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So You Want to Be an Innovator?

Rohrich, Rod J. M.D.; Rosen, Joseph M.D.; Longaker, Michael T. M.D., M.B.A.

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Plastic and Reconstructive Surgery: September 2010 - Volume 126 - Issue 3 - p 1107-1109
doi: 10.1097/PRS.0b013e3181e3b854
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We have all heard the expression “You can never be too thin, too wealthy, or have too many friends.” We would like to add that “You can never have too much innovation.” Considering our roots that lie in transplantation and general surgery, and considering that unlike other specialties, plastic surgery does not “own” a single organ in the body, plastic surgeons have relied on their ability to innovate to create a distinct and valued identity among physicians and surgical specialists. Innovation has not only formed our specialty, it remains one of our core capabilities that enables us to remain in the forefront of new technology in medicine. Furthermore, innovation will be a primary component of our future success. Plastic surgery does indeed own innovation as its “organ.”


What is “innovation” as opposed to “invention”? Innovation is a new way of doing something or “new stuff that is made useful.”1 It may refer to incremental and emergent or radical and revolutionary changes in thinking, products, processes, or organizations. The goal of innovation is positive change, to make someone or something better.2 Furthermore, innovation occurs when someone uses an invention or an idea to change how the world works, how people organize themselves, or how they conduct their lives. In this view, innovation occurs whether or not the act of innovating succeeds in generating value for its champions. Innovation is distinct from improvement in that it permeates society and can cause reorganization.2 Innovation is the introduction of new ideas, new processes, or new protocols that change the way we think, work, and live.

What makes an innovation “good” or worthwhile? A number of criteria can be assigned to this task, but four key elements are the following3:

  1. Innovations save lives, extend average life-span, or materially improve the quality of life (e.g., anesthetics, surgery, vaccines, antibiotics, and genetic screening).
  2. Innovations lead directly and indirectly to downstream derivative innovations that fundamentally alter how we live and what we are able to do as a species (e.g., mathematics, money, property ownership, containerized shipping, and the Internet).
  3. Innovations help to increase the amplifier effect of modern economies—increasing the standard of living for the population as a whole (e.g., printing, free markets, capital markets, and limited liability).
  4. Innovations free up people's time to do something besides just scramble endlessly for the food and shelter and clothing they need to survive.

Not surprisingly, different groups assign a wide variety of innovations to the “top 10 innovations of all time” list. For example, Business Week (Table 1) and the Foreign Policy Research Institute (Table 2) have ranked the top 10 innovations of all time quite differently.3,4 For plastic surgery, see our own suggested top 10 innovations as a specialty (Table 3), and the top 10 recent innovations in plastic surgery according to the definitions above (Table 4).

Table 1
Table 1:
Top Innovations of All Time According to Business Week
Table 2
Table 2:
Top Innovations of All Time According to the Foreign Policy Research Institute
Table 3
Table 3:
Top Plastic Surgery Innovations—Historical
Table 4
Table 4:
Recent Top 10 Innovations in Plastic Surgery

Given these broad definitions and examples, where does the specialty of plastic surgery need innovation? Reviewing our present state and prognosticating our future, what are the foreseeable areas of plastic surgery that need innovation? We think the following areas need further innovation for plastic surgery to continue to thrive well into the future: resident education and ongoing education, tissue engineering, transplantation, telemedicine, regeneration, robotics, and vastly improved translational medicine.

One of our primary missions is the training of our residents and fellows. We take the greatest pride in how well we have done to prepare our students for their future careers. Whether in private practice or in academic medicine and surgery following in our footsteps, we hope they will see farther than we have and continue the tradition of innovation that has made plastic surgery a vital subspecialty and that is integral to our future.

The residents that have just been admitted into our programs will complete their training in roughly 6 years and then will practice for another 35 years, as our mentors have before us and as we will in our careers. We are now in 2010—this will bring us to 2051. It seems like a long time in the future, but if we look back at just a few of our mentors, this was a time when Harry Buncke was developing instruments for microsurgery, Joe Murray performed the first kidney transplant, Rad Tanzer performed his first autogenous rib cartilage ear, and craniofacial surgery was born with Paul Tessier. It was also a time that hand surgery began in earnest with Bill Littler and the seeds of many of our other innovations took root.

These seeds—now in the form of tissue engineering and regenerative medicine—have just begun to shows signs that they will revolutionize our field. Along with robotics, we will see major innovations once again revitalize our specialty. They will also redefine our field of practice and once again help us to solve problems that were previously felt to have no solutions.

We will also see composite tissue allografts through transplantation move from research to translation to become a viable choice for our most severely injured patients. We must stay in the lead and remain the leaders in these innovations, as we are the innovators of surgery—it has been our place within the broader field of surgery.

Our residents and fellows must be prepared for their futures that will include these innovations and inventions along with others that we can only imagine at this tine. In addition to these new tools and techniques, we must enable them to prosper within an environment of health care delivery and reimbursement that will also be dramatically changed economically and through new regulations. The nature of practice with the addition of network tools such as the Internet and the Web will give each of our students a global reach.

We cannot predict each of the changes and innovations in our specialty and completely predict the environment that our specialty will work within, whether in private practice or within an academic center. However, we can make our overall plastic surgery educational system provide twenty-first–century tools of education, training, and simulation that will provide the framework for our trainees to succeed and, wherever possible, lead—either as the best-trained practitioners of our techniques or being the special few that contribute new innovations as our mentors have done and in some cases we have hoped to achieve.

Innovations take many forms, from regenerative medicine to how our Journal provides the dissemination of information in a real-time manner to update as rapidly as possible our members to their changing world. We are challenged to stay ahead and lead in both areas—moving research to translation and bringing the fruits of our research to our patients. When we look back at 2010, we will see the beginnings of many opportunities. Whether we use the past as our guide or create a future that is unique, plastic surgery has a philosophy of problem solving that is our birthright. Plastic surgeons are taking an important step to maintain a leadership position in innovation. On May 22 to 23, 2010, a new meeting called Technology Innovation in Plastic Surgery took place in San Francisco. This meeting may be an important milestone for plastic surgeons who want to innovate, and the technology and innovations discussed at Technology Innovation in Plastic Surgery may well revolutionize the field in the years and decades ahead.

We need to think carefully about how best to teach our trainees to be true problem solvers. Each will use his or her special area of expertise, but problem solving is something that can apply to the entire breadth of our specialty, from the very old to the very young, from those that suffer trauma to those that are faced with tumors.

So, you want to be an innovator? The world is wide open to innovation. Plastic surgery needs a constant flow of innovations. Now that we have seen some of the important areas in which we need to innovate, we will next look at key steps to take that make innovation possible. We will explore key tips to innovation. Now is the time to innovate in your practice, in your residency, in your professional and personal life. You will be better for doing it and so will our specialty. After all, we want the next generation of plastic surgeons to continue to own “innovation” as the major organ for plastic and reconstructive surgery.


1.McKeown M. The Truth About Innovation. London: Prentice Hall; 2008.
2.Wikipedia. Available at: Accessed February 22, 2010.
3.Keeley L. History's greatest innovations. Business Week Available at: Accessed February 22, 2010.
4.Husick LA. From stone to silicon: A brief survey of innovation. Philadelphia: Foreign Policy Research Institute; October 2008. Available at: Accessed February 22, 2010.
©2010American Society of Plastic Surgeons