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With training opportunities thus limited, surgeons were all the more eager to study with Jacques Joseph, whose reputation was at its zenith after the war. Internships and residencies were not yet widespread, and surgeons entered into paid preceptorships with Joseph, whose enormous practice included facelifts, otoplasties, and general plastic procedures of the body. Of the many Americans who traveled to Berlin to observe Joseph, none was more important to otolaryngology than Samuel Foman (1889-1971). It was Foman’s destiny to transfer Joseph’s knowledge to otolaryngology.
The avid interest of otolaryngologists in facial plastic surgery attracted many teachers, including general plastic surgeon Richard C. Webster, shown here at the 1985 Mt. Sinai rhinoplasty course. (Photo courtesy of Richard T. Farrior)
Neither a surgeon nor an otolaryngologist, Foman was an anatomist whose great interest was teaching, at which it is said he was brilliant. Foman became interested in facial plastic surgery during World War I (he trained medical officers in the U.S. Army Medical Reserve Corps) and lamented the lack of books and formal training on the subject. A marvelously thorough researcher and writer, Fomon undertook the compilation of all known work on facial plastic surgery to ensure that his students had a text. His research for the book took him to Europe and Joseph around the time that the ABPS was founded. Foman watched as general plastic surgeons began to monopolize plastic surgery procedures, blocking regional specialists from using them by restricting hospital privileges, refusing admittance to operating rooms, barring access to journals, and rejecting attendance at courses and meetings. Foman, whose life exemplified the open teaching ethos that would become the hallmark of facial plastic surgery, was especially irked that general plastic surgeons covered their work the moment he entered the operating room. He made up his mind to do something about this. He decided he not only would find out everything he could about facial plastic surgery, but he also would teach it to otolaryngologists.
In 1940, Foman organized a course, which over the years attracted more than seven hundred fifty otolaryngologists. One of the few places in the country that offered formal training in facial plastic surgery, Foman’s course caught the eye of two otolaryngologists. First, George Coates, editor of the prestigious Archives of Otolaryngology and professor of otolaryngology at the University of Pennsylvania, learned of Foman. His encouragement to the otolaryngologists at the University of Pennsylvania and their associated hospitals to take Foman’s courses earned him credit for advancing facial plastic surgery in otolaryngology. Through Coates, Foman met Dean Lierle, chairman of the department of otolaryngology at the University of Iowa, long-time secretary of the ABO, and probably the most powerful man in otolaryngology in the fifties and sixties. Lierle’s department, said to be one of the finest in the world at that time, was the only one providing full facial plastic surgery training within the structure of a residency program. He opened the doors of academia to Foman and made his course acceptable to otolaryngologists.
Even with Foman’s acceptance by Coates and Lierle, facial plastic surgery was not immediately embraced by otolaryngology. Although increasing numbers of otolaryngologists used plastic procedures whenever it was necessary in their work to shift tissues in ear surgery, to correct deformities caused by cancer ablations, to repair congenital deformities, and to provide other functional and aesthetic improvements the attitude persisted that facial plastic surgery was a bit frivolous. To be taken seriously, the emerging subspecialty apparently would have to establish itself independently, developing its own training programs and attracting enough surgeons to achieve viability as a noteworthy entity.