Opportunities available for comprehensive ophthalmologists to foray into plastic surgery
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The American Society of Ophthalmic Plastic and Reconstructive Surgery, founded in 1969, is dedicated to advancing education, research and quality clinical practice in oculoplastic surgery.
There are only 650 U.S.-based ASOPRS fellows. To become a fellow of ASOPRS, one must complete an ASOPRS-certified 2-year post-residency fellowship in oculoplastic surgery or have focused one’s practice on oculoplastic surgery for 7 years and pass demanding written and oral board examinations. One must also be certified by the American Board of Ophthalmology.
ASOPRS-certified oculoplastic surgeons are rare, representing only 3.5% of the just more than 18,000 U.S. ophthalmologists and, when divided into the U.S. population, are one per 500,000, whereas comprehensive ophthalmologists and subspecialty ophthalmologists who also provide comprehensive eye care are about one per 20,000. For this reason, most ASOPRS-certified oculoplastic surgeons are based in major cities. My state of Minnesota might justify 11 or 12 ASOPRS-certified oculoplastic surgeons. We have three in our practice at Minnesota Eye Consultants, and there are two at the University of Minnesota and another two at the Mayo Clinic. Altogether, as I count, there are nine in Minnesota, and all of them are busy.
The oculoplastic surgeon of today competes for patients with comprehensive ophthalmologists who perform plastic surgery, aesthetic dermatologists, some aesthetic ENT surgeons and especially members of the American Society of Plastic Surgeons, whose members number 11,000. To become a fellow of ASPS is also demanding and requires training in general surgery followed by an ASPS-certified fellowship and board examinations.
I looked at a Medscape 2022 report and was interested to find that plastic surgeons were both the best paid and the happiest physicians in America. Plastic surgery, and by inference oculoplastic surgery, is an attractive specialty. Eyelid surgery is only a small part of an ASPS-certified surgeon’s practice, but it is core to the oculoplastic surgeon’s work.
Like in cataract surgery, there are third-party pay and cash-pay procedures to perform. The definitions used by plastic surgeons are functional and cosmetic plastic surgery, like we anterior segment surgeons have standard cataract surgery and refractive cataract surgery. To do well financially as a plastic surgeon, it is important to participate in the cash-pay cosmetic plastic surgery sector and ideally the facility side of reimbursement. ASCs and office-based surgery centers are commonly utilized. We are all familiar with the functional oculoplastic procedures such as ptosis repair, entropion, ectropion, tear duct surgery, tumor removal and orbital surgery. On the cash-pay cosmetic side, the more common procedures are blepharoplasty, brow lift and the common cosmetic use of Botox (onabotulinumtoxinA, Allergan Aesthetics) injections, soft tissue fillers, chemical peels, laser skin rejuvenation and intense pulsed light.
When I first started private practice 45 years ago, my senior partners delegated to me all the oculoplastic surgery cases. Over the past 5 decades, more of these cases are being referred to fellowship-trained oculoplastic or plastic surgery specialists. That is the case in our practice, which is based in a major metropolitan area, but in a smaller, more rural community, oculoplastic surgery skills remain in demand locally. In addition, there is an opportunity for the comprehensive ophthalmologist to take a special interest in functional and/or cosmetic oculoplastic surgery, seek out and obtain further training, and offer this valuable service to their practice’s patients.
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