Patrick Byrne, MD, MBA
Chief, Integrated Surgical Institute,
Professor and Chair, Department of
Otolaryngology- Head and Neck Surgery,
Cleveland Clinic Foundation
Immediate Past President, Academy of
Facial Plastic and Reconstructive Surgery
Dr. Patrick Byrne is Chief of Cleveland
Clinic’s Integrated Surgical Institute (ISI) and Chair of the Department of
Otolaryngology–Head and Neck Surgery. In his role as ISI Chief, he leads five
surgical departments (Otolaryngology–Head and Neck Surgery, Orthopaedic
Surgery, Urology, Ophthalmology, and Plastic Surgery) as well as two
multidisciplinary centers (Endocrine Surgery and Breast Surgery), across
Cleveland Clinic’s global footprint in Ohio, Florida, London, and Abu Dhabi.
Prior to joining
Cleveland Clinic, Dr. Byrne spent nearly two decades at The Johns Hopkins
Hospital, where he served as Director of the Division of Facial Plastic and
Reconstructive Surgery and held professorships in Otolaryngology–Head and Neck
Surgery, Dermatology, and Biomedical Engineering. He co-directed the Johns
Hopkins Face Transplant Team and led major institutional initiatives, including
the development of a large multidisciplinary ambulatory surgery center.
An internationally
recognized facial plastic and reconstructive surgeon, Dr. Byrne specializes in
complex facial reconstruction, facial reanimation, and aesthetic surgery, with
particular expertise in rhinoplasty. He is widely known for his pioneering work
in the treatment of facial paralysis in both adults and children. His clinical
and translational research has resulted in more than 100 peer-reviewed
publications, as well as innovations in biomaterials and surgical device
development.
Dr. Byrne remains
actively engaged in clinical and academic endeavors, including co-directing the
Randolph Capone Cleft Lip and Palate Team at GBMC. He has founded several
healthcare startups and holds an MBA from The Wharton School.
He has led numerous
global humanitarian initiatives, establishing multidisciplinary cleft care
programs and performing reconstructive surgery in underserved regions
worldwide. He currently serves as Immediate Past President of the American
Academy of Facial Plastic and Reconstructive Surgery.
JT: What do you love the most,
and what do you dislike the most about facial plastic surgery?
PB: Oh, man, you just dive
right in. Love the most.. I love the impact we can have on patients. I love how
personal it is. I love how the bar is very high for technical precision. The
way I often share that with trainees who are wondering what to do, or patients
who are curious is this: I don't know that there's another field in which the
degree to which the patient and all their loved ones render judgment on your
surgical skills is so powerful. For essentially every other surgical specialty,
what happens in the OR is a black box. It's inside the body, or it's covered by
clothing, or, you know, it just isn't something that people can evaluate. But
in facial plastic surgery, a high percentage of what we do is not only on
display for the patient, and the world, and the loved ones to evaluate, but
it's usually on display on the one area of the body that is scrutinized the
most by far for its appearance: the face. I feel like there's something unique
about that that attracts certain personality types, and certainly I like being
in that crucible, I suppose.
What do I dislike? There are
certainly challenging conditions and patients we deal with. I think… the… level
of decision-making and psychological complexity is one of the things that makes
it very interesting to me over the years. But it is also a bit grueling. So, I
wouldn't say I dislike it so much, but in comparison to some other fields in
which there's a pretty discrete set of options. And there's a relatively
agreed-upon, correct treatment plan. That's often not remotely the case for
this subspecialty, in which there is enormous nuance in judgment. What we're
trying to really do, in most cases, is to produce a change in the psychological
state of the patient, that they perceive and experience as valuable and worth
going through the cost of surgery. I mean, all the elements of surgery,
including healing and swelling, all that. And you know, that makes it to me, a
more nuanced and complex decision-making process than maybe some other
specialties I could have chosen to focus on.
JT: That's a very, very
interesting thought process. I never thought about it like that. Thank you for
sharing that.
PB: Yeah, another way to put
a pin on that is this: Often in clinic, if there's a resident with me, and
certainly fellows early in the year, I'll draw on a little piece of paper two
circles, like a Venn diagram, and then see overlap in the middle. And in one
circle are patients who have a physical ailment, or deformity or dysfunction that
you feel confident that you can improve with a surgical procedure. And then in the
other circle of the Venn diagram is patients who have the mental ability to
experience the psychological benefits of any surgical procedure. And I try to
limit all my surgery only to the groups that have both. And it sounds simple,
but… it often isn't. Even in some cases, such as functional nasal surgery,
where it's not always easy to actually land on the patients who are in the
middle of that Venn diagram, we're constantly taking that into account. How
does this patient perceive this problem that they're dealing with? And, are
they capable of feeling better after it? Now, that's obviously for all the
elective stuff. A lot of what we do is elective.
Reconstructing a jaw after a
mandibulectomy or skin cancer, or trauma- that group of patients has similar
dynamic, because they we all care about what we look like. But the
decision-making is far more simple. And that's, a nice half of the field. The
aspects of reconstructive surgery where it's fairly straightforward, and
patients really need to be treated. The highly elective aspects is where a lot
of judgment and nuance comes in and gets more psychologically complex.
JT: I see. Thank you so
much. Clearly you've built a very impressive career across surgery, leadership,
and innovation at the highest level. What drives you on a day-to-day basis, and
how has that changed over time?
PB: What year are you?
JT: I'm a second year.
PB: Oh yeah, that's cool. I
remember, like, yesterday being a second-year resident, I'll tell you that, and
I think at that stage, I really wanted to be challenged, I wanted to do
complicated surgery, I wanted to do difficult surgery, I wanted to do big cases.
And so at that stage in my career, I was very, crystal clear in my mind that there
were certain areas of otolaryngology-head and neck surgery that I would hate,
and I just would never do it. And in my mind, you know, I really liked the
stuff that seemed big and difficult, so I was immediately drawn to head and
neck cancer, and then quickly pivoted to the reconstructive aspect of head and
neck cancer, including free tissue transfer. That was my first love. I just
want to do things that are difficult and challenging, and get really good at
it, and make an impact.
Overtime, what I realized I
really like building things and solving complicated problems. I think it's fun
to try to find a solution for a complicated nasal defect, but it's also fun to
try to solve for a program that's maybe not doing really well, and may not have
a lot of enthusiasm, or maybe not particularly productive, either academically
or clinically. And how do you rally a group of people to think more in terms of
a growth mindset, that “we can do this”, and “here's how we can do it”, “let's
figure it out together”. So that idea of building cool things became really,
really fun for me, building new programs that didn't exist before. Our new
fellowship program, our new cleft lip, and palate program, our aesthetic
program, our microvascular program, our research program, and so on. It’s just
a fun thing to do, because you're trying to make an impact that lasts beyond what
we can do as individuals. In the last few years that's what drove me. By the
way. I never, never aspired to any particular position. In a million years, I
never thought I'd be a chair, much less than a chief of an institute. But I
like building cool things.
In terms of the
self-identity, I just shared with somebody the other day, I think it's been
helpful for me, so, maybe you or your readers can ponder this: during the first
half of my career I had an intense desire to become a great surgeon or a great
leader. I really wanted to be great. So I was always very self-critical about
my surgical Procedures, and my ability, and the outcomes. But that evolved over
time a little bit. It's a subtle nuance, but it's been helpful to being someone
who is always trying to learn and get better. So, conceiving of myself, either
in terms of leadership, or clinical abilities, or as a father, or whatever it
is, I'm the type of person that is always gonna try to get better and learn
something every day. I think it's more helpful than aspiring to be great,
because we all have times where we fall short. And if we adopt the mindset of a
constant learner who's always growing. we manage that, and we learn from it a
little more efficiently, I think, and move on to becoming better quickly,
instead of, indexing on our shortcomings as much, if that makes sense.
JT: It does, and to me, it
sounds more like a stepwise or more mature, if you will, approach to becoming
great. It probably accomplishes the same goal, but through a different, more
realistic approach, maybe. Or at least that's my interpretation.
PB: Yeah, maybe…I think
you're right; it may be a little more focused on process and less on outcome. It's
the process of growing and getting better and putting in the work that we
should drive our satisfaction from probably more than the outcome of that
effort.
JT: And it's really
impressive how this approach transcends into the different aspects of your
professional life. You mentioned building cool things, I'm presuming the
operating room, and then in a department, the Cleveland Clinic health system
and the whole institution.
PB: Totally, it was making a
nose from scratch, and then that blends into building a division at Johns
Hopkins that we could be proud of, and building a fellowship program, building
the department at Cleveland Clinic that we can be proud of, and now we're
working on creating this sort of surgical specialties institute across the
globe, and it’s really exciting to build something special.
JT: For sure. And speaking
of Johns Hopkins, I was in our resident clinic this past Wednesday, with
another alumnus from Johns Hopkins, Dr. David Kennedy. He mentioned the Hale©
device, and he brought it to my attention, so I really wanted to ask you
about that. How did you develop an interest in medical devices? Having
discussed with you for a few minutes, I’ve already realized that you love
building cool things, but I would love to hear a little bit more about that, if
you're eager to share.
PB: Well, first, what an
honor that David Kennedy even knows about Hale©. That makes me feel
great. You just made my day, so thanks for that!
JT: He had very specific comments
about it - because I initially visited its Amazon website, and he was like “no,
you have to go to the Hale© website, this is where it says that Dr
Byrne was the one that created this”!
PB: Well, that was simply,
years and years and years of taking care of patients with nasal valve
obstruction. The Breathe Right strips helps a lot of people, but my intuition
all those years, was that it seemed like for about a third of patients it works
great and they use it, but probably two-thirds of patients with nasal valve
collapse who tried the Breathe Right strips say “yeah, it doesn't really work
for me”, or “I don't like it”, or “it doesn't stick to my skin”, or whatever it
is. So, for years, I was wondering if we can design something that pushes from
the inside, like a modified Cottle maneuver, instead of pulling from the outside,
and I thought it would probably work better.
When I started working on it
was when I was in the executive MBA program in Philadelphia, about 10, 12 years
ago. And it really helped me to organize an approach, and then worked with
engineers at Johns Hopkins to develop a product. By that time, there were other
entrants on the market. There are actually quite a few stents now. I think ours
is the most scientifically based and anatomic of any, and it definitely works.
Entrepreneurship is not for the faint of heart. I'm motivated, again, to build
something new that will outlast me and helps people. I think in anything we do,
like, there's nothing better than that. Let's put our efforts into something
that will help people, even when I'm underground. You know, that would be a
nice legacy to leave.
It’s a long story in terms of
the evolution of the company and all the ups and downs with that, because it is
tricky, but I tried to shepherd that alongside all of my other duties. And
there's pros and cons of that. Mostly cons of trying to do too much at once,
but I think, it's out there, and we're helping some people, so I'm pretty proud
about that.
JT: Thank you. Thanks for
sharing this story. Now, going back to something that you said earlier, you
said that initially you wanted to do big surgeries, and you had initially an
interest in head and neck cancer, and then pivoted to the reconstructive aspect
of it. So, what would you advise someone with a background on an adjacent yet
different field? Like head and neck cancer. Do you personally perceive that as
a barrier or, as a benefit, for a career in facial plastic surgery?
PB: Oh, no, I think it's not
uncommon for people with an interest in head and neck cancer treatment to
ultimately focus more and more on reconstruction. A little less common, like in
my case, where I kept evolving and even built a very busy aesthetic practice,
you know, and there's reasons why I pursued that. But, no, I think it's a
wonderful background for all kinds of reasons. I think it's a good fit. And,
you know, if there's one thing that I really feel strongly about, it's that
when a resident, a med student resident starts down a certain pathway, they
really should feel free if you feel confident that they're on the wrong
pathway, they should feel free to pivot.
I just had a wonderful
conversation a few weeks ago with a former resident at Hopkins in Otolaryngology
Head and Neck surgery, who now works for a big consulting firm. And, he
realized halfway through residency that, you know, this isn't really what I
want to do. And he's really happy, and he's applying his knowledge, both of
medicine, but also those years as a surgeon, to support his firm, clients, and
I think that's wonderful. So I think it's a good fit, but I also think no one
should feel stuck on a certain pathway in life.
JT: Thank you. That's,
that's really insightful. I don't know if you have time for one more question.
PB: Yep. Let's try to make
it through your list, if we can.
JT: Thank you. So I want to
move to research, which, I know is, is another interest of yours, probably,
given how productive you've been. Historically, FPRS compared for example to
head and neck, is lagging a little bit in high-quality, basic, and
translational research. I don't know if you think that this is a first
statement, but I'm curious to see what you think -do you see that changing? And
if you do, where do you think the real breakthroughs will come from in the
coming years?
PB: I don't think it's an
unfair statement at all. If you just look at NIH funding, then you know that head
and neck cancer and audiology/otology, if you were to combine them, tend to get
tend to receive a predominant share of the funding. And that's a reflection not
only of the priorities of our federal research infrastructure, but also
reflects, to some degree the amount of interest and activity bubbling up from
these fields. So, it's hard to know which is more impactful, but certainly
Facial Plastics has less translational and basic science, in a traditional
sense.
Despite that, in the public
sphere, there’s an enormous amount of investment, right? And that's because of
the multi-billion-dollar aesthetics industry. So, in terms of energy devices
and biologics and topical agents etc., there's a lot of interest there, for
sure. I am intent on contributing to, as best I can, to the advancement of
science within facial plastic and reconstructive surgery. And the way I view
the field is that there are 7 or 8 key domains within facial plastics, and I
always try to keep all of them in mind when we're talking about sustained
effort to build the program. That could be a training program for residents, it
could be a fellowship program, it could be a research program. And those areas
are: head and neck reconstruction, including free tissue transfer, skin cancer
management, including Mohs reconstruction, rhinoplasty, including revision, aging
face and all the stuff that comes with that, surgical and non-surgical, congenital
deformities including cleft lip and palate, facial paralysis and reanimation, trauma,
and probably should also include gender affirmation work, because it has some
unique aspects, although it combines the technical aspects of the rest. So, 7
or 8, depending on how you want to categorize it. And so, in the fellowship
programs I've been part of, and the program building I've been part of, in my
own learning and skills acquisition over my early years, I think it's important
to keep those different domains in mind, because they have quite obviously much
different foci in terms of any research investigation, any questions you're
going to ask.
As you know, there's a lot of work being done
in reconstructive surgery. With biomaterials and advanced patient-specific
planning. This is all advancing pretty rapidly with AI. In facial paralysis,
there's very interesting work being done for many decades now in nerve
regeneration. Hasn't translated yet into any big breakthroughs. We've made incremental
technical improvements that have transformed the field. But we haven't solved
yet for an artificial muscle, for example, to close the eyes and blink. Or an
artificial sphincter around the mouth for oral competence. I think that's on
the horizon, those sorts of things. We certainly hope so.
And then, you know, you go
down the list, and each one of these domains has an opportunity for us to have
better solutions. So, the optimist in me is that we can keep developing
programs that emphasize real research in the academic sphere and across all 7
or 8 domains of facial plastic surgery. But that's tricky, because if for example,
you're a head and neck cancer surgeon there's a whole infrastructure in place.
So, you are going to get your best opportunities in an academic location. And
then with that come all the resources and advantages of a research infrastructure,
including translational research. Whereas in facial plastics, depending on your
interest, people often tend to bifurcate into aesthetics and reconstructive.
I've never been one of those people, I've always done both, and I think it
works for me. But because of that bifurcation, many people go to private
practice, and even if they do want to do both, it's just hard to do both,
because then you don't have the support of the whole infrastructure that you
need, for example, to do free flaps. So you're siphoning much of the talent out
of academia and into this private sphere, just based on the practicalities of
practice support. Where people do get involved, they work with private
companies on device development. There's a lot of activity in our academy with
that. But I think that explains why, in general, though, there's a more sizable
corpus of research activity and people pursuing it in some of the other fields
than facial plastics.
As I said, though, I'm
really hopeful that places like Hopkins, Cleveland Clinic, several others, UC
San Francisco and Oregon, Michigan, Minnesota and others -I won't keep going,
because I'll leave some of my friends out somewhere- but there's a lot of good
places doing a lot of good facial plastic research, and I think we need to keep
pushing that.
JT: Thank you. This is really
encouraging, especially when coming from someone like you. No on to my next question: like you said,
you've built many different programs on many different levels, so I'm sure
you've hired a lot on all different levels. I'm just curious what traits you're
looking for, and what is an immediate red flag for you.
PB: Your questions are gonna
make my next appointment run late, because these are good questions, that I do
think about a lot. Here's something interesting for your readership to ponder.
There are certain personality traits that tend to correlate with a lot of
success as a medical student, a resident, a fellow, and a faculty member if
someone decides to go into, academics, or practitioner in private practice. These
include drive, ambition, discipline, high character, and honest self-assessment
in order to strive to continually improve. And those characteristics often lead
to very successful practices, including academic practices. I have some private
ventures, as you know, but I'll speak from the perspective of an academic, a
clinician here and later. Those traits aren't often helpful as a leader,
though. And in fact, sometimes there's a famous book by a guy named Marshall
Goldsmith, and the title sort of tells you where I'm going. It's called “What
Got You Here Won't Get You There”. When you're trying to
construct a team, for very practical reasons, you value teamwork, selflessness,
ability to be collegial and work with others, put some shared goal above
personal interest. You know, these are the things that highly functioning top
teams do. And sometimes, the traits that make superstar individuals don't
always mesh well with the team.
So, when we're recruiting,
what I try to find are those special people who have the drive, and the
ambition, and the uncompromising commitment to excellence that makes these
great innovators within surgery, and these great, huge practices. Because you
develop a reputation for being special, and people are drawn to that. But you
also need to have the self-awareness and system-level thinking to understand the
importance of the big picture, and how you integrate and support that.
These people are out there,
but it's harder it's harder to find than one might think, and I think that's
one of the things I learned as a chair that I didn't have insight into when I
was grinding away as a faculty member all those years in Baltimore. So, I look
for excellence. I stole this from someone else, but humble, hungry, and smart
is a good trifecta for people to have. The smart part implies talent. It's
better to have someone with more talent than less. But if they're not hungry to
contribute and grow and if they're not humble and aware of themselves and each
of our own dependence on each other for success, then I think you're missing
something in the sauce.
JT: I'm truly amazed that
you said that. Several years ago, maybe 5 years ago, I had someone in the blog
from Cleveland -I'll tell you who- who gave me a very similar answer. He used
the exact same three words, and it got stuck with me. I actually ended up
writing that on a piece of paper and even carried it with me when I moved. I had
it on my wall when I was doing my postdoc for 2 years and then when I was
interviewing for residency and it kept me motivated. That was Dr Ted Teknos
from Case Western and the Seidman Cancer Center, across the street from you!
PB: Oh, cool, I'll have to
tell Ted, that's a really great… he's an amazing guy, that's awesome! When work
out in the morning sometimes I listen to podcasts, and this morning I was
listening to Admiral McRaven's book
on leadership. It just came up on my Audible, and he gave a similar story that
emphasized the humble part. He thought he was going to get some sort of big
promotion. He was called in as a young ensign, and it turns out that his superlative
performance in his first year in the Navy was being rewarded by making him
construct a float for a parade. And he was so offended at first, but then he
learned a lesson that even the smallest task you want to take with humility and
do your best job, and that people who can adopt that and set aside their ego,
they tend to be more successful over the long term, and often get rewarded with
bigger opportunities.
JT: And I think that's a
very helpful lesson that translates to our experiences as residents, because we
oftentimes face those tasks, and it can be very tricky if you underestimate
them, or you don't put your whole self and your whole heart into them.
PB: Yeah, I mean, it can
feel as if sometimes trainees, understandably, feel like they're taken for
granted, right? And asked to do a bunch of scut work and that's not
appropriate. There is a balance, of course, because you have to stand up for
yourself, even as a trainee, to be respected. But you don't want to indulge -
none of us want to indulge- the entitled side of our personalities either,
right? Because it just doesn't help. It just doesn't help.
JT: For sure, and it doesn't
help you grow. Dr. Byrne, here’s my last question for you: What would you like
to be remembered for? What would you like your legacy to be?
PB: Well, I hope we build
cool things that last well beyond me, so if, there's discrete accomplishments,
I guess, that I would love to see happen, they're probably subordinate to the
type of person I hope I'm remembered as. But on the discrete accomplishment
side, my family's the most important. Really, the only opinions that truly
matter are about 7 people on this planet who I actually care what they think.
My four kids, my wife, my 3
siblings, and maybe some of my closest friends. And I say that not just
jokingly, because I think it's helpful not to be too concerned about what
people think of you. That is one thing that a very good friend of mine, who
actually has a prominent role now, nationally, said: I don't think I could be a
chair because, you know, I want to be liked too much, and I don't know if I
could make those tough decisions. Do you have kids?
JT: I don't.
PB: Now, you're young, but
someday you may. And even with your own kids. You, you have to make decisions
that they don't like because you love them. And you know that when you make
those decisions out of complete selfless love for your child, some of them,
they're gonna dislike you for it. But that's your job. Right? There are kids
running around in our clinic who are 4, 5, 7 years old, clearly addicted to an
iPad. And that's the narcotic that their parents use to keep them in line. And
they'll say, “well, gosh, but it's so hard, you know, I've got 2 or 3 other
kids, and otherwise he's screaming all the time”. And my thought is, well,
that's your job. Your job is to protect your child, and if they hate it, that's
what you have to do. And I feel very strongly about this, because that
translates into professional relationships, and as a leader. If you really care
about everybody in the organization that you're responsible for, you need to
prove it, and that includes not infrequently making decisions that at least
some people aren't gonna like. But if you care about them, and you care about
the organization, you just have to do it. So I'm prefacing, what I hope people will
remember about me. I hope that I'm seen as fair and always indexed on the
shared vision. I certainly strive for that. That we're gonna try to accomplish
something meaningful that makes the world a better place. If there's one thing
that I try to rally my life around, it's that I'm trying to live a life in
which I accomplish meaningful things, do meaningful work that makes the world
better, for someone. So that's probably as much as anything. I hope the Division
at Johns Hopkins and the Cleft Lip and Palate team I helped create in
Baltimore, and the Department that I've led, and the Institute that I've led,
and the companies I've started, hope they all do well and make the world a
better place long after I'm dead. That'd be nice. But, you know, there's some
luck involved there, too, so at least I gotta be a good person along the way. I
fail at that every day, for sure. But hopefully we all are just trying to get
better.
JT: That was an extremely
inspiring discussion. Thank you so much for sharing these thoughts. It was
incredible. I'm truly amazed, and I really appreciate your time. I know we went
way over time, and I appreciate you doing that.
PB: That's alright!
Appreciate it very much, Jason, I love what you're doing. Keep being creative
and following your own path. I think it's awesome!
JT: Thank you so much Dr
Byrne, really appreciate it!
