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Chasing the Future to Improve the Present Practice of Craniofacial Surgery

Habal, Mutaz B., MD, FICS, FRCSC, FACS

doi: 10.1097/SCS.0000000000005273
Editorial

Editor in chief/JCS,

Tampa, Florida, USA

mbhabal@verizon.net

“Words are not meant to stir the air only: they are capable of moving greater things.” —Natsume Soseki

“To gain mastery you must unite the qualities of spirit, strength, technique, and the ability to take the initiative.” —Sadami Yamada

“Once you question your own belief, it's over.” —Naruto Uzumaki

“The blue of the sky is one of the most special colors in the world, because the color is deep but see-through both at the same time.” —Cynthia Kadohata

“I have been brought up in a world dominated by honor; I have known neither crime, poverty, nor betrayal, and here I taste hatred for the first time: it is sublime, like a thirst for justice and revenge.” —Shan Sa

“From then on, my thesis hung over me like a curse, and with bloodshot eyes, I worked like a madman.” —Natsume Soseki

“Those who hurt others will also hurt themselves.” —Natsuki Takaya

“Before you can control your opponent's body you must first control his mind.” —Sadami Yamada

It seems like the future is already here. Indeed it is a new beginning, and we surgeons are working to remove all the geographic boundaries and artificial walls so we may continue to work as one global family. One group, collaborating together to build a better future for the coming juniors that need to have a global arena with no boundaries. So that those in need will have access to a global health system and patients or parents do not need to travel and incur extra expenses to seek reasonable medical attention that will be followed by treatment. Just as we have seen the Journal of Craniofacial Surgery advance into the global arena of healthcare to provide information to all and allow them to keep their skills sharpened for the betterment of the patients’ care and for a better outcome of the overall care on a global level, mastered by the skills of the surgeon that is based on solid training and foundation.

This brings us to the present issue. It is a reflection of the future, featuring colleagues from around the world who are part of our professional global family of craniofacial surgery. This special issue is dedicated to have our colleagues in the eastern hemisphere give us a taste of their hard work, innovations, and the progress they are having in their arena. The global arena of collaboration is here to stay in spite of any politics that try to separate, isolate, or discriminate. We will not hear any more “us” and “them,” for we are all people and surgeons for the common cause. We selected in this section quotations from Japanese philosophers for this issue, and our readers will do well to see that they apply to all of us. A special thank you to the energy and the organizational work of our editorial board member of Japanese heritage, Doctor Akira Yamada. He is the special edition editor and worked so hard to get the material organized and gathered as well as translated under one cover of the Journal of Craniofacial Surgery. We appreciate his loyalty and dedication to the editorial board and the journal.

In the past year, we have witnessed vast progress in all the fields we cover under plastic surgery. It has inspired the trumpeters who claim that we as a group are becoming stagnant. The new innovations present themselves with brilliant young surgeons from the Far East to the far south. The conferences that used to be concentrated in the western hemisphere are now global, and many do not need to travel to faraway lands to present their good work or discover new advances to enhance their practice.

As we were preparing this special issue, my thoughts fell to a surgeon who was a pioneer in the field and a family friend as well. Doctor Kitaro Ohmari, who was on the editorial board for many years at the inception of the journal. We asked another superb surgeon from Japan, Doctor Yamada, to translate Doctor Ohmari's work for an editorial that follows my note. Doctor Yamada, we knew, would be able to tell us about Japan's contributions and advances in the field. He did a fantastic job and I tip my hat to him. Bravo doctor Yamada for work well done. Now we come to the special issue theme, the rising sun. Appropriate not just because the sun rises in the East but also because the future is predicted and created there.

The progress this last year in the organizational structure has been very rewarding and patients will be pleased with it. The Chinese Craniofacial Association was formed under the umbrella of the Chinese Plastic Surgery Association. Leaders in the field from both China's biggest cities are brining the country's vast healthcare system under one umbrella. A foundation was added to that, which will be the right arm of the group to help patients in need. They are fostering cooperation between the specialties for the benefit of the patient, as well as a matrix form of work to avoid competition in a narrow field. On the same note, we traveled to South America to witness the first congress of the newly formed Latin American Craniofacial Association. That will bring another forum of communication so all the advances and innovations can be noted. The last one of the same focus was also done in Europe, in a gathering at the Queen Elizabeth II Centre. We must also note the Neuroplastic Surgical Society that was formed in Baltimore under the leadership of Doctors Gordon and Brem. We are pleased at the journal to be affiliated with all these groups, so we can provide the world with scholarly communication of research, innovation, and advancement.

The progress made in face transplant continue to be at the forefront. Two medical centers continue to lead the way and shall do so until all the intricate details are well understood. Not in the techniques of what goes where, but in the basic immune therapy to eventually produce a chimera through tolerance. This last advance in face transplant may not be in our lifetime.

A new avenue for the future will be genomic surgery. The discussion of changes and new beginnings would not be complete without genomic surgery and gene editing. The start was rocky and we still have many bumps in the road. Today, we are working on the serious ones. Since it requires good funding, the funders continue to call the shots and therefore the progress will be in control of the payers. As we always say, the power to control is always attached to the power to fund. The fear that the applications will be out of control is not really genuine, for scientists are usually reasonable and ethical.

The future will hopefully bring a reduction in the major disease that is out of control: trauma. It is in the civilian population of war zones with millions of people suffering from collateral damage. The children are the usually the ones affected most. We hope that the leaders will learn how to solve their differences peacefully rather than following old caveman ways of thinking that power is the only force to use to resolve an issue of disagreement. A hundred years after World War I, it is still a major fact of our existence. The progress will be done in prevention and not putting more screws in the skull or long bones to salvage the consequences of failure to prevent the occurrence of such clinical problems. I still remember in the early seventies I was at a presentation on fairing the forehead and skull, where we used miniscrews to fix the bone, and a the voice from the back said, “put these screws in your own head.”

To sum up, we have a noted the global changes in craniofacial surgery through an organizational structure and through a global interest in innovation and progress. We at the journal board are here to produce a modus of communication so the progress will continue for the benefit of the global patient, so the outcome will continue to improve, based not only on structural changes but on function and quality of life to make the individual be able to pursue the life they desire. The continued effort to learn how not to compromise but to improvise ways to reduce trauma's impact on everyday life will be a future direction as we are slowly resolving most issues in birth defects and oncologic problems. The future issue of the journal will eventually be there to relay to our readers how to prevent the occurrences of such issues and work hard on prevention. The goal is to keep inspiring the juniors’ generation to persue the best path to improve and progress, rather than follow the same old ways that were good for the past and not progressive for the future. My final message is do not look too hard to predict the future, for the future is here, and we are witnessing not evolutionary but revolutionary advances starting with a global health system in a global health community with no boundaries in education and innovation.

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© 2019 by Mutaz B. Habal, MD.