psychopathology have influenced one to undergo cosmetic surgical procedure(s).2,3 Social media, lower body mass index (BMI), body dissatisfaction, and appearance investment were significant predictors for considering cosmetic surgery.3,4

The American Academy of Cosmetic Surgery (AACS) provides two fellowship trainings in (1) General Cosmetic Surgery and (2) Facial Cosmetic Surgery. Since inception in 1985, AACS has been the leading educational provider for cosmetic surgery practitioners.5 The fellowship programs provide unmatched level of training and mentorship for 12 to 24 months.6 This article focused solely on the General Cosmetic Surgery fellowship. The General Cosmetic Surgery fellowship programs consider physicians from specialties of otolaryngology, ophthalmology, plastic surgery, oral and maxillofacial surgery, general surgery, obstetric/gynecology, thoracic surgery, urology, and orthopedic surgery.5 AACS requires 300 cosmetic surgical procedures per year prior to graduating.6

The aim of this article was to demonstrate the current trends of the operative experience by fellows of the General Cosmetic Surgery fellowship programs from July 1, 2015, to June 30, 2018. Did the fellowship training include the most commonly performed cosmetic surgical procedures from the general population according to the ASAPS and the American Society of Plastic Surgeons? Which major surgical procedures were commonly performed during training from July 1, 2015, to June 30, 2018? Which major surgical procedures were trending upward and downward from July 1, 2015, to June 30, 2018? How many major surgical procedures were each fellow trained from July 1, 2015, to June 30, 2018? The results can especially provide information to qualified applicants interested in pursuing a career in cosmetic surgery. Different programs (within AACS, residencies, or fellowships) provide different training in cosmetic surgical procedures. The surgical procedures can incorporate breast augmentation, breast lift, breast reduction, buttock implants and lift, blepharoplasty, forehead lift, rhytidectomy, labiaplasty, liposuction, malar augmentation, mentoplasty, neck lift, otoplasty, tummy tuck, to name a few. This is the first article that has analyzed current trends in surgical procedures logged by fellows from the AACS, from July 1, 2015, to June 30, 2018. Handler et al7 published a median of 687 total procedures performed by AACS fellows from 2007 to 2012. The authors also demonstrated the more rigorous exposure and graduation requirements to comparable cosmetic surgical programs.7

The research data were obtained from the AACS, with the committee’s permission on June 13, 2018. The number of programs and number of fellows who completed the fellowship training from July 1, 2015, to June 30, 2018, were analyzed (Table 1) to correlate to the surgical procedures reported by the fellows. For simplicity purposes, the graduation year will be used to refer to the academic year, ie, “2016” will refer to the academic year from July 1, 2015, to June 30, 2016, and so forth.

Table

Table 1. General Cosmetic Surgery Fellowship Programs Through AACS.

Table 1. General Cosmetic Surgery Fellowship Programs Through AACS.

The total surgical procedures reported by the General Cosmetic Surgery fellows from academic years 2016 to 2018 were obtained and analyzed. The data set did not include any individual case logs, but the total for each academic year. No identifying information of the fellows were on the data set. The total number of surgical procedures for each year was averaged according to the number of fellows for that academic year.

Categorization of the procedures was performed as follows. The nonsurgical and skin procedures were not included in the analysis to allow focus on the major surgical procedures. The nonsurgical and skin procedures that were excluded from the study constituted of dermal lesion removal, scar revisions, skin grafts, hair transplant, laser treatments, dermabrasion, deep chemical peels, sclerotherapy, and injectables (soft tissue fillers such as botulinum toxin, hyaluronic acid, poly-L-lactic acid, calcium hydroxylapatite).

The remaining surgical procedures that were focused on the study were categorized as follows abdominoplasty (traditional, circumferential, mini, and panniculectomy), body implants (gluteal, calf, pectoral, bicep), breast augmentation (silicone, saline, with implant), breast implant capsule surgery, breast implant explantation, breast re-augmentation, breast reconstruction, breast reduction, breast lift, brow or forehead lift, eyelid surgery, face and neck lift, facial implants (cheek, chin, mandibular, temporal), fat grafting (gluteal and face), female to male chest reconstruction, gynecomastia surgery, liposuction (with focus on the top 3 body parts—abdomen, lower back, and waist), otoplasty, rhinoplasty, soft tissue excision (axilloplasty, brachioplasty, buttock lift, labiaplasty, mons lift, thigh lift, and upper back lift), and vein procedures. Averages, trends, correlation coefficient, and coefficient of determination were calculated using Microsoft Office Professional Plus 2013 Excel functions “AVERAGE,” “TREND,” “CORREL,” and “RSQ” respectively. Microsoft Excel trend function is linear by default.

Other procedures that were not categorized but included in the total surgical procedures (Tables 2 and 5) were symmastia, revision of reconstructed breast, removal of tissue expanders, breast pocket revision, breast pocket conversion, myocutaneous flap, fasciocutaneous flap, removal of facial implants, chin reduction, buccal fat pad excision, and tracheal shave. These procedures are considered major operative cases per fellowship requirements by the AACS.

Table

Table 2. Average Procedures per Fellow and Total Overall Procedures as Reported From Academic Year 2016 to 2018.

Table 2. Average Procedures per Fellow and Total Overall Procedures as Reported From Academic Year 2016 to 2018.

Since the inception of the AACS, there has been a gradual increase in the number of fellowships with the General Cosmetic Surgery programs. Table 1 demonstrated the number of fellowship programs and the number of those positions filled from academic year 2016 to 2018.

From academic year 2016 to 2018 (Table 1), the programs have increased by 26.3% (from 19 to 24 programs), the number of fellows has increased by 61.5% (from 13 to 21 fellows), and the fellowship fill rate has increased by 27.9% (from 68.4% to 87.5%). The fellowship applicants from academic year 2016 to 2018 had specialties in plastic surgery, general surgery, obstetrics and gynecology, oral and maxillofacial surgery, orthopedic surgery, and otolaryngology. Subspecialities of the applicants included plastic surgery, otolaryngology/facial plastic surgery, colorectal surgery, breast surgery, minimally invasive surgery, bariatric surgery, surgical critical care, pelvic surgery, and sports orthopedic surgery.

The average total procedures per fellow for each academic year were depicted in Table 2. There was an increase in the averaged total surgical procedures from academic year 2016 to 2017 but showed a decrease in 2018 from 2016 and 2017. The trend for 2019 was estimated at 572.4. Overall, the average surgical procedures per fellow for academic years from 2016 to 2018 are 633.3.

Table 3 showed the calculations for the major surgical procedures for each academic year. Table 4 and Figure 1 depicted the ten most common surgical procedures, in order of the decreasing averages for academic year 2018. Liposuction was the most common surgical procedure averaged for each academic year. This has more than doubled (2016 and 2018) or more than tripled (2017) the second most common operative procedure, which was breast augmentation. Liposuction was most commonly performed on the abdomen, lower back, and waist and least commonly on the calves.

Table

Table 3. Major Surgical Procedures From Academic Year 2016 to 2018.

Table 3. Major Surgical Procedures From Academic Year 2016 to 2018.

Table

Table 4. Top 10 Surgical Procedures From Academic Years 2016 to 2018.

Table 4. Top 10 Surgical Procedures From Academic Years 2016 to 2018.


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Figure 1. Top 10 most common surgical procedures for academic years 2016-2018 (in descending order per academic year 2018).

Breast augmentation with silicone implants was more than triple that of saline implant breast augmentation (Table 3). The most common implant placement was to the breast, while placement into other body parts, including face, were far less common, and showed negative trends. Rationally, implant removal and implant replacement were more common with breast implants. The second most common implant placement was to the chin.

For each academic year, the liposuction average was more than 4 times the average of abdominoplasty, which was the third most common procedure. Overall, traditional abdominoplasty was the most common technique performed, followed by Avelar technique, then mini-abdominoplasty (Table 3). The most common soft tissue excision was abdominoplasty, followed by brachioplasty, then mons lift.

From academic years 2016 to 2018, the top 3 most common surgical procedures remained in the same ranking, while the other surgical procedures varied in ranking. Breast reduction/lift, fat grafting, and eyelid surgery were the fourth, fifth, and sixth common procedures in academic year 2018, consecutively. Each of these categories had averages over 30 from 2016 to 2018. The most common fat grafting technique in 2018 was to the buttocks, which nearly doubled from 2017 to 2018. The face was the second most common fat grafted area in 2018, but was the most common fat grafted area in 2017. Breast lift was more than 3 times as common as breast reduction. The most common breast lift technique performed was inverted “T,” followed by vertical technique. Overall from 2016 to 2018, the most common facial cosmetic surgery performed was eyelid surgery, followed by face/neck lift, then rhinoplasty. Open rhinoplasty was more commonly performed than closed rhinoplasty technique.

Tables 3 and 5 displayed the surgical procedures that have demonstrated an increasing trend from academic years 2016 to 2018 by using the coefficient of correlation values greater than or equal to 0.8. Similarly, Tables 3 and 5 displayed procedures that have demonstrated a decreasing trend from academic years 2016 to 2018, using the coefficient of correlation value less than or equal to −0.8. Stronger relationships with correlation coefficient values greater than or equal to 0.9 and less than or equal to −0.9 were asterisked in Table 5. The strongest positive relationships as increasing trend were circumferential abdominoplasty; the coefficient of correlation was close to 1 (ie, 0.99874), with a high coefficient of determination of 0.99749. However, the average procedures per year were minimal (0-2.2). Other increasing trends with coefficient of correlation values greater than or equal to 0.8 included breast re-augmentation, fat grafting to buttocks, axilloplasty and upper back lift with coefficient of determination ranging from 0.75 to 0.99, except for fat grafting to the buttocks with 0.64. Increasing trends with coefficient of correlation values 0.7 to 0.8 included labiaplasty, however with low coefficient of determination of 0.51.

Table

Table 5. Surgical Procedure Trends.

Table 5. Surgical Procedure Trends.

The strongest negative relationship as decreasing trend was the overall body implants surgery, with the coefficient of correlation close to −1 (ie, 0.99999) with a high coefficient of determination with 0.9998. However, the average procedures per year were minimal (0.9-2.2), and the subcategories showed lower negative correlation with values (−0.77 to −0.32 from Table 3) with minimal averages per subcategories (from 0 to 1.5). Another strong negative relationship as decreasing trend were the vein procedures, with the coefficient of correlation also close to −1 (ie, −0.99927) with a high coefficient of determination with 0.99854. The other decreasing trends with the coefficient of correlation less than or equal to −0.8 with a coefficient of determination greater than 0.7 were noted with breast reconstruction, breast reduction, facial implants (cheek and temporal), female to male chest reconstruction, gynecomastia mastectomy, brachioplasty, buttock lift, mons lift, and thigh lift.

Overall from academic years 2016 to 2018, the fellows have logged an average of 293.0 body, 189.6 breast, and 109.5 facial surgical procedures (Figure 2). The common procedures with more than 15 procedures averaged from 2016 to 2018 include traditional abdominoplasty, breast augmentation, breast implant capsule surgery, breast re-augmentation, breast lift, blepharoplasty, face lift, rhinoplasty, fat grafting to buttocks, and liposuction. The less common procedures with less than 5 procedures averaged from 2016 to 2018 include circumferential abdominoplasty, body implants, breast reconstruction, brow lift, facial implants, female to male chest reconstruction, gynecomastia mastectomy, otoplasty, axilloplasty, brachioplasty, buttock lift, labiaplasty, mons lift, thigh lift, and upper back lift.


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Figure 2. Average number of body, breast, and facial surgical procedures from academic years 2016 to 2018.

Since 1985, AACS has increased their number of fellowship programs from 19 to 24, demonstrating a growth rate of 12.4% from academic year 2016 to 2018. AACS continues to grow, with over 1,600 members from multi-specialties background focusing on cosmetic surgery education and patient benefits.5 The increasing percentage of fellowship program fill rate per year revealed the increasing popularity of the AACS fellowship programs (Table 1), which demonstrated a growth rate of 13.1% from academic year 2016 to 2018. Likewise, the number of fellows has grown by 27.1% from academic year 2016 to 2018.

According to the American Society of Aesthetic Plastic Surgery, the top 5 surgical procedures in 2017 were breast augmentation, liposuction, eyelid surgery, breast lift, and tummy tuck, in decreasing frequency.1 According to the American Society of Plastic Surgeons, the top 5 surgical procedures in 2017 were breast augmentation, liposuction, rhinoplasty, eyelid surgery, and tummy tuck.8 Per the International Society of Aesthetic Plastic Surgery’s International Survey on Aesthetic/Cosmetic Procedures performed in 2017, the United States was ranked number one with the most total surgical and nonsurgical procedures performed, with over 4.3 million surgical procedures performed by approximately 6800 plastic surgeons.9 Worldwide, the top 5 surgical procedures performed in decreasing order were breast augmentation, liposuction, eyelid surgery, rhinoplasty, and tummy tuck.9 In this article, Table 4 highlighted the top 5 cosmetic surgical procedures in 2017 reported by the American Society of Aesthetic Plastic Surgery and the American Society of Plastic Surgeons. The top 3 procedures logged by the AACS fellows from academic years 2016 to 2018 remained steady as liposuction, followed by breast augmentation and abdominoplasty as comparable to the aforementioned statistics. Breast reduction/lift and eyelid surgery remained in the top 6. Rhinoplasty had a decreasing trend over the years, however still averaged 14 procedures per fellow in academic year 2018 compared to 18 in 2016. Fat grafting gradually up trended each year, increasing from 28 average procedures in academic year 2016 to 37 in 2018, becoming the fifth most common procedure by academic year 2018. Soft tissue excision (axilloplasty, brachioplasty, buttock lift, labiaplasty, mons lift, thigh lift, upper back lift) drastically halved from academic year 2016 to 2018, falling out of the top 10 surgical procedures logged. Breast re-augmentation with implant steadily increased each year from academic year 2016 to 2018.

Individual fellow case logs were not available, only the total cases per year; hence, the ranges, modes, or medians of the surgical procedures could not be produced. The correlation coefficients and trends apply if the relationship throughout the years was linear, which was difficult to determine, as only 3 years were used for the calculation; or the relationship is merely undeterminable due to a nonlinear and/or varied correlation. Trends with exponential relationship were calculated separately which demonstrated similar numbers. Henceforth, the calculated correlation coefficients and trends were meant as approximations, and not as true values; overinterpretation should be avoided.10,11 Future trends were difficult to predict each year, as many factors have influence on the number of the surgical procedures logged, such as, but not exclusive to, number of fellowship programs, number of attendings (trainers), number of fellows (trainees), mandatory procedure requirements, curriculum modification, software issues for logging (inaccurate codes, descriptive ambiguity or nonexistence, complex categorization), knowledge on appropriate coding or logging, case log habits (underreporting, overreporting), case log fatigue, fellow duty hours, fellow’s operative interests, geography, economy, procedure popularity, media influence, societal norm, and patient preference.24,1216

With the increasing number of AACS fellowship programs, there was a decreasing trend in the yearly number of surgical procedures logged by the fellows. Handler et al published a median of 687 procedures per fellow from 2007 to 2012 compared to the mean of 633.3 in this study for 2016 to 2018. Albeit mean and not median were used in this article, both values depict strongly undertaking the 300 minimum AACS requirements per year for graduation. The decrease in total procedures can be due to many factors such as but not exclusive of (1) less robust practices for the new fellowship programs that have just opened versus the very well-established programs, (2) the programs that were filled for that year were not as busy as the programs filled for other years, and (3) method of logging surgical procedures by the fellows. Factors mentioned regarding future trend predictability may also contribute. AACS has strict requirements for certifying fellowship programs, especially with regard to fellow training and exposure.

Learning curves will vary from procedures, and experiences can significantly impact operative efficiency and long-term survival.17,18 Learning curve for “quick septoplasty” required only 20 procedures.19 What are the true methods for measuring the learning curve? What quantifies and qualifies competency and adeptness? Learning curves are decreased with formal training courses, cadaveric training, and assistance from expert surgeons.20 Accreditation Council for Graduate Medical Education (ACGME) requirements for plastic surgery were tabulated with the averages from the AACS fellows (Table 3).21 Albeit AACS fellows have logged higher averages, the minimum numbers to achieve competency or proficiency may be difficult to determine, especially with complex techniques or complex cases.22,23 These numbers may be affected by prior experiences, mentorships, case exposures, and level of skills.22,23 This article was not to verify correlation of averages and trends with level of surgical competency, proficiency, or expertise, which are multifaceted topics and beyond the scope of this study. Nonetheless, the more exposure to procedures with active learning, complex skills development, adaptive solving techniques, appropriate feedback, cadaveric model training, continual education, outcome improvement training,2431,22 the more a fellow can thoughtfully and strategically master skills through the AACS apprenticeship model with varying anatomy, varying surgical technique approaches, and varying dexterity. The AACS fellowship model allows for one-on-one training with direct feedback, interactive didactics, formal lectures, and cadaver training in general body and facial cosmetic surgery, to accomplish their operative training aspirations in aesthetic surgery.

The study demonstrated increasing, decreasing, and neutral trends over the academic years from July 1, 2015 to June 30, 2018. The AACS General Cosmetic fellowship programs continue to provide training exposure of surgical procedures that are commonly performed in the United States, such as breast augmentation, liposuction, abdominoplasty, breast lift, eyelid surgery, and rhinoplasty. The trends of the logged surgical procedures may help guide future training needs and help prospective fellow applicants decide on how to choose their preferred fellowship program with AACS. Further studies are recommended to study any causative or correlative analyses.

Special thank you to Ms. Margaret Bengtson and to the American Academy of Cosmetic Surgery for providing the raw data for this article.

Research Ethics and Patient Consent
No identifying information were received as raw data for this research. Only tallied numbers were obtained for the surgical procedures relevant to the research. Hence, no consents were needed from the non-identifiable subjects.

Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD
Grace Valina  https://orcid.org/0000-0003-4728-834X

1. American Society for Aesthetic Plastic Surgery . Cosmetic surgery national data bank statistics 2017. Aesthet Surg J. 2017;37(suppl 2):129. doi:10.1093/asj/sjx076.
Google Scholar | Crossref

2. Milothridis, P, Pavlidis, L, Haidich, AB, Panagopoulou, E. A systematic review of the factors predicting the interest in cosmetic plastic surgery. Indian J Plast Surg. 2016;49(3):397402. doi:10.4103/0970-0358.197224.
Google Scholar | Crossref | Medline

3. Slevec, J, Tiggemann, M. Attitudes toward cosmetic surgery in middle-aged women: body image, aging anxiety, and the media. Psychol Women Quart. 2010;34(1):6574. doi:10.1111/j.1471-6402.2009.01542.x.
Google Scholar | SAGE Journals | ISI

4. Swami, V. Body appreciation, media influence, and weight status predict consideration of cosmetic surgery among female undergraduates. Body Image. 2009;6(4):315317. doi:10.1016/j.bodyim.2009.07.001.
Google Scholar | Crossref | Medline | ISI

5. American Academy of Cosmetic Surgery . About us. https://www.cosmeticsurgery.org/page/About. Accessed March 19, 2019.
Google Scholar

6. American Academy of Cosmetic Surgery . AACS certified cosmetic surgery fellowshipshttps://www.cosmeticsurgery.org/page/Fellowship_Main. Accessed March 19, 2019.
Google Scholar

7. Handler, E, Tavassoli, J, Dhaliwal, H, Murray, M, Haiavy, J. A review of general cosmetic surgery training in fellowship programs offered by the American academy of cosmetic surgery. J Oral Maxillofac Surg. 2015;73(4):580586. doi:10.1016/j.joms.2014.11.019.
Google Scholar | Crossref | Medline

8. American Society of Plastic Surgeons . 2017 plastic surgery statistics report. Published 2017https://www.plasticsurgery.org/documents/News/Statistics/2017/plastic-surgery-statistics-report-2017.pdf. Accessed March 19, 2019.
Google Scholar

9. International Society of Aesthetic Plastic Surgery . International survey on aesthetic/cosmetic procedures performed in 2017. Published 2018https://www.isaps.org/wp-content/uploads/2018/10/ISAPS_2017_International_Study_Cosmetic_Procedures.pdf. Accessed March 19, 2019.
Google Scholar

10. Schober, P, Boer, C, Schwarte, L. Correlation coefficients. Anesth Analg. 2018;126(5):17631768. doi:10.1213/ane.0000000000002864.
Google Scholar | Crossref | Medline

11. Akoglu, H. User’s guide to correlation coefficients. Turk J Emerg Med. 2018;18(3):9193. doi:10.1016/j.tjem.2018.08.001.
Google Scholar | Crossref | Medline

12. Naik, N, Abbott, E, Aho, J, et alThe ACGME case log system may not accurately represent operative experience among general surgery interns. J Surg Educ. 2017;74(6):e106e110. doi:10.1016/j.jsurg.2017.09.032.
Google Scholar | Crossref | Medline

13. McPheeters, M, Talcott, R, Hubbard, M, Haines, S, Hunt, MA. Assessing the accuracy of neurological surgery resident case logs at a single institution. Surg Neurol Int. 2017;8:206. doi:10.4103/sni.sni_83_17.
Google Scholar | Crossref | Medline

14. Balla, F, Garwe, T, Motghare, P, et alEvaluating coding accuracy in general surgery residents’ Accreditation Council for Graduate Medical Education procedural case logs. J Surg Educ. 2016;73(6):e59e63. doi:10.1016/j.jsurg.2016.07.017.
Google Scholar | Crossref | Medline

15. Dermody, SM, Gao, W, McGinn, JD, Malekzadeh, S. Case-logging practices in otolaryngology residency training: national survey of residents and program directors. Otolaryngol Head Neck Surg. 2017;156(6):10721077. doi:10.1177/0194599817702622.
Google Scholar | SAGE Journals | ISI

16. Cairo, S, Craig, W, Gutheil, C, et alQuantitative analysis of surgical residency reform: using case-logs to evaluate resident experience. J Surg Educ. 2019;76(1):2535. doi:10.1016/j.jsurg.2018.05.013.
Google Scholar | Crossref | Medline

17. Maruthappu, M, Duclos, A, Lipsitz, SR, Orgill, D, Carty, MJ. Surgical learning curves and operative efficiency: a cross-specialty observational study. BMJ Open. 2015;5(3):e006679. doi:10.1136/bmjopen-2014-006679.
Google Scholar | Crossref | Medline | ISI

18. Burt, BM, ElBardissi, AW, Huckman, RS, et alInfluence of experience and the surgical learning curve on long-term patient outcomes in cardiac surgery. J Thorac Cardiovasc Surg. 2015;150(5): 10611068.e3. doi:10.1016/j.jtcvs.2015.07.068.
Google Scholar | Crossref | Medline

19. D’Ascanio, L, Manzini, M. Quick septoplasty: surgical technique and learning curve. Aesthetic Plast Surg. 2009;33:814818. doi:10.1007/s00266-009-9388-y.
Google Scholar | Crossref | Medline

20. Hasan, A . New surgical procedures: can we minimise the learning curve? BMJ;320(7228):171173. doi:10.1136/bmj.320.7228.171.
Google Scholar | Crossref | Medline

21. Accreditation Council for Graduate Medical Education (ACGME) . Operative minimums effective July 1, 2014 review committee for plastic surgeryhttps://www.acgme.org/Portals/0/PFAssets/ProgramResources/Operative_Minimums_effective_07012014.pdf. Accessed April 18, 2019.
Google Scholar

22. Yeolekar, A, Qadri, H. The learning curve in surgical practice and its applicability to rhinoplasty. Indian J Otolaryngol. 2017;70(1):3842. doi:10.1007/s12070-017-1199-x.
Google Scholar | Crossref

23. Khan, N, Abboudi, H, Khan, MS, Dasgupta, P, Ahmed, K. Measuring the surgical ‘learning curve’: methods, variables and competency. BJU Int. 2013;113(3):504508. doi:10.1111/bju.12197.
Google Scholar | Crossref | Medline

24. Wulf, G, Shea, C, Lewthwaite, R. Motor skill learning and performance: a review of influential factors. Med Educ. 2010;44(1):7584. doi:10.1111/j.1365-2923.2009.03421.x.
Google Scholar | Crossref | Medline | ISI

25. Doyle Howley, L, Martindale, J. The efficacy of standardized patient feedback in clinical teaching: a mixed methods analysis. Med Educ Online. 2004;9(1):4356. doi:10.3402/meo.v9i.4356.
Google Scholar | Crossref | Medline

26. Wulf, G, Shea, C, Matschiner, S. Frequent feedback enhances complex motor skill learning. J Motor Behav. 1998;30(2):180192. doi:10.1080/00222899809601335.
Google Scholar | Crossref | Medline | ISI

27. Porte, M, Xeroulis, G, Reznick, R, Dubrowski, A. Verbal feedback from an expert is more effective than self-accessed feedback about motion efficiency in learning new surgical skills. Am J Surg. 2007;193(1):105110. doi:10.1016/j.amjsurg.2006.03.016.
Google Scholar | Crossref | Medline

28. Salerno, S, Jackson, J, O’Malley, PG. Interactive faculty development seminars improve the quality of written feedback in ambulatory teaching. J Gen Intern Med. 2003;18(10):831834. doi:10.1046/j.1525-1497.2003.20739.x.
Google Scholar | Crossref | Medline | ISI

29. Veloski, J, Boex, J, Grasberger, M, Evans, A, Wolfson, D. Systematic review of the literature on assessment, feedback and physicians’ clinical performance: BEME Guide No 7. Med Teach. 2006;28(2):117128. doi:10.1080/01421590600622665.
Google Scholar | Crossref | Medline

30. Ramani, S, Krackov, SK. Twelve tips for giving feedback effectively in the clinical environment. Med Teach. 2012;34(10):787791. doi:10.3109/0142159X.2012.684916.
Google Scholar | Crossref | Medline

31. Abernethy, B, Poolton, J, Masters, R, Patil, NG. Implications of an expertise model for surgical skills training. ANZ J Surg. 2008;78(12):10921095. doi:10.1111/j.1445-2197.2008.04756.x.
Google Scholar | Crossref | Medline

Author Biographies

Grace Valina, MD, is affiliated with Sarasota Surgical Arts, FL, USA.

Alberico Sessa, MD, is affiliated with Sarasota Surgical Arts, FL, USA.

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