Bialowas, Christie

Abstract Purpose Imposter syndrome (IS) is a “behavioral health phenomenon described as self-doubt of intellect, skills, or accomplishments among high-achieving individuals” that has been associated with psychological distress, burnout, anxiety, and depression, and has also been shown to negatively impact career retention and job performance. Previous studies, while rare, have demonstrated remarkably high rates of IS amongst surgical trainees, but include little information on contributing factors. The purpose of this study was to broadly explore IS in surgical trainees across specialties.Methods An anonymous electronic survey aimed at identifying the prevalence, severity, and underlying factors contributing to IS in surgical trainees was developed by members of the ASE Graduate Surgical Education Committee and distributed to list servs of surgical residents across specialties at twelve institutions. Descriptive statistics, univariate analysis, and multivariable analysis were performed to identify differences in and factors contributing to IS.Results A total of 155 survey responses were received. Seventy-one percent of respondents report significant or intense IS, with women demonstrating more severe IS. Residents identified interactions with peers or other residents as triggering more feelings of IS compared to faculty or patients. Prior IS training, feeling a sense of belonging in residency, and lower incidence of microaggressions were associated with less severe IS.Conclusions IS remains prevalent and severe amongst surgical trainees. Although previous work has identified many personal factors that contribute to IS, this study is one of the first of its kind to identify environmental and experiential (context-dependent) factors associated with more severe IS.

Summary: With the advent of the subspecialty of orthoplastic surgery, there has been a greater involvement of plastic surgeons in limb reconstruction, congenital anomalies, and salvage procedures. Understanding embryology helps plastic surgeons better understand how to reconstruct lower extremity congenital defects and how development of the lower limb affects what can be done to reconstruct the adult lower limb. There is significant discussion in the literature regarding embryology and development of craniofacial structures and the upper extremity; however, the development of the lower limb remains largely unexplored. This review aims to elucidate the embryologic development of the lower limb, congenital anomalies that may present to the plastic surgeon, and reconstructive options.

AbstractA novel treatment approach to address the nasolabial fold is the insertion facial suspension threads. However, there is a paucity of data available to guide insertion techniques and material selection. Three female and two male cephalic specimens of Caucasian ethnicity (73.6 ± 6.5 years; 21.41 ± 2.2 kg/m2) were included into this experimental split-face study. One facial side was treated with polycaprolactone (PCL) thread: 180 mm, bidirectional, 18G 100 mm cannula, 20 degrees trajectory, preauricular approach whereas the contralateral side was treated with polydioxanone (PDO) thread: 100 mm, bidirectional, 19G, 60 mm cannula, 50 degrees trajectory, infraorbital approach. Three-dimensional imaging outcome measures included vertical and horizontal skin displacement and volume changes at the nasolabial sulcus, at the labiomandibular sulcus, and along the jawline. Comparing PCL 180 mm 20 degrees to PDO 100 mm 50 degrees: vertical lifting effect 1.42 ± 2.63 mm versus 1.24 ± 1.88 mm (p = 0.906); horizontal lifting effect 3.42 ± 1.44 mm versus –2.02 ± 1.84 mm (p = 0.001); nasolabial volume change –0.80 ± 0.65 mL versus –0.52 ± 0.17 mL (p = 0.367); labiomandibular volume change –0.45 ± 0.42 mL versus –0.16 ± 0.16 mL (p = 0.191); jawline volume change 0.02 ± 0.43 mL versus –0.01 ± 0.21 mL (p = 0.892). The study provides objective evidence for the short-term effectiveness of facial suspension threads in treating the nasolabial folds. The results point toward a better aesthetic outcome when utilizing long facial suspension threads that can effect full-face changes as compared with short facial suspension threads.