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Over the next two decades, courses and study groups proliferated, as facial plastic surgeons independently pursued training and recognition. While Foman’s course continued in New York, two of his students established their own courses, which focused on their own special interests.
Before the days of television, students watched a master surgeon from the distant rows of an operating theater, as shown above in Irving Goldman’s 1961 class. In the top row, Goldman (center) stands with his “lieutenants”: Hueston King, Samuel M. Bloom, Trent W. Smith, Henry A. Thomas, Irvin J. Fine, Goldman, Sidney S. euerstein, Howard Bancks, Lewis J. Rutledge, Charles Aronson, and Robert M. Hui. Among the many students who went on to make major contributions to facial plastic surgery were W. E. Goodman (second row, fifth from right), who fourteen years later helped to introduce the external rhinoplasty to American surgeons, F. F. Rubin (first row, second from right), who designed the Rubin nasal instruments, and David King (first row, far right) who later became a member of the Goldman course faculty. (Photo courtesy of Robert L. Simons and Sidney Feuerstein
Maurice H. Cottle (1898-1981) returned from his Foman courses to concentrate on nasal function and in the late forties began to teach rhinology in a rigorous course that ran from 8 a.m. to 11 p.m. for seven to ten days at a stretch. He both charmed and intimidated his students with lectures that mixed his immense knowledge of anatomy, surgery, philosophy, religion, art, music, and psychiatry. From each student he demanded perfection because rhinology itself, he believed, was such a stern taskmaster. Its mastery required a lifetime, and Cottle himself devoted the first part of his life to the septum, the next decade to the nasal valve, and the next ten years to the pyramid. During the final part of his life he was concerned with rhinologic functional testing. Indeed, Cottle was concerned with function all of his life. His extensive work in the relationship of the nose to the heart and lungs and in the development of simple breathing tests that can signal potential heart trouble are still basic today.
After his studies with Foman, Irving B. Goldman (1898-1975) pursued his single-minded interest in aesthetic surgery of the nose, which led him in 1953 to organize a two-week course at Mt. Sinai Hospital in New York. The course which continues to this day under the leadership of William Lawson, with the long-time support of two surgeons who graduated from Mt. Sinai residencies to eventually assume AAFPRS presidencies, Robert L. Simons (AAFPRS president in 1985) and Frank M. Kamer (AAFPRS president in 1988) is still considered one of the jewels in the residency program. Goldman tried any new technique he felt would improve the nose. By 1957, he had developed the so-called “Goldman tip,” in which he cut the angle between the mesial and lateral crura and sutured the mesial crura together, resulting in improved tip projection. He published his procedure in a paper titled “The Importance of the Mesial Crura in Nasal Tip Reconstruction” in the Archives of Otolaryngology in 1957. Goldman’s superb surgical skills stood in sharp contrast to his rough and ready character. A heavy smoker and former boxer, he was neither genteel in his appearance nor in his interactions with others. He demanded absolute loyalty among his students, and his dogmatic manner either inspired others or completely turned them off.
Beyond the formal courses of Foman, Cottle, and Goldman, ad hoc study groups ruled the day. Word would go out that a master operator had scheduled a particular procedure the next day, and surgeons would fly into town to watch and critique the operation. “That’s how the leadership stimulated others to teach,” Webster recalled, by making time in their own busy practice schedules to share knowledge with the younger surgeons. In this way, “the pool of knowledge just expanded,” Morey L. Parkes said. Moreover, a new generation of leaders was trained.
After courses, Goldman typically gathered with his favorite trainees, as shown below, holding court and brandishing his ubiquitous cigar. From left: Goldman, unknown surgeon, William Schwartz, unknown surgeon, Lionello Ponti, Irvin J. Fine, and Joseph Freeman. (Photo courtesy of Robert L. Simons and Sidney Feuerstein)
Parkes, who would go on to serve as AAFPRS president in 1968, made repeated trips to learn rhinoplasty techniques from Foman, as others would later fly to Parkes’s Beverly Hills office to learn the nuances of other facial plastic surgery procedures. Jack R. Anderson, the dynamic first secretary of the AAFPRS, learned facelifts from Ira Tresley (AAFPRS president in 1969) in Chicago, where Anderson (AAFPRS president in 1971) flew on twenty-five separate occasions to watch the master at work. Anderson also found Morris Feldstein, an ophthalmologist at Mt. Sinai, willing to teach blepharoplasties, and flew there to learn that procedure. Sidney S. Feuerstein (AAFPRS president in 1980) flew to Chicago on many occasions to learn otoplasty from Oscar Becker.
Through these informal study groups, an essential body of knowledge about facial plastic surgery developed. Richard T. Farrior (AAFPRS president in 1967, AAO-HNS president in 1990) vividly recalls hosting such a meeting for a group in Tampa, Florida, which included Jack Anderson, Oscar Becker, John Dickinson, Louis Feit, Jesse Fuchs, Irving Goldman, Benito Rish, Abraham Silver, Ira Tresley, and William Wright. He operated before his peers and then engaged in their constructive criticism and anecdotal experiences. These sessions built on basic principles then taught in otolaryngology residencies, but applied these principles in new ways. Creating these new training opportunities attracted a certain individual. Early facial plastic surgeons burned with the fire of an inner determination, had strong personalities, and sparred over philosophic differences. Yet, their common thirst for learning created a bond that they transmitted to their disciples, who in turn spread the word, drawing increasing numbers of otolaryngologists to facial plastic surgery.
Early leaders of the AAFPRS strove to expand facial plastic surgery within otolaryngology training programs, while also developing courses for continuing medical education. Five major contributors (left) to these efforts were (from left): Samuel Bloom, the second AAFPRS treasurer, and past presidents William Wright, Jack Anderson, Ira Tresley, and Carl Patterson.
Patterson’s leadership continued for years, and he welcomed the involvement of other early leaders as shown in the informal gathering below (from left): Patterson, Walter E. Berman and Trent W. Smith. (Photos courtesy of Carl Patterson))
Contributing to the flood of interest were certain external events. The discovery of antibiotics and chemotherapeutic agents in the forties eliminated the life-threatening infections that comprised the practice of many otolaryngologists. Meanwhile, the need for facial plastic surgeons grew with the rising incidence of cancer and the advent of the automobile, which added a new source of facial trauma. Also, a more appearance-oriented society increased the demand for cosmetic work, which had become more acceptable.
By 1960, grassroots interest in facial plastic surgery among otolaryngologists had spread across the country. If the center of facial plastic surgery in the forties and fifties was New York with Foman and Goldman and their students and with such men as Abraham Silver, Howard Diamond, and Louis Feit, it soon had followers (including future AAFPRS leaders) in California among them, Walter E. Berman (AAFPRS president in 1972), Ed Lipsett, Parkes, and Jesse Fuchs, whose practice came into Parkes’s hands after Fuchs met an untimely death at the height of his career. In the Midwest, the big names were Cottle, Tresley and Becker, and of course Lierle. Eventually this tremendous American interest in facial plastic surgery spread across the Atlantic ocean. A series of courses, co-sponsored by the AAFPRS, was organized by Horst Wullstein and his wife Sabrina, also a physician, at the University of Wurzburg. The courses attracted Tony Bull of England, Claus Walter of Germany and others, who eventually formed the European Academy of Facial Surgery, also known as the Joseph Society, named in honor of the modern subspecialty’s founder.