ISSUE 143: Special Section

Know A Good Doctor? We Do.

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A Team Approach with a Shared Vision for Excellence

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LEXINGTON David E. Cowen, MD, FACS, has a commitment to the region that is as deep as his passion for eyes. By embracing innovation in oculoplastics and challenging the status quo, he serves his patient constituency and his legion of referring colleagues. His Lexington-based practice, Oculoplastic & Orbital Consultants, has a reach extending well beyond the Bluegrass and provides both reconstructive and aesthetic services. His independent practice has been built with a simple value: “Taking care of my patients and referring doctors in a manner that is excellent and makes them feel important and valued.”

Oculoplastics is both art and science, says Cowen, because “we preserve the form and function of the areas surrounding the eyes, particularly the eyelids, eyebrows, eye sockets, and tear ducts.” Respecting the delicate nature of these tissues and honoring the significance of their appearance is Cowen’s daily work. For him there is nothing that attracts our attention more than a person’s eyes, so the value of safeguarding their appearance is paramount. Oculoplastics’ draw for Cowen was two-fold, “There is an element of artistry in the procedures that can make something function well and look really good.”

Interest and Commitment Build a Practice

Cowen graduated, with distinction, from the University of Kentucky College of Medicine in 1988. After an internship in general surgery, he returned to UK for ophthalmology residency because he enjoyed the “very delicate, precise nature of the surgery.” He then completed two fellowships, one in ophthalmic plastic and reconstructive surgery at the University of Toronto followed by a fellowship in craniofacial plastic surgery in Toronto, Canada.

It was during his fellowship program in ophthalmic and plastic reconstructive surgery that Cowen says he “expanded the scope of what I focused on to broader areas around the eyelids, eye sockets, and to a lesser degree, the face.” After Cowen joined the faculty at UK in the mid-90s, he developed an entire oculoplastic service there. This led to building a similar service at the VA hospital, “which is a place that I have always loved and enjoyed.”

Cowen’s next move grew out of his commitment to the people of the region. He says, “I realized very quickly that my real heart and passion was for the people of Kentucky – and bringing the excellence of my subspecialty to them.” As such, he focused on developing a surgery practice that would reach the underserved in Eastern Kentucky and central Appalachia. To do this effectively, Cowen needed to go to these places and establish relationships with physicians there. Over the next seven years, he developed relationships with clinics and doctors across a broad spectrum of medicine in that region. Cowen’s hard work has produced an extensive network of clinics and physicians across central Appalachia who know him as their go-to guy for oculoplastic needs.

The “Go-To Eye Plastics Guy” for Babies to 90-Year-Olds

“My patient population spans from babies to 90-year-olds,” says Cowen. Patients come to him with issues related to eyelids, tear ducts, and tumors.

His pediatric population usually has life-impacting birth deformities and congenital defects, such as ptosis or droopy eyelids. Cowen notes, “Correcting a congenital ptosis that could affect vision as a child grows is a key procedure.”

Most of his patients are in the 50- to 80-year-old range. Ptosis (droopy eyelids and brows) accounts for the largest percentage of his overall patient population. He also sees many people with tear duct issues and considers himself a “plumber of the eye,” as he has become adept at reconstructing tear drain systems.

Cancers around the eye account for 15 to 20 percent of his adult patients. Some of these are orbital tumors, but addressing skin cancers is a particular interest of Cowen’s. Many doctors who normally address cancers of the face are reluctant to work on the sensitive tissues around the eye, so this is where his skills are highly valuable.

To effectively address skin cancer reconstruction, Cowen often works hand-in-hand with Central Kentucky’s Mohs surgeons. Just hours after a Mohs surgeon removes a lesion through layered ablation, Cowen comes in to do the reconstructive work. Whether it was simply a biopsy or a full tumor removal, the reconstructive work can be critical. As he says, “A resulting defect on the eyelid the size of your thumb is unacceptable: the eyelid will not function properly, and the eye will be lost. The loss of an eye is a 25 percent disability to a patient. My personal opinion is that you want to save every millimeter of eyelid possible.”

Cowen has lectured nationally and internationally on state-of-the-art techniques for eyelid reconstruction and published articles in Ophthalmic Surgery, Current Ocular Therapy, and The Journal of the American Society of Ophthalmic & Reconstructive Surgery.

Cosmetic procedures are an important and growing segment of Cowen’s patient population. Pharmaceutical grade products and non-surgical services complement procedures such as eyelid surgery, brow lifting, and laser resurfacing.

Putting Surgery Second for Graves’ Disease

Another particular concern is thyroid eye disease, aka, Graves’ disease. Treating Graves’, the troubling manifestation of an autoimmune disease in the thyroid that results in secretion of excess thyroid hormone, comprises about 10 percent of his practice. Swelling around the eyes, bulging eyes, tear duct malfunction, and eyelid retraction are prominent symptoms that oculoplastic surgeons address. For Cowen, managing Graves’ disease, preventing vision loss, and correcting its resulting deformities is a complex and engaging challenge. “My goal is to stabilize the condition and avoid surgery, whenever possible,” he says.

Cowen knows he bucks the surgery-first trend, noting that, “There are a lot of things you can operate on, but you don’t have to.” He utilizes steroids, anti-inflammatories, and even radiation in an attempt to hold down the painful and extremely unattractive swelling that can afflict Graves’ sufferers during the most acute stages of the disease. His preference for exhausting all options before surgery has earned him an excellent reputation among endocrinologists, who are the primary referrers of Graves’ patients.

Moving Forward: Oculoplastics and the Independent Doctor

Cowen has a fervor for the dynamism of his field, which he has combined with his business acumen to establish the premier independent oculoplastics service in the region. He knows he is the beneficiary of the trend in medicine towards sub-specialization. He attributes the expertise that has evolved in his field, and the high expectations of referring doctors, to “the advancement in fellowship and subspecialty training and the development of new techniques.” The increase in the quality of reconstruction, which relies largely on precision, has been greatly enhanced by the advent of lasers. He also cites close work with other specialists as a key to developments in oculoplastics, particularly with regards to complex cases like Graves’ disease. Innovation in cosmetic services is quite robust these days, he notes.

Staying focused on a subspecialty has allowed Cowen to devote considerable energy to how his practice could be maximally effective and broad reaching. His decision to stay independent has been justified by careful development of a professional network, enduring commitment to regional service and charitable work, and cultivation of a comprehensive office experience.

Early on, Cowen established a presence in Hazard, Whitesburg, Harlan, and Springfield. He was always asking, “Where are the patients and doctors that need me?” Now he has settled on a permanent presence in Prestonsburg, London/Corbin, and Ashland, as these are the population centers that make his travel cost effective. But his early efforts have assured that many local doctors elsewhere seek him out for the oculoplastic needs of their patients.

Cowen has an enthusiasm for helping those in need. His love for people has sent him to China, Haiti, and Thailand. His desire once led him to Haiti for an emergency surgery on a young girl that was unable to leave the country. He also participates with Surgery on Sunday, World Medical Mission, and His Servant’s Hands programs.

Success Comes from a Shared Vision for Excellence

Cowen’s model for success starts with his desire to serve the citizens of the Commonwealth and his appreciation for the delicate importance of the human eye. Staying independent has allowed him to honor both passions successfully for over 20 years, performing over 47,000 surgical procedures.

Serving patients, their families, and their local doctors, with the help of employees devoted to his vision, fuels the long hours and drives his commitment: “We have a unique ability to take care of and pay attention to both our referring doctors and our patients,” he says. The staffers who support him at his Lexington office – he calls them his “five amazing women” – comprise a well-oiled machine. He is proud to say, “I allow all these women to bring their strengths to my practice, which provides a unique experience for our patients and doctors.”

Cowen’s desire for excellence with his yearning for mastery unites the two aspects of his work. He concludes, “To take the principles and practices of general plastic surgery and apply them to an area as dynamic and delicate as the eye, so that it functions and is aesthetically pleasing, is why I love what I do.”