Dr. G. Richard Holt - Professor

FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY
A UTHSCSA Perspective

G. Richard Holt, MD, MSE, MPH
Professor and Program Director
Department of Otolaryngology-Head and Neck Surgery

As a young person, I was really interested in any task that required some level of spacial orientation in conjunction with manual dexterity—that is, model-building, structure projects, auto remodeling, artwork, and baseball.  For some unknown reason to me, I had a notion that I wanted to be a surgeon before I even went to college—I had never seen any human surgery, except for helping a friend’s father with his veterinary practice.  In medical school, anatomy was my favorite subject, and, as a junior and senior medical student, I was able to perform many more procedures than students are allowed to perform now (that was a different time) so that I felt confident I had the requisite motor skills to become a surgeon.  After two years of general surgery as a resident, one of my friends told me about a new field that was on the rise in the ENT specialty, called facial plastic and reconstructive surgery.  This was 1972, and the discipline was just beginning to catch on, as was head and neck surgery.

I was immediately drawn to the notion of being able to combine engineering with artwork to achieve a result that would be visible for the patient and all to see.  It was this unique combination of structural reconstruction and aesthetics that attracted me.  At first, I enjoyed the challenge of facial trauma repair, and then progressed into more difficult reconstructions involving soft tissue repair and functional restoration.  Together with my wife, Dr. Jean Holt, we began a career of orbital and periorbital reconstruction that has maintained its challenges and rewards.

Choosing the subspecialty of facial plastic and reconstructive surgery is not for everyone.  I do believe it requires an inherent spacial orientation capability, as well as some artistic skills.  You have to be able to visualize the completed reconstruction before you have even started it.  Not everyone has that skill.  It also combines a fine motor skill for wound closure with a keen ability to improvise and sometimes invent novel solutions to reconstructive problems.  Much of the capabilities are right-brained in nature (artistic and aesthetic appreciation) with a strong support from the left brain (understanding physics, bioengineering, and geometric patterns).  The field draws an individual who can study a diagram in a book for a procedure and understand it so thoroughly that one can accomplish it in surgery without becoming confused. 

I have particularly enjoyed the application of biomaterials and bioengineering to the research side of the subspecialty.  I obtained a graduate degree in bioengineering from the University of Texas at Austin in order to better understand the biomechanics of hard and soft tissues of the face.   I studied the science of osseointegration of implants in Sweden and helped initiate the process in the United States.  I have been a NASA-funded scientist studying the effects of microgravity using a unique bone growth chamber.  Most recently, in conjunction with Drs. David Hood and Christian Stallworth, we are investigating novel matrix implants in rabbits, and the possibility of in vivo alteration of the deviated nasal septum using non-surgical techniques. 

I owe a great deal of my capabilities in facial reconstructive surgery to the mentorship of great men in the field—Drs. Per Ingvar Branemark (Sweden), Claus Walter (Switzerland), and Richard Farrior (USA).  Each one of us in FPRS will have mentors who will shape our personal and professional approach to patients, and will give us skills and knowledge to handle even the most difficult of reconstruction challenges.  They also reinforced to me that a grateful patient is always at the end of our endeavors, should we do the very best we can for each and every patient who seeks our assistance. 

So, if you, as a resident, are facile with small dexterous work, have a good sense of spacial orientation, have a background in math or engineering, and an esthetic capability (art, drawing), you should definitely consider the subspecialty of facial plastic and reconstructive surgery.  You will be constantly challenged to find novel approaches to improving an unfortunate patient’s cosmetic and functional restrictions.

G. Richard Holt, MD