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Plastic Surgery, Greatness, and Keeping Our Edge (Reply to Sisti et al.)

Swanson, Eric M.D.

Plastic and Reconstructive Surgery: December 2016 - Volume 138 - Issue 6 - p 1083e–1084e
doi: 10.1097/PRS.0000000000002818

Swanson Center 11413 Ash Street Leawood, Kan. 66211

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Sisti et al.1 concur with Khouri2 that plastic surgeons need to look beyond personal glorification for motivation. The problem is, Khouri is conflicted on this point, stating that part of his motivation for enrolling at medical school was a yearning for greatness.2 Khouri reports that his fellow students become depressed and even suicidal when they fall short of greatness,2 reflecting the (unfortunate) contemporary demand for conspicuous achievement by students.3 Stating that to “improve the human condition every day means you have already achieved greatness”1,2 sounds wonderful, but is naive. We cannot all be great. The reality is, half of us are destined to be below average. Plastic surgeons do better to focus on making a contribution to the specialty, and not one that is motivated solely by profit.3 As a famous American president might have phrased it, Ask not what plastic surgery can do for you but what you can do for plastic surgery.

Sisti et al.1 consider cosmetic and plastic surgery to be dissimilar, with different objectives: form versus function rather than form and function. They view aesthetics as the bridge that joins plastic surgery (meaning reconstructive surgery) with cosmetic surgery.1 In fact, plastic surgery encompasses both reconstructive and cosmetic surgery, which is one reason our society name was abbreviated to the American Society of Plastic Surgeons. Incidentally, cosmetic surgery training is considered an essential part of the American plastic surgery residency curriculum.4

Great as he was, I would not want Michelangelo to be my surgeon, chipping away and trying to liberate a human form in my body, believing he was uniquely touched by genius and divinely inspired.5 It is not reassuring that he had no use for measurements, perhaps explaining why David’s hands, particularly the right hand, are disproportionately large, or perhaps that was intentional (at least that is the contemporary spin). With some hubris, plastic surgeons often cultivate the public perception that we are artists.6 Goldwyn6 joked about wishing he were wearing a beret and a paint-spotted frock when asked by a patient if he paints in his spare time. In truth, plastic surgeons are not sculptors; we do not model clay or marble. Few patients would want their surgeon to indulge his or her artistic impulses in the operating room.5 The template is already there. Plastic surgeons are renovators.3,5 We seek to bring existing tissues to their original (or in the case of cosmetic surgery, their ideal) form.3,5,7 Plastic surgeons require excellent manual skills, but also a critical (and scientific) mind to select valid surgical methods.

Even today, it is possible to sit through an entire day of breast surgery, face lift, body contouring, buttock augmentation, or rhinoplasty presentations, listening to the surgeons’ clinical impressions, without seeing a single set of standardized before and after photographs with measurements. Plastic surgeons attend medical school, and not a fine arts academy, for a reason.3 We need to rededicate ourselves to the scientific method.5 We need to use a ruler (or its computerized analogue) along with a scalpel. In the absence of measurements, we make no progress. Without the scientific method, nothing is ever proven and nothing is ever disproven, a sort of nonscientific purgatory.5 Sadly, we are now in our fifth decade of published articles (>100 and counting) claiming autoaugmentation using existing breast tissue and suspension sutures.5

The scope of our specialty is changing.8 We need to hold on to cosmetic surgery and make sure we protect this hugely important patient group. Young plastic surgeons need to master augmentation/mastopexy, liposuction, and abdominoplasty, and then learn to perform mommy makeovers. We need to see to it that oral surgeons, general surgeons, and gynecologists keep performing oral surgery, general surgery, and gynecology. Ironically, plastic surgeons sometimes seem more interested in assigning risk to combined procedures rather than learning how to perform them safely together.9 Despite not having a body part to call our own,1,7 we can be assured of our future by embracing the scientific method, espousing professionalism (i.e., putting science before marketing and resisting commercial temptations), and outperforming our competitors.5 Plastic surgery is also defined by a commitment to excellence.

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The author declares no potential conflicts of interest with respect to the research, authorship, and publication of this communication. The author received no financial support for the research, authorship, and publication of this communication.

Eric Swanson, M.D.

Swanson Center

11413 Ash Street

Leawood, Kan. 66211

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1. Sisti A, Tassinari J, Nisi G, Grimaldi L. Thoughts about the name of our discipline. Plast Reconstr Surg. Post Acceptance: August 16, 2016.
2. Khouri RK Jr. Chasing greatness. Plast Reconstr Surg. 2015;135:464e–465e.
3. Swanson E. The pursuit of greatness in plastic surgery. Plast Reconstr Surg. 2016;137:908e–909e.
4. The American Board of Plastic Surgery, Inc. Written examination and maintenance of certification program. Available at: Accessed May 14, 2016.
5. Swanson E. The plastic surgeon: Artist or scientist? Plast Reconstr Surg. 2013;131:182–184.
6. Goldwyn RM. The plastic surgeon as an artist. Plast Reconstr Surg. 2003;112:327.
7. Chandra R, Agarwal R, Agarwal D. Redefining plastic surgery. Plast Reconstr Surg Global Open 2016;4:e706.
8. Higgins JP. The diminishing presence of plastic surgeons in hand surgery: A critical analysis. Plast Reconstr Surg. 2010;125:248–260.
9. Swanson E. Our own worst enemy. Plast Reconstr Surg. 2016:137:911e–914e.
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