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Aesthetic Requirements for CCT

via the ISCP Plastic Surgery Curriculum (Aug 2021 Edition)

In order to be awarded an outcome 6 at the final ARCP for aesthetic training, trainees must be able to satisfy the following specific certification requirements.

1. Indicative aesthetic numbers (Performed/assisted) - 100 

2. Requirements as outlined in each aesthetic subsection syllabus (click to expand):

   •  Aesthetic Surgery of Face, Orbit & Neck

     OBJECTIVE

     Acquires competence in the diagnosis, aesthetic assessment and safe management of all patients presenting for consideration of avoidance or reversal of the features of physiological aging of the face, brow, neck and orbits.

     KNOWLEDGE

     BASIC

     Should be able to demonstrate knowledge of: psychology of the desire for anti-aging interventions features denoting high-risk groups of patients that may present for surgical rejuvenation normal facial anatomy and its common variants, including clear understanding of the blood supply, sensory and motor innervation facial musculature and the course and distribution of the facial nerve

     INTERMEDIATE

     Should be able to demonstrate knowledge of: accurate assessment and analysis of the pattern of face aging injectable fillers available, their uses, contraindications and interactions pharmacology of paralytic agents, the different formulations and the muscle groups to which they may be applied role of fillers and paralytics in the overall patient management plan indications for, and design of, endoscopic and open browlift and foreheadplasty fixation methods in brow lift indications and contraindications for facelift anatomy of the SMAS layer and how it may be modified facial fat pads and how they change with time variation of designs for facelift incisions different methods of facelifting different methods of necklifting designs and variations of blepharoplasty, upper and lower role of submental lipectomy and liposuction management of complications of rejuvenation surgery

     ADVANCED

     Should be able to demonstrate knowledge of: applications, indications, limitations and complications of blepharoplasty alone and in combination with other techniques.

     CLINICAL SKILLS

     BASIC

     assess and deliver non-operative management of the acute surgical patient take history to include features relevant to the assessment and management of the aesthetic features of the head and neck examine the patient to include relevant aesthetic features of the head and neck

     INTERMEDIATE

     assessment and analysis of all the features of the aging eyelid demonstrate knowledge of the management algorithms, combinations and permutations of the rejuvenation procedures covered in this section including appropriate investigations record accurate assessment of the pattern of symptoms and physical features

     ADVANCED

     demonstrate skills of analysis and diagnostic synthesis, judgement, surgical planning prepare an overall management plan for a given patient assess the psychological suitability for rejuvenation surgery and appropriately refer for expert advice as necessary undertake risk benefit analysis of non-pathological based surgery counsel and consent a patient for rejuvenation intervention define the subgroup of patients that can be managed by nonsurgical intervention recognise and counsel the unrealistic patient manage the situation whereby a patient’s best interests are served by declining to treat that patient deal with disappointment and postoperative dissatisfaction

     TECHNICAL SKILLS AND PROCEDURES

     BASIC

     planning, designing and performing excision of facial skin lesions for aesthetic indications selecting and using injectables for fine rhytids using paralytics to weaken aging muscle groups upper lid blepharoplasty

     INTERMEDIATE

     facelift with plication of the SMAS MACS lift submental lipectomy liposuction for the face and neck areas. pan or regional facial rejuvenation by laser / chemical peel / dermabrasion

     ADVANCED

     lower lid blepharoplasty by external or transconjunctival approaches

   • Rhinoplasty and Otoplasty

     OBJECTIVE

     Competence in the diagnosis, planning and management of all aspects of aesthetic nasal and aesthetic ear surgery

     KNOWLEDGE

     BASIC

     Should demonstrate knowledge of:

     Rhinoplasty anatomy of the nose including detailed description of the bone, cartilage, soft tissue structures, aesthetic units blood supply of the nose including ophthalmic artery, facial artery and angular artery as well as nerve supply physiological functions of the nose and how these may be affected by nasal surgery facial aesthetics including the psychological implications of rhinoplasty surgery dysmorphophobia and recognises clinical features of condition local anaesthesia and the use of topical agents such as cocaine

     Otoplasty anatomy of the ear including embryology and growth (including nomenclature of different elements of the ear) blood supply of the ear including branches from external carotid artery, posterior auricular artery and superficial temporal artery nerve supply of the ear including auriculotemporal nerve, great auricular nerve, branches of the vagus nerve and lesser occipital nerve

     INTERMEDIATE

     Should demonstrate knowledge of:

     Rhinoplasty techniques to manage the nasal dorsum including dorsal hump reduction and dorsal augmentation different osteotomy techniques including placement of osteotomies techniques of endonasal and open approaches, including appropriate selection of surgical technique management of the alar cartilages and septum including resection, dome suturing and cartilage grafting techniques endonasal and open approaches to rhinoplasty techniques for nasal tip adjustment including resection, suturing, control of projection management of septal trauma

     Otoplasty appropriate age-related considerations in respect of timing of otoplasty. cartilage maturation non-surgical management including neonatal moulding techniques anaesthesia including use of local anaesthesia and appropriate infiltration/blocks classification of prominent ears and definitions of cup ear, lop ear and Stahl’s deformity surgical techniques for prominent ear correction including cartilage scoring e.g. Chongchet and suture-only techniques e.g. modified Mustardé various dressing techniques with their relative merits potential complications of prominent ear correction with risk factors for the same, including infection and necrosis of cartilage and skin

     ADVANCED

     Should demonstrate knowledge of:

     Rhinoplasty complications of rhinoplasty surgery including functional complications secondary rhinoplasty techniques with indications for same

     Otoplasty the reconstructive techniques available for treatment of significant necrosis or deformity following prominent ear correction

     CLINICAL SKILLS

     BASIC

     Should demonstrate ability to:

     Rhinoplasty arrange appropriate views for clinical photographic record elicit focussed history in respect of the rhinoplasty patient examine patient with reference to the nose including preoperative analysis of appearance and function recognise the need for psychological assessment and identifies dysmorphophobia

     Otoplasty clinically assess the patient with reference to the external ear and demonstrates appropriate communication when dealing with the paediatric patients arrange appropriate views for clinical photographic record take consent for primary otoplasty modifying communication when dealing with paediatric patient recognise the need for psychological assessment and identifies dysmorphophobia

     INTERMEDIATE

     Should demonstrate ability to:

     Rhinoplasty clinically assess and analyse nasal defects including issues of balance and proportion make a surgical plan for primary rhinoplasty using skills of analysis and judgement counsel and consent patient for rhinoplasty surgery recognise and counsel the unrealistic patient explain to patient when rhinoplasty not in best interests of patient

     Otoplasty clinically assess and analyse ear deformities including issues of symmetry and proportion make a surgical plan for primary otoplasty using skills of analysis and judgement counsel and consent patient for otoplasty surgery recognise and counsel the unrealistic patient explain to patient when otoplasty not in best interests of patient

     ADVANCED

     Should demonstrate ability to:

     Rhinoplasty examine the patient with reference to the nose including preoperative analysis of appearance and function deal with disappointment and postoperative dissatisfaction make a surgical plan for secondary using skills of analysis and judgement counsel and consent patient needing secondary rhinoplasty surgery recognise and counsel the unrealistic patient explain to patient when rhinoplasty not in best interests of patient

     Otoplasty deal with postoperative complications deal with disappointment and postoperative dissatisfaction make a surgical plan for secondary otoplasty using skills of analysis and judgement counsel and consent patient for secondary otoplasty surgery recognise and counsel the unrealistic patient

     TECHNICAL SKILLS AND PROCEDURES

     BASIC

     Should be able to perform:

     Rhinoplasty application of internal and external nasal splints drainage of septal haematoma harvesting cartilage graft from ear and costochondral junction nasal packing for bleeding infiltrating nose with local anaesthetic and administer topical agents such as cocaine osteotomies of nasal bones (various patterns)

     Otoplasty infiltration of ears with local anaesthesia including greater auricular nerve blocks application of prominent ear head dressing

     INTERMEDIATE

     Should be able to perform:

     Rhinoplasty closed approach to the septum with or without concomitant rhinoplasty submucous resection of spurs approach to the septum during open rhinoplasty enlargement of septal perforation to reduce symptoms cartilage graft harvest from nasal septum adjustment of nasal dorsum including dorsal hump, reduction and dorsal augmentation

     Otoplasty primary otoplasty with cartilage-scoring techniques primary otoplasty with suture-only techniques management of complications including haemorrhage, infection and necrosis of skin and cartilage

     ADVANCED

     Should be able to perform

     Rhinoplasty harvesting calvarial bone graft septoplasty surgery including scoring and SMR techniques septoplasty with or without cartilage grafting management of complications including haemorrhage secondary procedures to correct unsatisfactory results closure of septal perforation reconstruction of septum for nasal support

     Otoplasty secondary procedures to correct unsatisfactory results including ear reconstruction techniques (see Ear Reconstruction Module) techniques to correct other deformities such as cup ear, lop ear and Stahl’s deformity

   • Rejuvenation/restoration of the trunk, body contouring, liposuction & fat grafting

     OBJECTIVE

     Acquire competence in the assessment, planning correction and management of all aspects of body lifting and contouring

     KNOWLEDGE

     BASIC

     Should demonstrate knowledge of: anatomy of the skin and subcutis patterns and organisation of the blood and nerve supply of the relevant regions of the skin pattern of relaxed skin tension lines over the whole body pathogenesis of thromboembolic disease, and the prophylaxis and management of these disorders selection of appropriate prophylactic antibiotics

     INTERMEDIATE

     Should demonstrate knowledge of: principles of bariatric surgery metabolic consequences of bariatric surgery pathogenesis, effects and management of tissue necrosis appropriate placement of incisions for best aesthetic outcome complications of skin-tailoring surgery principles of liposuction and know of the different devices and their relative risks and benefits effects of postoperative changes in body weight and pregnancy in this group of patients pathology and principles of fat grafting

     ADVANCED

     Should demonstrate knowledge of: psychological condition of dysmorphophobia condition of monosymptomatic hyperchondriacal psychosis psychosexual impacts of body image disorder patterns of acquired skin excess syndromic abnormalities of skin laxity forms of lipodystrophy, its patterns and presentations specific complications of the various techniques of liposuction techniques, donor sites and morbidity of fat grafting the developing research into trophic/non-volumetric effects of fat grafts

     CLINICAL SKILLS

     BASIC

     Should demonstrate ability to: assess and deliver non-operative management of the acute surgical patient take history to include features relevant to the assessment and management of body contour problems examine the patient with reference to patterns of skin excess and laxity to include assessment and documentation of symptomatically unpleasing body contours

     INTERMEDIATE

     Should demonstrate ability to: undertake clinical assessment for the perceived deformities covered in this module translate presenting complaints into an appropriate plan for potential intervention recognise the patient seeking treatment of obesity by body contouring

     ADVANCED

     Should demonstrate ability to: make a surgical plan for the individual patient in respect of conditions covered in this module using skills of analysis and judgement assess the psychological suitability for body contouring surgery and appropriately refers for psychological advice as necessary perform risk-benefit analysis of non-pathological based surgery counsel and consent a patient for an episode of body contouring surgery communicate the range of secondary effects of a given operation and suggest adjuvant procedures or alternative techniques accurately assess local volume excess and translate that into a plan for liposuction recognise lipodystrophies recognise local fat deficiencies which will benefit from fat grafting recognise and counsel the unrealistic patient explain to patient when body contouring surgery not in best interests of patient deal with disappointment and postoperative dissatisfaction

     TECHNICAL SKILLS AND PROCEDURES

     BASIC

     Should be able to undertake: wound management and dressing care management of the necrotic wound and its defect range of wound closure techniques application of closed suction drainage

     INTERMEDIATE

     Should be able to perform: various patterns of abdominoplasty correction of lax abdominal musculature regional liposuction scar revision including management of the ‘dogear’ fat graft harvest and preparation of fat grafts undertakes local lipofilling with fat graft

     ADVANCED

     Should be able to perform: modified abdominoplasty in the presence of unfavourable abdominal scarring brachioplasty BELT/body lift buttock lift thigh lift liposuction of the arms or distal to the mid thigh, major circumferential liposuction complex combination procedures major staged fat graft for general contour restoration secondary contouring procedures to correct unsatisfactory results