#WomenInMedicine at Thieme

Can you tell us about your research experience for your article The Rhytidectomy Scar: Analysis of Patient and Surgeon Perspectives? What were your most significant findings and how will these affect future research?

Anisha Kumar, MD: This study analyzes the perception of the rhytidectomy scar from the perspective of cosmetic patients and surgeons. Cross-sectional surveys were administered in-person to in cosmetic patients and online to facial plastic and reconstructive surgeons in the USA. 

Quantitative analysis indicates that while both surgeons and cosmetic patients viewed hypopigmented scars less favorably, surgeons were more concerned with pre-tragal incision and blunted hair tuft. Furthermore, the number of rhytidectomies performed by surgeons resulted in more critical analysis of the scars presented in this study. Qualitative analysis of the frequent use of "natural" in the patient comments suggests the importance of maintaining a sense of "normalcy" as well. In contrast, the surgeon comments are most frequently about the relationship between the scar and surrounding anatomic structures, suggesting a descriptive focus on the technicality of scar placement and subsequent anatomic result. 

Cosmetic patients are primarily concerned about general scar appearance while surgeons are more focused on the technical orientation of the scar. An understanding and comparison of the language and perceptions of surgeons and cosmetic patients regarding rhytidectomy scars is vital in creating aesthetic results and managing patient expectations. 

What are the seminal papers in the field of rhytidectomy scar?

Anisha Kumar, MD:
Becker FF. The Preauricular Portion of the Rhytidectomy Incision. Arch Otolaryngology Head Neck Surg. 1994; 120(2):166-71. 

Kridel RW, Liu ES. Techniques for Creating Inconspicuous Facelift Scars: Avoiding Visible Incisions and Loss of Temporal Hair. Arch Facial Plastic Surgery 2003; 5(4):325-33. 

Roy S, Buckingham ED. Comparison of W-Plasty and Straight-Line Trichophytic Closure on Aesthetic Outcomes of Occipital Hairline Scars in Rhytidectomy. JAMA Facial Plastic Surgery 2018; 20(1), 14.

Kumar AR, Lu GN, Lee E, Kontis TC. The Rhytidectomy Scar: Analysis of Patient and Surgeon Perspectives. Facial Plastic Surgery. 2022 Jun. 

What is the significance of being a female specialist in your field?

Anisha Kumar, MD: Many of my patients are women, and their medical conditions range from head and neck cancer to elective cosmetic enhancements. For patients at either end of the spectrum of conditions, there is profound vulnerability in considering procedures that impact the appearance of their faces—their identities. Usually in the initial consult, the patient and I need to discuss her priorities and what she is most apprehensive about in the treatment and healing process. Therefore, as the clinician, I have a just few minutes in the beginning of the consult to establish rapport and a sense of security for the patient so we can have an open discussion. Numerous female patients have told me that they feel “more comfortable” sharing their concerns and insecurities about their facial appearance with a female specialist. Often, the patient and I will commiserate about the societal expectations of how women should look, dress, and remain youthful. These shared experiences allow my patients and I to build trust and longitudinal partnerships in their medical care. 

Have you had an opportunity to stand up for gender equality, women’s rights, or simply support other women? Please share.

Anisha Kumar, MD: I am an active member of the international non-profit organization, the Alumnae-i Network of Harvard Women (ANHW) Inc. As part of the Early College Awareness committee, I participate in the Her Honor Mentoring Program in New York as a mentor to female high school seniors. I have been a Career Journey Mentor as a panelist for the Pathful Connect program, a national virtual learning platform to introduce middle school and high school students to different career paths.  I am also on the ANHW New York Steering Committee, helping to organize get-togethers and events for Harvard female alumnae in New York.

Furthermore, I am very passionate about advocating for women, especially in fields such as surgery where female representation is limited. During the COVID-19 pandemic in 2020, I joined Zvelle’s international initiative for women, titled “Walk How You Want.” Through this collaboration, I along with other female leaders shared our career trajectories—our challenges, support systems, and role models—to encourage women to be relentless and unapologetic as they pursue their goals. 

Why is it important for hospitals and universities to have women on staff including in leading positions?

Anisha Kumar, MD: Female leaders are crucial for hospitals and universities. As a large subset of students, hospital employees, physicians, professors, and university employees are women, it is important for those individuals to be represented in the leadership of those institutions. 

Furthermore, female providers in healthcare have different skillset and expertise that positively impact patient care. In 2023, a multi-hospital study analyzed long-term surgical outcomes of female and male surgeons in Canada, California, Georgia, Tennessee, Washington DC, and Texas. The study looked at 1 million patient outcomes and found that patients treated by a female surgeon had a statistically significant lower risk-adjusted likelihood of complications.¹ While this study was not designed to study the underlying cause for the difference and possible solutions, it is an important large database analysis that indicates the quantifiable benefits of women as healthcare providers, warranting leadership positions. 

1 Wallis CJD, Jerath A, Aminoltejari K, et al. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. JAMA Surg. 2023; 158(11):1185–1194. doi:10.1001/jamasurg.2023.3744

Dr. Anisha R. Kumar is the Director of Facial Plastic and Reconstructive Surgery at White Plains Hospital in Westchester, New York. She completed her undergraduate degree from Harvard University and her medical degree from Stanford University School of Medicine. She then completed her residency in the Department of Otolaryngology–Head and Neck Surgery at Johns Hopkins Hospital and a fellowship in facial plastic and reconstructive surgery at the Icahn School of Medicine at Mount Sinai. Dr. Kumar has an academic background in medical anthropology, and her research interests include the social perception of facial plastic surgery and quality of life measures associated with facial deformities.

Can you describe what major projects you are currently working on and what impact they will have?

Rosalind Lai, MD: I am very thrilled to be working on our next installment of Buffalo’s Video Atlas series. Be sure to stay tuned for more details!

How can women specifically contribute to progress in medical science and care?

Rosalind Lai, MD: There are many ways women contribute to the progress in medical science! Women researchers bring diverse perspective to research and play a pivotal role in driving advancements in the field. Women mentors and educators inspire our next generation of neurosurgeons and neurointerventionalists, driving diversity and inclusivity. 
My own path to neurosurgery has been profoundly influenced by the guidance and mentorship of remarkable women in this field. Just as they have guided my journey, I am committed to empowering the next generation of future trainees, medical students, and residents into pursuing their interest in neurosurgery and scientific research.

Do you think your gender affects your work? If so, how?

Rosalind Lai, MD: As a neurosurgeon, regardless of gender, we are committed to providing the highest standard of care for every patient!

How can medical research and care contribute to lower gender inequality in our society?

Rosalind Lai, MD: Being a woman in the field of neurosurgery and research has certainly presented a lot of opportunities. One of my areas of research focus is understanding why women have a higher rate of developing cerebral aneurysms. Our lab is studying blood and tissue from patients with cerebral aneurysms to better identify genetic markers which may affect women differently. We believe this is due to a combination of genetic and hormonal factors, but we have yet to find the answer. Certainly, being a woman in neurosurgery has fostered this research interest!

Dr. Rosalind Lai is an Assistant Professor of Neurosurgery at the State University of New York (SUNY). She completed her medical school training at Harvard Medical School and pursued her residency training in Neurological Surgery at Brigham and Women’s Hospital/Boston Children Hospital. After residency, Dr. Lai completed a fellowship in endovascular neurosurgery and is currently a dual trained cerebrovascular and endovascular neurosurgeon at the University at Buffalo Neurosurgery.