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Focus on Philip L. Custer, MD

Philip Custer, MD, is a professor in the department of Ophthalmology and Visual Sciences. His areas of specialty include ophthalmic plastic reconstructive surgery; eyelid and orbital malignancies; cosmetic eyelid, forehead and cheek surgery.

Dr. Custer sees patients at the Eye Center in the Center for Advanced Medicine, 4921 Parkview Place, Suite C, 12th floor.


What led you to choose your specialty?

My undergraduate training was in biomedical engineering and that lead to an interest in different specialties that had biomechanical systems. I was very intrigued by the function of the eye and the orbit. All the instrumentation really fit into my background. It’s not only just the function of the eye -- it’s the movement of the eye, the eyelids, the bony structure around the eye and the tear duct system. All those things have to be properly functioning for the eye to have effective vision and for the two eyes to work together. A lot of what I do is not so much with the eyeball itself as it is with the surrounding soft tissue.
Dr. Custer performing surgery

What brought you to Washington University?

I was fortunate to do my residency here in ophthalmology. After my residency, I left St. Louis for fellowship training in oculoplastic surgery at the Bascom Palmer Eye Institute in Miami, Florida. At that time, there wasn’t anyone doing this type of work at Barnes-Jewish Hospital, so I knew there was a need for that specialty. I liked St. Louis and it was a great opportunity to come back here after my fellowship.

Which aspect of your practice is most interesting?

What keeps things interesting year after year is the diversity of patients that I am able to see. I’ve got a great practice that allows me to treat people of all ages and backgrounds. We are faced with complex conditions that allow us to work with the other wonderful specialists here at the hospital. We also deal with both reconstructive work and cosmetic surgery. I don’t get bored because every day is a new challenge.

What problems are you seeing from chronic sun exposure?

In general, we are certainly seeing a lot more skin cancer, many of which occur around the eye -- a particularly difficult area to manage. Often we’ll coordinate treatment with the Mohs surgeons from the Dermatology Division, who are specialists in the removal of skin cancers. After the Mohs surgeon removes the cancer, we will reconstruct the eyelid and repair the defect. Our goal is to not only have a functioning lid that opens and closes, but also to achieve the best possible appearance for the patient. Both procedures are often done in the same day.

Have the demographics changed in your patients over the years?

Yes, first of all we are seeing younger patients who are interested in cosmetic surgery of the face and eyes. Secondly, we are now seeing more men. Cosmetic surgery is becoming more accepted for both men and women. I can remember a time when someone had cosmetic surgery and it was talked about in whispers. Now it is freely discussed and people are more open about it.

What new developments in your field are you most excited about?

As I look at the changes in my specialty during my career, I see there’s been an ongoing emphasis to take a cosmetic approach to the management of functional problems. With regards to incision planning, there’s been a growing emphasis on performing the surgery in a way that not only takes care of the problem but optimizes the cosmetic result. We’re applying many of the techniques used in aesthetic eyelid and facial surgery in our reconstructive work. When someone has a fracture of the orbit, we’re now making incisions similar to what we use for cosmetic eyelid surgery. In the past, we’d make incisions all the way across the skin of the lids. Now many of those incisions are actually placed on the backside of the eyelid – where they can be hidden and there is a minimal, if any, apparent scar.

In that same vein, we’re also doing procedures with much smaller incisions. We used to raise an upper eyelid through an incision all the way across the eyelid -- now the incision is less than half an inch. I see that trend continuing in all of medicine, but particularly with what we are doing.

Where are you from?

I grew up in Iowa, but I spent a lot of time in Nashville, Tennessee before moving here to practice. My wife and I have been here a number of years and we’re very happy in St. Louis.

Which particular award or achievement is most gratifying to you?

Several years ago I was appointed as a Director for the American Board of Ophthalmology. My duties include working with other leaders in ophthalmology to develop standards for board certification and supervision of the testing process for people to become board certified in our specialty.

What do you do when you’re not working?

My wife and I are both very busy. We live in the city and like the urban lifestyle – particularly in the summer when we are able to enjoy our free time having a late dinner at one of the sidewalk cafes in the West End. We also enjoy traveling. After that, I tend to spend what little free time I have trying to master the game of golf.

What is the best advice you’ve ever received?

There’s really no place for mediocrity in medicine. If I were to give advice to a young surgeon or someone starting out today, it would be to make sure you take the time for each patient. If you do that, you’ll be able to do the best job possible for every day’s situation. I consider my primary mentor to be Dr. Dick Tenzel. He was an outstanding oculoplastic surgeon with whom I trained in Miami.

What lifestyle change could most benefit our health?

Speaking from an oculoplastic surgeon’s point of view, I think there are two things that would most benefit everyone. Number one is sun protection. We’re now learning that more and more eye problems are related to chronic sun exposure. As mentioned before, I spend a lot of my time dealing with skin cancers. So, if we all start getting in the habit of wearing sunglasses (with UV light protection) and sunscreen (with UVA and UVB protection) – we’re going to see fewer people suffering from skin cancers down the road.

Number two is eye injury prevention. We tend to see a lot of eye injuries that are preventable. We need make sure we’re extra cautious and wear protective eye wear whenever it’s needed – playing sports, working in the shop, working on our car, using power tools. If we could accomplish those two things that would make my job a lot easier – or at least less busy.

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Copyright 2015 Washington University School of Medicine