About

Jeffrey Robert Marcus is a Professor of Surgery at Duke University, holding additional titles as Professor in Pediatrics and Professor in Head & Neck Surgery & Communication Sciences. He is based at the Duke Department of Surgery, located in the Brown Zone at Duke South in Durham, North Carolina. His professional roles encompass a broad spectrum of surgical disciplines, including Plastic, Maxillofacial, and Oral Surgery, General Surgery, Pediatric Plastic and Craniomaxillofacial Surgery, and Reconstructive Surgery. Dr. Marcus's academic and clinical work is integrated within Duke's comprehensive surgical training programs, including the General Surgery Residency Program and the Integrated Plastic and Reconstructive Surgery Residency Program. His expertise and contributions support the department's mission in education, research, and patient care, with a focus on advancing surgical techniques and improving outcomes in his areas of specialization.

Research topics

• Surgery
• Medicine
• Orthodontics
• Biology
• Mathematics
• Engineering
• Combinatorics
• Anatomy

Selected publications

• Endoscopic strip craniectomy with helmet therapy for craniosynostosis: a retrospective review of the Sydney experience

  Australasian Journal of Plastic Surgery · 2026-05-05

  articleOpen access

  Introduction: Endoscopic strip craniectomy (ESC) followed by helmet therapy is a minimally invasive technique that has emerged as an alternative to open cranial vault procedures to manage young infants with craniosynostosis. In 2022, the Sydney Children’s Hospitals Network adopted ESC as part of a revised, age-sensitive management algorithm for craniosynostosis. This study is a retrospective chart review of patients with craniosynostosis treated with ESC and postoperative helmet therapy at the Sydney Children’s Hospitals Network. Methods: Patients with craniosynostosis seen at the Sydney Children’s Hospitals Network between November 2022 and January 2025 were included in the study. Patient demographics, operative and helmet details, outcomes and complications were collected. Results: A total of 82 patients (25 female; 57 male; mean age 3.4 months) underwent ESC during the study period to treat sagittal (39), metopic (29), unicoronal (11), multi-suture (2) and lambdoid (1) craniosynostosis in a combined approach with plastic surgery and neurosurgery. Intraoperative (6%) and postoperative (14.6%) complications did not result in any long-term consequences. The transfusion rate was 48.7 per cent. The duration of helmet therapy was six to eight months, with an average of 10 fitting appointments. Five (6.1%) patients had late surgery (one due to unsatisfactory aesthetic correction, four related to elevated intracranial pressure). Conclusion: Endoscopic strip craniectomy with helmet therapy is a safe and effective treatment for infants under four months of age with craniosynostosis and should be available for patients. However, the need for frequent helmet adjustments poses a burden on families, which must be considered in preoperative planning and counselling. Longer follow-up and quantitative morphometric comparison with established techniques (eg, spring cranioplasty, fronto-orbital advancement and remodelling) is needed.

  PublisherOA PDFDOI

• Comparative Analysis of Spreader Grafts and Spreader Flaps on Intranasal Drug Delivery Efficiency to Posterolateral Nasal Wall

  FACE · 2025-01-13 · 1 citations

  article

  Background: This study compared the impact of spreader grafts (SG) and spreader flaps (SF) on the transport of intranasal drug delivery to target the posterolateral nasal wall. Method: SG and SF were each performed in sequence on two cadaveric specimens after soft tissue elevation technique. Computed tomography scans were acquired following each procedure to generate anatomic models for computational fluid dynamics simulation of intranasal sprays under the following conditions: inhalation rate (15 and 30 L/min), spray velocity (1, 5, and 10 m/s), spray released location (center, lateral, medial, top, and bottom), head position (upright, tilted-forward, tilted-backward, and supine), and particle diameter (1-100 µm). Percentage of particles deposited on the posterolateral nasal wall were calculated. Results: For Specimen 1, highest posterolateral wall depositions were Pre-Op: left = 74%, right = 74%; SF: left = 53%, right = 22%; SG: left = 60%, right = 61%. For Specimen 2, highest posterolateral wall depositions were Pre-Op: left = 25%, right = 83%; SF: left = 29%, right = 76%; SG: left = 14%, right = 72%. In general, posterolateral wall deposition was higher at 30 L/min inhalation rate and at 1 m/s spray velocity. Conclusions: Drug delivery targeting the posterolateral nasal wall appears to be dependent on many factors. However, midvault nasal reconstruction does not increase drug delivery to the posterolateral nasal wall.

  PublisherDOI

• Sensor System to Capture Spatial & Temporal Pressure Distribution from Ballistic Impact Armour Back-Face Deformation

  2025-01-01

  article
  PublisherDOI

• A Rating Scale for Obtaining Specific, Actionable Evaluations of Nasolabial Aesthetics after Unilateral Cleft Lip Repair

  Plastic & Reconstructive Surgery · 2025-09-23

  articleOpen access

  BACKGROUND: Surgeons pursuing improvement in the aesthetic outcomes of their cleft lip repairs may benefit from a granular scale evaluating individual objectives of the repair. METHODS: A working group of 9 surgeons convened to develop an assessment scale for nasolabial aesthetics after unilateral cleft lip repair. The group identified objectives of the repair that could be evaluated using two-dimensional facial photographs. Scale items were developed to appraise success or failure in achieving each objective. Scale items were iteratively tested and refined. The scale was subsequently implemented as part of a Continuing Medical Education course that included self-evaluation and peer-to-peer education, culminating in the formation of individual plans for improvement. RESULTS: Twelve distinct objectives of unilateral cleft lip repair were identified, of which 10 could be evaluated using photographs routinely obtained in clinical practice. A comprehensive scale was developed, incorporating these 10 objectives. Each scale item takes the form of a binary (yes/no) question evaluating a specific aesthetic concept, with accompanying reference images. Intrarater reliability for each item ranged from moderate to substantial (kappa value, 0.57 to 0.81). Interrater reliability ranged from fair to substantial (kappa value, 0.27 to 0.81). When implemented in a Continuing Medical Education course, the scale enabled surgeons to identify specific opportunities for improvement in their repair and specific surgical maneuvers to adopt in pursuit of these improvements. CONCLUSIONS: A new scale for evaluating outcomes of unilateral cleft lip repair is presented. The scale provides specific, actionable evaluations for individual objectives of the repair.

  PublisherDOI

• High Definition Magnetic Resonance Imaging of Nasal Tip Ligaments Illustrates Rationale for Ligamentous Preservation

  Plastic & Reconstructive Surgery · 2025-11-17

  articleSenior author

  BACKGROUND: Although preservation rhinoplasty was described many years ago, it has recently been brought to the forefront of our field. Skin and soft tissue envelope (SSTE) preservation is of particular interest as it prevents the previously-accepted disassembly and reconstruction of the nasal tip. This ligamentous anatomy has only been described through gross dissection, which is limited. MRI of the nasal tip would give a more holistic understanding of this ligamentous anatomy. OBJECTIVES: To provide a more complete anatomic description of the nasal tip ligaments through high-definition MRI. Additionally, to apply this knowledge through our technique of tip ligament preservation and suspension. METHODS: Nasal specimens were harvested from cadavers and processed through a fixation and contrast protocol. Imaging of specimens was completed in a high-definition (55 µm) small-animal MRI scanner. Image analysis with focus on identification of insertion, origin, and course of nasal tip ligaments was completed by all authors independently. The group's tip ligament preservation technique was described. RESULTS: The cartilaginous (septum and lower lateral cartilages) and ligamentous (interdomal, intercrural, and Pitanguy's) structures of the nasal tip were identified. The insertion, origin, and course of the above ligaments was analyzed and further-described. Segmentation of nasal tip structures was completed to create a three-dimensional model for further study. CONCLUSION: This is the first study to utilize high-definition MRI to define the nasal tip support ligaments. A three-dimensional model was created to better understand structural relationships. Through anatomic analysis and technique description, surgeons will now be better-equipped to abide by SSTE preservation techniques of the nasal tip.

  PublisherDOI

• Quality and Reliability of 2D and 3D Clinical Photographs in Plastic Surgery: A Scoping Review

  Aesthetic Plastic Surgery · 2025-02-27 · 3 citations

  review
  PublisherDOI

• The status of diversity, equity, and inclusion in plastic surgery

  Current Problems in Surgery · 2025-05-30 · 2 citations

  articleOpen accessSenior author
  PublisherDOI

• A 5-Step Simplification of the Fisher Anatomical Subunit Cleft Lip Repair

  Plastic & Reconstructive Surgery · 2025-09-03

  article1st authorCorresponding

  SUMMARY: Unilateral cleft lip repair methods have evolved from straight-line repairs to geometric procedures, rotation-advancement, and contemporary hybrid techniques. The Fisher anatomical subunit repair is a versatile, effective, and highly reproducible technique. It utilizes mathematical precision in design, avoids multi-point closure, minimizes scar burden, and does not compromise horizontal lip length for vertical height in various deformities. Despite these benefits, the repair has been criticized for its complexity. We describe a five-step distillation of the repair intended to clarify the procedure and provide adoptees an entry point to the benefits of the technique.

  PublisherDOI

• Explicit Values as Guides to Recruitment, Program Identity, and Culture

  Plastic & Reconstructive Surgery · 2024-02-20

  article1st authorCorresponding

  The residency match is termed such not only because it comes as a result of numerical pairing of two sets of rank order listings, but also because some shared sentiment resonates between the program and the candidate. The most common question to those engaged in the selection of residents is, “What do you look for in an applicant?” It is a fair question, but one not necessarily answered easily and also varying from one program to the next. Even within and among faculty of a single program, the answer may not exist in explicit form. We have generally relied on objective and subjective candidate data to help us to predict the success and future trajectory of our trainees to determine ranking. Our specialty is one of the most competitive in which to match, and our reliance on traditional data points has inflated the bar for these criteria. Does this serve the programs well? Does it serve the candidates well? Does it serve the specialty well? When a practice seeks to hire a new surgeon, they will typically review the prospective candidate’s curriculum vitae to examine their achievements and educational history. This subjective data may lead to a practice contacting references to decide if they want to offer an interview. In this situation, practice partners may not agree on the attributes and qualities they seek in a new surgeon for their practice. Some may focus on pedigree of training; others rely on the word of a well-known or trusted referee. Does this process uniformly lead to hiring a surgeon that fits well with the practice? Returning to the residency match, another way to approach resident selection is to consciously focus on those shared elements between program and candidate and defining those that are most important. Understanding inherent variability among programs, the elements would ideally be easily stated, informed by prior performance, predictive of success as defined by the program itself, and as free from bias as possible. Many programs—our own included—have gone through the exercise of defining explicit statements on programmatic “vision,” “mission,” and “values.” These statements can be easily forgotten after the exercise is complete, only to be found perhaps on a website; but they should have purpose. The vision is often a lofty aspiration; the mission statement delivers a more pragmatic framework for action as inspired by the vision. Finally, and importantly, the values are the characteristics that define who we are as individuals and as a group. When values are used to guide recruitment, they allow us to direct our path forward to who we want to be in the future. If you have spent time formulating the values that are important to your program or practice, then let those values be the primary guide in the process of building your team. Consider the common objective criteria that have traditionally been used to guide resident selection: standardized test scores, educational pedigree, medical school grades, and research productivity. Numeric scores are convenient because they can be used practically as a surrogate for aptitude, thereby allowing establishment of cutoff values and reducing the total number of applications requiring more thorough review. Although it is the subject of a much broader discussion, the more disproportionately weighted the United States Medical Licensing Examination (USMLE) Step 1 score became over time, the more focus it received from candidates and medical schools, the higher the threshold bars rose, and the less valuable the score became as a measure of aptitude or as a predictor of future success. As a consequence, the USMLE Step 1 examination became pass/fail in 2021.1 Course grading has also shifted to pass/fail in many U.S. medical schools, and is nonstandardized and difficult to interpret from one institution to the next. At present, the USMLE Step 2 Clinical Knowledge score remains as a quantified and standardized data point in the application process. However, performance in this examination has been increasingly emphasized and prioritized by both applicants and programs. Subjective assessment also remains influential. We value the opinions of our colleagues; however, we have to be careful how much emphasis we place on letters of recommendation. Letters of recommendation can convey bias.2 Aside from this, letters of recommendation require a degree of interpretation. A strong letter is not the longest letter, recounting the accomplishments already noted on the curriculum vitae. It is not a letter with the most glowing praise and laden with adjectives, but without qualifying direct observations. The letters that carry weight are those that are grounded in some level of direct interaction or observation, in which examples can be shared that portray the character of the candidate. She or he is a team player (in what way specifically?). He or she has high emotional intelligence (as evidenced by what experiences or observations?). Character is to a person as values are to a program. The match is therefore very much a two-way exercise in knowing thyself. Carefully written letters provide background and evidence that can directly support a selection process that is guided by the program’s explicit values. As the author Scott Page teaches and has demonstrated using examples in a broad spectrum of entities and businesses, diversity (in all/any form) is one of the most consistent predictors of organizational success.3 Thus, it stands to reason that if we wish to be the best program we can be, that we should aim to seek out a candidate pool with individuals from a wide range of backgrounds and experiences who have maximized their success with the opportunities they have had. However, we have seen that many of the data points we use to create the candidate pool have limitations and biases that would favor a narrower pool if relied on primarily or exclusively. A “values mindset” can help to better guide the process. A program or practice that has taken the time to define the values that portray its desired state will likely find several or many that resonate with a candidate. Values are guides, and some may be prioritized differently than others; some may be so highly prioritized that they are requisite. For example, some programs may prioritize “scientific discovery” or “scholarly commitment” more than others. Others may strongly weight an environment based on teamwork and cultivation of leadership skills. The differences help to distinguish programs in the way they intend. Defining these values clearly and outwardly is helpful not only to the candidates, but also to the program. You are more likely to achieve the outcomes you seek if you first define them. A diverse group of candidates can match the program’s values in different ways, and still match. Values guide the selection process by virtue of the fact that they are easily stated, can be informed by prior performance, and can be predictive of success as defined by the program itself. When used with purpose and intent, explicit values are a means to avoid implicit bias and help both the program and the candidate to achieve their shared goals. The difficulty with using a values-based selection process is that, unlike USMLE scores, there is no single place to find a particular value on an application. There is no score for teamwork, professionalism, or resilience. Finding the values you seek is a matter of detective work and requires a greater commitment. The good news is that true character tends to show up repeatedly over the course of life, often throughout an application, and quite likely in an interview if it is consciously prioritized. For example, resilience does not show up overnight. It is the result of obstacles overcome, often many, that have been placed in the way of a candidate’s journey to the interview seat in front of you. Values can be spotted in recurring experiences or patterns of behavior over time. Even the candidate may not realize it. Values are not always in the lines of the application or even the essays. They are sometimes between the lines, and that is where you also need to read. There is a further benefit of using a values mindset to guide the process of selection. When the members of a large team truly share a set of values, they establish a culture. Once a culture becomes established, it tends to self-perpetuate. The values and the culture require ongoing attention, like tending a garden, ensuring that the identity of the program will persist even when its members change. What if, after defining a set of values, it is recognized that an adjustment in the culture is necessary? The decision to change culture generally starts at the top. In a unique advantage of a residency program as opposed to other organizations, however, the process of change works most effectively and efficiently from the ground up. The program faculty are relatively static; in fact, value is often ascribed to faculty stability and lack of attrition. In contrast, the residency is constantly fluid. Change is inherent, as an equal number of new residents come in every year at the same time graduates go out. A program can place focus on a set of values and build a team around those values by consciously seeking them out in the process of resident selection every year. The program will soon become what it desires through the people it recruits, and the residents will set the tone for the program. It will then be the leader’s challenge to inspire the faculty and other more permanent members of the program to rally in support of those values. The residents will be an incredibly persuasive and valuable asset in that process. When a program or practice applies a values mindset to its process of recruitment, the effects can be far-reaching and transformative. Values-based selection provides a clear process to build and maintain a completely self-determined program identity, while limiting biases and facilitating cohesiveness. When an applicant for residency asks, “what do you look for in an applicant,” you could tell them to look at the website. Or any member of your program can just tell them. DISCLOSURE The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this article.

  PublisherDOI

• Early Simultaneous Cross Facial Nerve Graft and Masseteric Nerve Transfer for Facial Paralysis after Tumor Resection

  Plastic & Reconstructive Surgery Global Open · 2023-03-01 · 7 citations

  articleOpen accessSenior authorCorresponding

  Background: We describe a new approach for facial reanimation after skull base tumor resection with known facial nerve sacrifice, involving simultaneous masseter nerve transfer with selective cross facial nerve grafting (CFNG) within days after tumor surgery. This preliminary study compared outcomes of this approach versus a staged procedure involving a masseter nerve “babysitter” performed in a delayed timeline. Methods: Patients undergoing masseter nerve transfer and CFNG for facial paralysis after skull base tumor resection were consented to participate in video interviews. Facial Clinimetric Evaluation (FaCE) Scale (0–100) patient-reported outcome, eFACE, and Facial Grading Scale scores were compared. Results: Nine patients had unilateral facial paralysis from resection of a schwannoma (56%), acoustic neuroma (33%), or vascular malformation (11%). Five underwent early simultaneous CFNG and masseter nerve transfer (mean 3.6 days after resection), whereas four underwent two-stage reanimation including a babysitter procedure (mean 218 days after resection). Postoperative FaCE scale and Facial Grading Scale scores were similar in both groups ( P > 0.05). Postoperative mean eFACE scores were similar for both groups for smile (early: 71.5 versus delayed: 75.5; P = 0.08), static (76.3 versus 82.1; P = 0.32), and dynamic scores (59.7 versus 64.9; P = 0.19); however, synkinesis scores were inferior in the early group (76.4 versus 91.1; P = 0.04). Conclusions: Early simultaneous masseter nerve transfer and CFNG provides reanimated movement sooner and in fewer stages than a staged approach in a delayed timeline. The early technique appears to result in similar clinician- and patient-reported outcomes compared with delayed procedures; however, in this preliminary study, the early approach was associated with greater synkinesis, meriting further investigation.

  PublisherDOI

Frequent coauthors

• Alexander C. Allori

  Duke University

  146 shared

• Detlev Erdmann

  Duke Medical Center

  90 shared

• David M. Fisher

  Hospital for Sick Children

  85 shared

• Ronald M. Zuker

  82 shared

• William P. Magee

  Children's Hospital of Los Angeles

  81 shared

• Gavin J. Lenz

  81 shared

• Anna R. Carlson

  Helen DeVos Children's Hospital

  70 shared

• Srinivasan Mukundan

  Boston Children's Hospital

  65 shared