During the Oculofacial Plastic Surgery Fellowship, you receive exposure to state-of-the-art diagnostic and treatment techniques in the field of eye plastic and orbital surgery. You obtain the foundation of clinical and surgical skills that permits you to assimilate new diagnostic methods and surgical techniques, as well as participate in the process of innovation in patient care.

Your training is delivered in a highly collegial environment by a team of medical specialists who are supported by an excellent administrative, secretarial, and technical staff. A unified electronic medical record is available at all clinical and hospital locations.

Clinical training

You are exposed to the entire spectrum of oculoplastic, lacrimal, and orbital disorders, including:

• Diagnostic evaluation and medical and surgical treatment of eyelid disorders, including eyelid neoplasms and eyelid malpositions (ptosis, entropion, ectropion, and eyelid retraction)
• Eyelash abnormalities
• Eyelid reconstruction
• Laser therapy of vascular and pigmented cutaneous lesions
• Aesthetic surgical techniques, including mid-face and SOOF lift procedures, facial and cervical rhytidectomy
• Aesthetic minimally invasive techniques, including laser resurfacing, chemical peel, soft tissue fillers, IPL, Kybella, botulinum toxin injection
• Endoscopic brow and forehead elevation
• Lacrimal procedures, including canalicular reconstruction and conjunctival DCR with Jones tube placement
• External and endoscopic lacrimal surgery
• Management of orbital disease, including orbital biopsy, orbital tumor resection, orbital decompression surgery, and management of complex orbitofacial trauma

Although the clinical and surgical volume may vary somewhat from year to year, fellows in recent years have participated in more than 3500 surgical procedures during their training, with well over half of those being done as primary surgeon.

First year schedule

The first year is structured around the weekly clinic and OR schedule, with the weekly schedule determined by the fellow based on case complexity and other service needs. When all attending physicians are away from the clinic, you will devote time to research or to ad hoc electives in plastic surgery, ENT, surgical dermatology, or other areas of clinical interest. During their first year, fellows spend approximately 40% of their time with Dr. Bradley, 30% with Dr. Tooley, and 30% with Dr. Wagner.

Second year schedule

The approximately six months that you will spend on the oculofacial plastic surgery service during the second year are structured similarly to the sample weekly block schedule above. You will work with increased independence, to the point of complete autonomy, in the clinic and the OR during the second year.

Additionally, the following rotations and electives are completed in the second year:

• Aesthetic surgery (Dr. Tarbet, Seattle): 8 weeks
• Otolaryngology: 4 weeks
• Plastic surgery: 4 weeks
• Dermatologic surgery: 2 weeks
• Neuro-radiology: 1 week
• Ocularist: 1 week
• Research: 6 weeks

Total elective time: 26 weeks

Anatomy facilities

The Department of Anatomy features a well-equipped gross anatomy dissection laboratory, complete with preparation facilities, lecture room, and the state-of-the-art Center for Procedural Skills Mastery. 

The Center for Procedural Skills Mastery is intended for staff and trainees as they learn and perfect clinical procedures on cadaveric specimens. This space was designed to accommodate several small groups or a single group (up to 60 people). In addition, a large area is dedicated as a gross anatomy teaching laboratory, cadaver procurement, and preparation facility.

Funds for fellow anatomic dissection are available through the Department of Ophthalmology Education Fund.

Additionally, we offer a soft tissue dissection course annually, in which, as a fellow, you will participate both as an instructor in basic suture techniques for the residents, and as a trainee for more complex flaps. You also have the opportunity to help complete pro-sections for the orbital anatomy module for first-year medical students.

General call responsibilities

As a fellow, you will have no on-call duties in general Ophthalmology. Specifically, there are no expectations that you see general ophthalmology patients in the clinic or participate in general ophthalmology cases in the OR. You will perform inpatient ophthalmology consultations six half-days per year, with technician support.

Teaching opportunities

As a fellow, you are an invaluable resource for teaching residents in the clinic, OR, and emergency room. While all resident surgical cases are staffed by attending physicians in the Department of Ophthalmology, our fellow provides much of the hands-on instruction for on-call and office-based surgery. As you gain surgical skills, you will be given increasing opportunities to directly supervise resident surgery, with the attending faculty immediately available for additional instruction. 

You will also be involved in the preparation of academic conferences and grand rounds. You will lead periodic Oculofacial Plastic Surgery Conferences. You have the opportunity to provide medical student and resident instruction in orbital anatomy. Additionally, you will help run an annual course on soft tissue techniques for the residents. 

Evaluation

To ensure acquisition of adequate knowledge and development of appropriate technical skills, your performance is monitored carefully during the course of the Oculofacial Plastic Surgery Fellowship. Formal evaluation by supervising faculty members occurs semi-annually.