Align Surgical Associates’ active research program is unique among private surgical practices. We sat down recently with Align’s first research director, Dr. Arya Akhavan, to find out more:

1. Introduce yourself and tell me about your role.

I’m a plastic surgeon who took a break from my residency training to dive fully into research. I met Drs. Satterwhite and Pang through my work as founder of the American Society of Plastic Surgeons’ LGBT group ASPS Pride Forum. Align already had studies underway but needed someone to coordinate them all, introduce new ones and manage the Stanford Medical students and residents involved in the studies.

2. Describe Align’s research program.

Align Surgical has a large number of active and ongoing research studies looking at patient outcomes, how patients feel about the surgeries that they’ve had, how we can improve the way that we offer patient surgery, and how we train upcoming plastic surgeons to do these surgeries. We just presented seven studies at the USPATH conference last November and have three book chapters set for publication in textbooks in our fields. We also have seven more ongoing studies and a few more in process – it’s a lot!

3. A research program is unusual for a private practice. Why does Align have one?

It starts with the personal motivation of the Align physicians and staff wanting to give back to the community. Anything that we can do to improve the care that we give to our trans, nonbinary and gender-diverse patients. Our surgeons are all academically minded as well; they came from big academic hospitals and want to continue doing the same kind of research they were doing, just in a private practice setting. There are also research studies that you can run as a private practice that you may not have the patient population for in an academic medical center, or there might be university-level or state policies around trans healthcare that complicate matters. In a private practice, we’re not beholden to other institutional policies, but instead work very closely with an independent ethics board to ensure academic best practices that are not subject to politics. Funding sources are also not a concern as a private practice – you don’t have to apply for a grant and then wait six to 18 months to start your study. You can just decide as a practice,” This is meaningful to us. This is how we want to contribute. Let’s do it.”

4. Does Align collaborate with other practices or organizations?

Quite a bit. Currently, we have ongoing research partnerships studies and book chapters with the University of Washington, Stanford University, Mount Sinai in New York, FacialTeam in Spain, and UCLA with their facial gender-affirmation program.

5. What is a notable finding to come out of Align’s research program?

Obviously, during the COVID pandemic, we could not see patients in our clinic for a long while. We had to see them on Zoom or by phone, meaning the first time we would meet a patient in person and do an actual exam would be on the day of surgery! So, we did a study to find out if patients were happy with having all of their appointments on Zoom. And it turned out that there wasn’t really a difference at all [in their level of comfort and satisfaction].

For most things, patients didn’t care if they had an appointment via phone, Zoom or in-person. A small subset of patients preferred to have Zoom or phone appointments and send in a set of photos to the surgeons.

For other patients, [using remote technology] meant they didn’t have to risk traveling somewhere and being outed accidentally or running into a difficult interpersonal situation.

And from the surgeons’ perspective, the quality of photos that we received were actually high-quality and consistent enough to make a surgical plan without any substantial changes on the day of surgery.

I have to admit, I wasn’t expecting that! Especially for work on the face, which involves a lot of very fine detail. However, I think patients who are having gender-affirmation surgery are very, very motivated and are willing and able to take very detailed, very accurate photos following the guides that we provide.

6. What’s ahead for 2024?

With the rise in Chat GPT and other AI models, patients are now turning to them for medical advice. Some examples: “Am I a good candidate for this type of gender affirmation surgery?” or “Can you tell me more about having a phalloplasty?” However, depending on which questions the patients are asking, sometimes the AI platforms give completely wrong information and even give unethical descriptions. We’re working on a set of studies looking at how these different AI models provide information and how accurate the information is. We’re concerned that patients might be getting all kinds of completely wrong information, and they could be totally unaware that what they find online hasn’t been written by a real doctor. So that’s a lot of what we’ll be doing in 2024.



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