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Laws of Plastic Surgery

Goldwyn, Robert M. M.D.

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Plastic and Reconstructive Surgery: October 2004 - Volume 114 - Issue - p 13
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We pitiful human beings, born not of our will, are thrust into this world, which throughout our lives we try to comprehend. To make sense of our existence, we seek the verities; we try to formulate laws of earthly happenstance and human behavior—basic tenets akin to the laws of gravity and energy. Take, for example, Benjamin Franklin’s fundamental: “… in this world nothing is certain but death and taxes.” And closer to our time is the observation of Professor Parkinson: “Work expands so as to fill the time available for its completion. Thus, an elderly lady of leisure can spend the entire day in writing and dispatching a postcard to her niece at Bognor Regis. An hour will be spent in finding the postcard, another in hunting for spectacles, half an hour in search for the address… ”

As valid as the law seems, it is not always true. There are, I am sure, older retired women who would never devote more than a half hour to writing to their relatives. So we have another law: “Every rule has an exception (even this one).” Whether the exception proves the rule, or the rule, the exception, I leave to that genre of professional deep thinkers, known as logicians.

The laws concerning how our world functions or malfunctions contain much wisdom in few words. While we might add a qualifying “usually” to the statement, its soundness and acumen remain incontrovertible. That the law does not hold for every circumstance should not disconcert us. The imprecision of precision—à la Heisenberg— is a preoccupation of today’s mathematics and physics.

I have made a list of some of my favorite rules; a few are lesser known, and none is original with me:1

  • Nothing minor ever happens to a car on the weekend.
  • A consultant is an ordinary person a long way from home.
  • In an undeveloped country, you don’t drink the water; in a developed country, you don’t breathe the air.
  • Nature abhors a hero.
  • The tire is only flat at the bottom.
  • Sex is hereditary. If your parents never had it, chances are you won’t either.
  • The easiest way to find something lost around the house is to buy a replacement.
  • A memorandum is written not to inform the reader but to protect the writer.
  • There are three ways to get something done: Do it yourself, hire someone, or forbid your kids to do it.
  • Food that tastes the best has the highest number of calories.
  • When the plane you’re on is late, the plane you want to transfer to is on time.
  • The odds are six to five that the light at the end of the tunnel is the headlight of an oncoming express train.
  • Permit me a few “laws” of plastic surgery:
  • The preoperative photos that are lost are always of the patient with the best result.
  • The last stitch in a blepharoplasty always starts bleeding.
  • No insurance company ever makes a mistake in your favor.
  • No medical organization to which you belong ever reduces its dues.
  • The patient whose operation you do for visiting surgeons will have the hematoma.
  • VIPs are magnets for complications.
  • The patient with the best initial result never returns for follow-up.
  • The dissatisfied patient never moves away.
  • The older the surgeon, the less he or she perceives the need to retire.
  • The older plastic surgeon never thinks there is room for a younger one in town.
  • The initial sponge count is never correct when you are behind schedule.
  • The rhinoplasty patient with only a fair result is your most enthusiastic supporter.
  • The lengthy operative note (discharge summary) is the one that gets lost.
  • No surgeon ever has enough operating time.
  • No hospital ever has enough operating rooms or personnel.
  • Plastic surgeons resent a colleague in direct proportion to the aesthetic content of his appearance in the media. Corollary: The expert on hypospadias is never maligned.
  • Most surgeons lack the enzyme allowing them to praise the results of a colleague.
  • Most surgeons feel a twinge of pleasure at another’s complication.

Our readers doubtless have better rules of their own—and that, perhaps, is another law.


1.Dickson, P. The Official Rules. New York: Dell, 1981.
©2004American Society of Plastic Surgeons