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Dr. Seth. “We meet with the patient anddiscuss their facial features with them,deciding which features to focus on toUnderstandinghelp them appear more feminine. Ideally,Gender Dysphoriathis helps them better assimilate intoGender dysphoria is an adjustmentsociety as a female.”disorder that occurs when birth genderThe hairline and brow are areas thatdoes not match one’s gender identity.are typically worked on to feminize a“Persons who have gender dysphoriaface. Lowering and reshaping a recedinghave had significant difficulties dealinghairline typical of a male creates awith this their entire life,” notes Dr. Seth.characteristically female appearance.“Our hope is to decrease many of theMale and female foreheads are alsoissues and stresses that patientsquite different. Female foreheads have aencounter by treating or altering thegentle slope without a prominent browgender defining facial characteristicsridge. In males the bony ridge of theand matching the face to what the mindbrow projects outward. So Drs. Knottperceives using gender transformativeand Seth often perform a surgery tosurgery. This surgery is importantreshape and contour the forehead.because it allows patients to better“It’s a very powerful technique,”adjust and assimilate into society andexplains Dr. Knott. “A single incisionto be happier.”on the forehead allows us to advance“These patients really struggle withthe hairline, raise the brows, reshapetheir fundamental identity” explainsthe bony ridge, and enlarge andDr. Knott. “They feel that they havereshape the eyes.”essentially been placed in a body withIn the lower portion of the face, athe wrong gender since birth, and wechange in gender perception can behelp them realize a life-long dream tocreated by altering the shape of the nosebecome physically who they have alwaysand jaw. Rhinoplasty can be used tofelt they are psychosocially. Our patientsshape a smaller, more female appearingare on a lengthy journey, and we arenose. Typically, males have a squaredprivileged to be able to help themjaw and females have a slightly pointedaccomplish just one small part of theirjaw, so to feminize the jawbone thetransformation.”outside layer is shaped to a point. FatPatients who begin their gendermay also be transferred from the bodytransformation before puberty do notto the cheeks to accentuate femininity.need facial surgery because they receiveIf the patient is older, there arehormone therapy from an endocrinologistadditional considerations. “If you lookor other specialist. Drs. Seth and Knottat beauty, femininity and youthfulnesscare for patients who have already goneare inextricably linked in society’sthrough puberty. Those post-pubertalperception,” notes Dr. Knott. “So ifmales who undergo FFS requireyou want to make someone appearreductive surgery to the skeleton of themore feminine you also try to make herface to make it appear more feminine.appear more youthful.”“We were motivated to do thisManaging Individualsurgery because of the importantConsiderationsimpact we can make for our patients,”The OHNS Facial Plastic Surgery ClinicDr. Seth adds.receives referrals from different centersIn addition to private payment forwithin San Francisco. Typically, patientstheseprocedures, Drs. Seth and Knottare referred from their psychologist’sacceptsome insurance coverage,office. Patients are under medical careincludingthe San Francisco Healthand have been deemed stable, healthy,Plan. “It is important that insurers areand appropriate for consideration ofbeginning to understand the socialfacial surgery. A key part of the practiceimplications and suffering transgenderis working with each patient individuallypatients have. Being able to relieve theto focus on their specific needs.“Patients come to us wearing makeup psychological stress that can come withand wigs to make them appear feminine. gender dysphoria through surgicalprocedures is an important tool that weThis is the way they have gone aboutare proud to provide to the communitylife for years – using techniques toof San Francisco,” says Dr. Seth. ncamouflage their facial features,” saysContinued from page 1Dr. P. Daniel Knott isdirector of facial plastic andreconstructive surgery inOtolaryngology – Head andNeck Surgery at UCSFMedical Center and is anassociate professor ofotolaryngology at UCSF.Dr. Knott, who joined UCSFin 2011 after 10 years at theCleveland Clinic, has trainingand experience in facial aesthetics andmicrovascular surgery. His expertiseincludes treatment of facial paralysis,facial rejuvenation, reconstruction offacial cutaneous malignancies, minimallyinvasive facial soft tissue augmentation,rhinoplasty and free tissue transfer.In his research, he is helping developnew methods for palatal and orbitomaxillary reconstruction, microvasculartreatment of osteonecrosis andcartilage bioengineering. He has wonseveral national awards for his research,which includes studies of head andneck tissue transplantation. Dr. Knottearned a medical degree at theSchool of Medicine at the University ofCalifornia, San Diego and completeda five-year surgical residency at theCleveland Clinic in otolaryngology –head and neck surgery. He alsocompleted a fellowship in facialplastic and reconstructive surgery atUCLA Medical Center.Dr. Rahul Seth is anassistant professor in theFacial Plastic andReconstructive Surgerydivision of the Otolaryngology– Head and Neck SurgeryDepartment at UCSF. Hecompleted fellowship trainingat UCLA following completionof a five-year surgicalresidency at the ClevelandClinic. Board certified in Otolaryngology– Head and Neck Surgery and FacialPlastic and Reconstructive Surgery,Dr. Seth’s expertise is in the treatmentof facial aesthetics and rejuvenation ofthe aging face, rhinoplasty and nasalairway surgery, treatment of facialparalysis, reconstruction of facialcutaneous malignancies, and free tissuetransfer microvascular reconstructionof the face, head, and neck. nHeadsUp! Spring 20173

Extending a TraditionSupporting Community, Familiesand Children in the East BayA“t UCSF Benioff Children’s HospitalOakland (BCHO) even the mostfragile newborns and the mostmedically complex children receive anunsurpassed level of care, and our OHNSdepartment works in concert with theentire community of medical providersthere to ensure that those childrenreceive it,” explains pediatric otolaryngologist Jordan Virbalas, MD. He andfellow pediatric otolaryngologists GaraniNadaraja and David Conrad, MDs, arecommitted to providingthe best in care forchildren in the East Bayand beyond.“An important goalis to ensure access tohigh level pediatricotolaryngological care toall kids in the East Bay,a community that Igrew up in and holdvery dear to me,”Garani Nadaraja, MDnotes Dr. Nadaraja, anassistant professor of OtolaryngologyHead and Neck Surgery, who leads theteam. As an integral part of UCSFBCHO, the Otolaryngology Departmentoffers comprehensive services thatencompass the full range of pediatricotolaryngology offerings.With experts in more than 43 distinctpediatric specialties, UCSF BCHO has acentury-long tradition of protecting andadvancing the health and wellbeing ofchildren through clinical care, teachingand research. UCSF BCHO is one of twosolely-designated Level One pediatrictrauma centers in the region. Each year,it handles more than 45,000 emergencydepartment visits, and it has one ofNorthern California’s largest pediatricintensive care units. The hospital alsoprovides outpatient care to underservedchildren in much of Northern California.A Distinguished HistoryThe OHNS Department at UCSF BCHOhas a long history, beginning in 1963,when Children’s Hospital Oaklandopened its first speech and hearingcenter for hearing aid consultation, oneof three in the entire East Bay. UCSF’sOHNS Department was also involvedover many years in the Children’sHospital Oakland comprehensiveprogram for newborn hearing lossscreening. That program enables audiologists to identify congenital hearingloss within just weeks of a child’s birth.In 2014 Children’s Hospital &Research Center Oakland affiliated withUCSF Benioff Children’s Hospital SanFrancisco in Mission Bay. Since then theJordan Virbalas, MDDavid Conrad, MDOakland and Mission Bay campuseshave embarked on a partnership tobroaden the combined expertise to bothsides of the bay. While the degree ofintegration varies between departments,OHNS has provided a model forcomplete integration. Examples ofthis close partnership include havingOHNS fellows experience both sites.In addition, joint participation includesthe vascular anomalies conference,aerodigestive conference, hearing lossclinic, and frequent resident didacticand case conferences.Continued Collaboration“We aim to create a seamless pediatricOHNS system that provides excellentpatient care and advances our coregoals of innovation and research atboth sites,” explains Dr. Conrad. “It isimportant to build on current partnerships through continued collaborationand multidisciplinary conferences.”While some multidisciplinaryconferences remain site-specific, UCSFBCHO pediatric otolaryngologists areworking to expand the joint cochlearimplantation program and are excited tohave resident and fellow participation inNew AppointmentCharles Limb, MD, has been appointed Medical Director of CochlearImplantation at UCSF Benioff Children’s Hospital, Oakland.Dr. Limb is currently the Francis A. Sooy Professor and Chief of the Division ofOtology, Neurotology, and Skull Base Surgery at UCSF. He is also the Director ofthe Douglas Grant Cochlear Implant Center at UCSF.“With this appointment, the cochlear implant programs throughout UCSF arenow unified under Dr. Limb’s leadership, building upon the legacy of UCSF as oneof the pioneers in the field of cochlear implantation,” said Department ChairmanAndrew H. Murr, MD, who announced the appointment with David Durand, MD, andSteven Wilson, MD.A graduate of Harvard College and Yale School of Medicine, Dr. Limb trained atJohns Hopkins in Otolaryngology – Head and Neck Surgery and completed afellowship in neurotology there before becoming a full-time faculty member in 2003.He also completed post-doctoral training at the NIH in functional neuroimaging.Dr. Limb is an expert in complex sound perception in cochlear implantation and theneuroscience of music, and he has lectured worldwide on this topic. n4HeadsUp! Spring 2017CharlesLimb, MD

Oakland. In fact, Charles Limb, MD,was recently appointed medical directorof Cochlear Implantation at UCSFBCHO. The Oakland location alsooffers a broad spectrum of pathologyand provides care to an underservedpediatric patient population, whichprovides a rewarding and valuableexperience to the residents and fellows.“It is gratifying to have the chanceto work closely with other colleaguesin a multidisciplinary approach toprovide the best care to our patients,”says Dr. Conrad. He adds that“we look forward to continuing thistradition as a shared vision betweencampuses, and this partnership allowsa combination of resources and acollective mindset in our approach tosome of the most challenging diseaseswithin pediatric ENT.”Department Chairman Andrew H.Murr, MD, says that “we are excitedabout the opportunity to better serveboth our East Bay and San Franciscocommunities in pediatric otolaryngology– head and neck surgery. We willcontinue to fine-tune seamless servicebetween our two children’s hospitalsand are actively recruiting new facultymembers to this exciting team.UCSF BCHO is a place for personalattention and a sense of community forgeneration upon generation of familieswho can experience the facility theydeserve. “UCSF Benioff Oakland isunique because it feels like one bigfamily” notes Dr. Nadaraja. “In turn, weall take pride in each other’s success.” nPGY-5 Residents Acceptedto Premier FellowshipsIn announcing plans for Drs. Nicholas Dewyer, JonathanOverdevest and Matthew Tamplen, Chair Andrew Murr, MD,noted with pride that “three of our chief residents have beenplaced into stellar fellowships.”In July 2017, Nicholas Dewyer, MD will join theNeurotology Fellowship program of the HarvardMedical School Department of Otolaryngology atMassachusetts Eye and Ear Infirmary. Dr. Dewyerwill complete his five-year OHNS residency at UCSFin June 2017. He attended medical school at theUniversity of Michigan in Ann Arbor, where he alsocompleted his undergraduate degree in BiomedicalEngineering. “There are many things that I appreciatefrom my residency at UCSF, but foremost are thepeople with whom I’ve had a chance to work,” noted Dr. Dewyer. “I don’t thinkthere is a better group of residents and faculty anywhere.”“It has been a stellar learning environment, withpassionate mentors, and opportunities for growthwithin a continually adaptive health care system,”noted Jonathan Overdevest, MD, PhD, who willcomplete his five-year residency program in June 2017.He will begin a Rhinology and Skull Base SurgeryFellowship in Stanford University’s Department ofOtolaryngology – Head and Neck Surgery in July.“Camaraderie and compassion resonate asinstrumental ingredients provided by our programthroughout my training experience at UCSF OHNS. Faculty here have beensupportive of our development into autonomous clinicians, more than simplytraining us to be reliable residents,” said Dr. Overdevest, who completed hismedical degree, PhD and MS at the University of Virginia, Charlottesville afterearning his undergraduate degree from Cornell University, College of Arts andSciences, in Ithaca, New York.After completing his five-year OHNS residencyprogram at UCSF, Matthew Tamplen, MD will begina Facial Plastic and Reconstructive Surgery Fellowshipat the University of South Florida, Tampa, in July.Dr. Tamplen observed that “at UCSF I was able toreceive high quality training in all as

Dr. P. Daniel Knott is director of facial plastic and reconstructive surgery in Otolaryngology – Head and Neck Surgery at UCSF Medical Center and is an associate professor of otolaryngology at UCSF. Dr. Knott, who joined UCSF in 2011 after 10 years at the Cleveland Clinic, has training