‘Do you want to be great? Or will you be satisfied being average?’

CMF pioneer Paul Manson strives for perfection as both a surgeon and a teacher

09 September 2020

Paul Manson

When the rising stars of craniomaxillofacial (CMF) surgery cite their inspirations, Dr Paul Manson is invariably among them and it’s no wonder: Manson is a CMF pioneer with a distinguished career spanning more than five decades—and no plans for slowing down.

Manson has been empowering young surgeons for decades, yet he is remarkably humble when confronted with his legacy of inspiring others.

“I’ve been inspired by the patients I’ve treated and the residents and fellows I’ve trained, and the remarkable people I cooperate with in educational ventures,” Manson says. “They’ve all inspired and taught me. The only way you get better is by having other people review what you do, contribute their criticisms and ideas, in order to come up with a better composite solution.” Further, listening carefully to your patients and what they tell you about you and their operations will make you a better surgeon and physician.”

Manson speaks from vast experience. For 30 years, he was professor and chief of the Plastic Surgery Division at the R. Adams Cowley Shock Trauma Unit at the University of Maryland, the world’s most renowned trauma unit. He was also chief of plastic surgery at Johns Hopkins Hospital (Baltimore, United States) for 20 years; as professor of plastic and reconstructive surgery at the renowned Johns University School of Medicine, he has more than 480 peer-reviewed articles, five books, 115 chapters, and over USD 10 million in research grants, awards, and endowments to his credit. For years, he was a craniofacial consultant to Walter Reed Army Medical Center, and also to Oregon Health Sciences University, where he received a distinguished service citation. In his US Army career, Manson commanded a health center and received the US Army Commendation Medal. At Johns Hopkins, he was one of 30 individuals in its history honored by the Distinguished Service Professor citation, and a member of its elite clinician group, the Miller Colson Academy. Manson was instrumental in establishing the original classification and treatment for frontal bone fractures, and treatment algorithms for midface, orbital, and nasoethmoidal fractures. One of his favorites was the classification and algorithm for treatment of facial defects: avulsive gunshot and shotgun wounds. In the second half of his career, he has applied those principles to the operative treatment of facial skin cancers of all severities.

His many contributions have empowered surgeons, improved patient outcomes, and inspired respect among his peers. Manson is lauded as “the president of everything,” including the AO Foundation (2008–2010), the American Society of Maxillofacial Surgeons, the John Staige Davis Society of Maryland, the Association of Academic Chairman in Plastic Surgery (Program Directors in Plastic Surgery), and the American Association of Plastic Surgeons, the premier association of plastic surgeons in the world.

At this stage in his career, Manson has earned the right to slow down, but he resists the notion and continues to teach, treat patients, and lecture internationally.

“I enjoy doing it. My hobby is learning and that’s how I spend my time,” he says, ticking off a schedule that begins at 4:30 a.m. and encompasses international conference calls, arriving at the office by 7 am, and seeing patients from 7:30 am to 4 pm. On the days that he isn’t seeing patients in the clinic, he’s in the operating room where he wears two hats: surgeon and teacher. He is especially passionate about teaching his trainees good habits, principles and techniques “that will stay with them forever,” and equally important, courteous and effective operating room and interpersonal behavior.

“Every patient must have two diagnoses: 1) the problem for which they are seeking consultation, and 2) their emotional response to that, and that of their family. Only knowing both can allow you to be the most effective physician,” says Manson.

“I’ve trained 150 plastic surgery residents and Johns Hopkins Department of Art as Applied to Medicine graduate students, 32 craniofacial fellows, including 15 chairs of plastic surgery, and 20-plus program directors in the US, and they have gone on to contribute significantly, refining and doing better the principles they learned,” he says with genuine modesty. “That is fundamental, and it’s remarkable. They all go out and design better operations and define better principles than I could do—they make the world better.”

Underscoring how important this ongoing knowledge transfer is, Manson recalls how treating self-inflicted gunshot wounds to the face formed his trajectory as a surgeon. These cases “taught me how to reconstruct all defects of the face promptly and effectively, how valuable existing tissue was, and how to repair or replace it early or immediately with the best results,” he explains.

“The better you can reconstruct the patient’s face, the better the patient will be able to move forward with his or her life,” he says. “Over time, I learned to do this with a degree of perfection, and I learned some fundamental principles that I have gone on to apply to cancer treatment of all severities. The face is everything to a person’s identity and ability to communicate and interface with their colleagues effectively—and early and immediate proper management is absolutely essential. Hope is not lost, if you do the right things!”

Widely recognized as one of the “greats” in the world of CMF, Manson is a staunch champion of fellowship education—including the AO Fellowships—and sees them as a way of transforming the education of young surgeons beyond the ordinary by exposing them to the knowledge from multiple disciplines, taking learning and experience to a new level, and is not pursued by many.

“Brian Alpert taught me to get the five disciplines doing facial injury repair and reconstruction to cooperate in their educational ventures; the AO CMF group was the first organization to do this,” he says. “Here in the AO, we have common protected venues
for interaction which create opportunities to help each other problem solve and learn.”

“Do you want to be great? Or will you be satisfied being average?” he asks. “If you want to be great, do multiple training periods in other disciplines; don’t be afraid to go across the world to get the best training, no matter what the sacrifice. The best people I have trained have done two or three fellowships; this has created maybe a dozen of the best CMF surgeons in the world—super-specialists amalgamating the knowledge from several disciplines—and they are all much more talented than I am because they fully captured these several educational opportunities.”

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