American Society of Plastic Surgeons
For Medical Professionals

Cosmetic results are impacted by reconstructive training

We are fond of saying that to become a great cosmetic surgeon, one must first be a great reconstructive surgeon. This is for several reasons. First, the thought process of reconstructive surgery, which includes understanding design principles, geometry, proportion, as well as anatomy and physiology, requires meticulous planning and execution of techniques in order to achieve the best result. But in addition to achieving good function, reconstructive surgeons are always thinking about how the result will look.

Breast reconstruction, for example, is one of the most emotionally and psychologically important procedures for patients because it directly impacts how a patient feels about herself as reflected in how "normal" her body can be made to look after the difficult diagnosis of breast cancer. A great breast reconstruction result can have profound effects on improving a patient's self-image and self-esteem and in counteracting the negative psychological impact of dealing with the diagnosis. If that is not the essence of cosmetic surgery, what is?

How about a plastic surgeon specializing in craniofacial reconstruction, who takes down and rebuilds entire faces and skulls for severe deformities; can anyone logically argue that a weekend training course or a brief preceptorship in cosmetic procedures could possibly substitute for experience in such complex, demanding work? Or a plastic surgeon experienced in facial transplantation: could anything be harder than orchestrating and successfully completing a 20-hour microsurgical team operation that instantaneously transforms a human being's entire existence and ability to be seen in society? That is the absolute epitome of aesthetic surgery, and it comes from having superb technical abilities honed through taking on complex reconstructive challenges and making the result look darned good.

I guarantee that the typical plastic surgeon with extensive reconstructive experience for breast and skin cancer patients has a much more elaborate "toolkit" of techniques to achieve high quality results with a high degree of consistency, than someone who took a weekend facelift course. He/she has also had, through residency and continuing education programs, the opportunity to see suboptimal (and, at times, downright bad) results and learn approaches to improving them and in managing patient expectations. These are not skills easily learned in short periods of time. As one of my plastic surgery instructors was fond of telling me, "Good judgment comes from experience. Experience comes from bad judgment." We plastic surgeons are fortunate to be able to enter practice with enough experience in a supervised setting that we are well equipped to manage and mitigate - and, particularly, to diligently try to prevent - complications of procedures. I believe it is our educational background in plastic surgery, which emphasizes restoration of form and function, that separates us from those who attempt to make a fast buck with limited training.

If this comes across as territorial, it's because of this: I am fiercely proud of my profession and the rigorous demands placed on my colleagues and on me, and I am easily moved to action when I see a dilution or distortion of our specialty propagated by practitioners without appropriate training or ethical standards. I am passionate that plastic surgery - from the Greek plastikos meaning "to mold" or "to shape" - must continue to mold and properly shape the public's perception, so that you patients can make a good choice by selecting a board-certified plastic surgeon when you seek cosmetic surgery.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.


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