California Skin Institute Advanced Dermatologic Surgery Fellowship
This California Skin Institute’s Advanced Dermatologic Surgery Fellowship is a one year (53 weeks) program designed to provide a comprehensive exposure to the most advanced local anesthesia skin surgery techniques available including: Mohs Micrographic Surgery; advanced reconstructive surgery; general dermatologic surgery, cosmetic and medically-indicated laser surgery, and a broad range of advanced cosmetic surgery procedures including face lifts, blepharoplasty, and liposuction. An additional benefit of this program for both the academic and private practice dermatologic surgeon is exposure to the business and marketing practices of an successful dermatologic surgery practice that opened its doors in 1996 in one of the most competitive markets in the country.
The California Skin Institute consists of seven offices from San Francisco to San Jose and is the largest private practice of dermatology in Northern California consisting of 21 dermatology and pathology providers. The fellowship primarily operates out of the Mountain View and San Jose locations. The Mountain View office consists of a 5000 square foot of space, including a 1000 square foot Medicare-approved surgery center, staffed by 20 employees. We have a Fraxel Dual® Dual laser, Fraxel Dual® re:pair laser, Ulthera, CoolSculpting®, Pinpointe Nail Fungus Laser, Laserscope Gemini 532/1064nm laser, Intense Pulsed Light device, Blu-U, Diode hair laser, VersaPulse® Cosmetic Laser 532nm vascular laser, Q-switched Alexandrite, Q-switched Nd:YAG, and an Ultrapulse carbon dioxide laser. The San Jose consists of a 10,600 square foot facility that is staffed by 30 employees and has a full service pathology laboratory led by a board certified dermatopathologist, dedicated laser rooms, a 2400 sq ft Medicare-approved surgery center, conference room, skin bar, and centralized business office. Additional lasers similar to Mountain View are present in addition to an Omnilux and long pulsed Nd:YAG.
Additional Clinical Faculty:
1) Suzy Butler, MD, Fellowship-trained Mohs Surgeon.
2) Peter, Levin, MD Former Director of Oculoplastic Surgery at Stanford University Medical Center (SUMC). The Fellow will be able to work directly with Dr. Levin in advanced periorbital reconstructions cases, periorbital cosmetic surgery, and non-cosmetic services such as ptosis repair and lid tightening procedures.
3) James Newman, MD Clinical Instructor, Department of Otolaryngology and Head and Neck Surgery, Stanford University and Fellowship-Trained Facial Plastic Surgeon (former fellow of Dr. Goode) currently in private practice and teaching at the Stanford VA Hospital one day/week. The Fellow will participate with Dr. Newman in more advanced cosmetic procedures including endoscopic browlift and mid-facelift procedures, advanced facial rejuvenation, and radiofrequency rejuvenation.
Mohs Surgery and Facial Reconstruction
Dr. Morganroth was a former American College of Mohs Surgery fellowship director from 2004-2011 prior to the conversion to ACGME oversight of Mohs fellowships. This fellowship is not ACGME approved. The Mohs practice is very active and continues to grow. 2012 volume will exceed 1700 cases and is expected in have significant growth with the ongoing practice expansion. The Mohs cases have the same complexity and histologic variation as the cases referred to local academic centers including melanoma, melanoma in situ, Merkel cell carcinoma, Paget’s disease, sebaceous carcinoma, microcystic adnexal carcinoma, dermatofibromasarcoma protuberans, apocrine carcinoma, atypical fibroxanthoma, and eccrine carcinoma.
All reconstructions are done under local anesthesia immediately following extirpation of the skin cancers. The full range of reconstructive techniques are utilized including two-stage pedicle flaps, cartilage grafts, and advanced flap and graft combinations. As a result of our good technique, many patients with large tumors are referred to us by local plastic surgeons for Mohs and to have us do the complex repairs including nasal cartilage framework restoration and forehead flaps or for larger periorbital tumors. As a result, it is extremely rare that a Mohs defect is sent out for reconstruction unless the Mohs case is referred by another surgical specialist who plans to do the repair or defects that involve >50% of eyelid loss.
General Dermatologic Surgery
For fellows interested in general dermatologic surgery, we frequently see patients in consultation for revision of surgical scars, excision of benign and malignant tumors, keloid excision, laser surgery for syringomata and sebaceous hyperplasia, and congenital nevi, hemangiomata, and port wine stains.
Advanced Cosmetic Dermatologic Surgery
A key benefit of this fellowship is the unique opportunity to participate on the leading edge of cosmetic dermatologic surgery. The fellowship offers a unique experience in providing innovative and original local anesthesia rejuvenation procedures to patients that expect a similar outcome to traditional techniques performed with general anesthesia.
The monthly cosmetic caseload typically consists of 10-26 major procedures even during the economic challenges of 2008-2009. Examples of major procedures include: upper and lower blepharoplasty, periorbital laser, and full face TCA peel; 3 to 5 area tumescent liposuction; neck liposuction and chin-jowl implant; mini-facelift combined with a number of procedures. Minor procedures examples include: neck liposuction and submentoplasty; TCA chemical peel; upper blepharoplasty; and liposuction of the arms. A unique feature of this practice is the complexity of the cosmetic cases. For example, it is common that patients undergo a facelift, necklift, submentoplasty, upper blepharoplasty, lower blepharoplasty, chin implant, laser resurfacing of the perirorbital and perioral area, and TCA peeling of the balance of the face completely under local anesthesia in one sitting.
Some weeks are very busy. For example, during one week in June 2006 the following surgical cases occurred: 28 Mohs cases; 4 full facelifts (includes neck lifts and submentoplasty); 7 blepharoplasties; 6 TCA peels; 6 laser resurfacing procedures; 1 body liposuction; and dozens of Botox, fillers, sclerotherapy, and laser procedures. Examples of cosmetic procedures can be found within the Gallery page.
The fellow is expected to actively participate in all consultations, pre-operative visits, procedures, and post-operative visits. Ample opportunity will be provided for the fellow to perform a portion of the procedure as soon as possible and ultimately perform solo procedures once competent in the techniques.
Cosmetic procedures performed with local anesthesia that the fellow will assist in and perform solo include the following procedures numbers:
- Tumescent liposuction of the face and body (approximately 150+/year)
- Face-lifting procedures (approximately 75+/year and growing)
- Neck-lifting procedures (performed in >80% of facelift procedures)
- Submentoplasty/platysmal plication (done in >90% facelifts and 25% neck lipos)
- Browlift (approximately 2-3/year)
- Blepharoplasty (140+/year of 2 and 4-lid procedures)
- Chin augmentation (approximately 25/year)
- Scar revision surgery (dozens/year)
- Hair transplant surgery (a few cases/year)
- TCA Chemical peeling (120+/year)
- Laser/light/ultrasound surgery (we operate 21 devices)—approximately 500+/year
- Microlipoinjection/fat transfer (12+/year)
- Sclerotherapy (approximately 120+/year)
- BOTOX® Cosmeticand Dysport® (approximately 500+/year)
- Collagen, Restylane®, Perlane®, JUVÉDERM®XC, Sculptra® Aesthetic, and RADIESSE® (approx. 500+/year)
Research and Publication Opportunities
The fellow will be expected to initiate a clinical research project at the beginning of the year and submit a paper to the ACMMSCO and ASDS annual meetings for the current or following year. There is an enormous opportunity for an ambitious fellow to present and publish in both the reconstructive and cosmetic literature through book chapters, articles by invitation, and lectures at various dermatologic surgery and facial plastic surgery meetings.
Where are Dr. Morganroth’s previous fellows working now?
- The 2004-2005 fellow is the second surgeon in the Department of Dermatology at The University of Connecticut in Hartford, CT.
- The 2005-2006 fellow is the second surgeon in the Department of Dermatology at Oregon Health and Science University in Portland, OR.
- The 2006-2007 fellow is in private practice in suburban Philadelphia.
- The 2007-2008 fellow is clinical faculty in the Loma Linda Dept of Dermatology and works at the Veterans Hospital in addition to private practice.
- The 2008-2009 fellow is active military surgeon stationed in San Antonio, Texas
- The 2009-2010 fellow is in private practice in Southern California
- The 2010-2011 fellow is in private practice in Southern California
This fellowship is in a very busy private practice and caters to an educated and demanding patient population living in Northern California. Excellent interpersonal skills, patient care, and surgical techniques are necessary prerequisites for the fellow. Candidates must be a graduate of an ABMS-approved residency in dermatology, otolaryngology, plastic surgery, or ophthalmology. Unlike prior years, this fellowship is independent of the Mohs College or ACGME, therefore it will not participate in the match. The positions will be filled on a first come basis by invitation.
The applicant should include the following information in their application packet:
- Three letters of reference from faculty members with direct knowledge and observation of applicant’s surgical skills and patient interaction. One letter should be from your program’s dermatologic surgeon.
- Curriculum vitae
- Personal statement
- A brief statement of applicant’s career plans following their fellowship
- A brief summary of the applicant’s surgical training to date including:- Names, addresses, and phone numbers of surgery mentors- Description of training including education and experience in:- Mohs Micrographic Surgery
- Flap and graft reconstruction
- Liposuction of the face and body
- Face and neck lifting techniques
- Chemical peeling
- Hair transplantation
- Laser surgery
- Number and types of procedures performed by applicant during residency training
NOTE: We are interested in training individuals who want to work hard and be on the advancing edge of dermatologic surgery. We understand that not all applicants will have exposure to these cosmetic techniques during residency. Experience in these procedures is not a prerequisite for the fellowship and applicants with all levels of surgical training are encouraged to apply.
Send application packet to:
California Skin Institute
Advanced Dermatologic Surgery Fellowship
c/o Darien Whang
525 South Drive, Ste. 115
Mountain View, CA 94040