209
PRAISE FOR COSMETIC SURGERY
TABLE 1. WHAT A DERMATOLOGIC COSMETIC
SURGEON MUST BE
book
, T. Baker3
Surgical Rejuvenation of the Face
complains about the scarce training in cosmetic
surgery received by the residents in plastic sur-
gery and advocated for a change, stating that
“our formal training programs were as defi-
cient in aesthetic surgery as most programs. . . .
The mention of aesthetic surgery to our teach-
ers was often met with supercilious disdain. As
a result of this gap in our formal training, we
were forced to educate ourselves during the
early years of our practice. The public then, as
well as now, expected a plastic surgeon to be
expert in aesthetic surgery first and foremost.
We would have welcomed a ‘how-to-do-it’
book on aesthetic surgery.”3
Dermatologic surgery began to develop in
the middle of the decade of the 1960s.1 How-
ever, as it occurred with plastic surgery, pio-
neers in this field were seen as iconoclasts and
newcomers, similar to dilettantes and surreal-
ists. It was limited to the practice of direct skin
closures, the removal of small nevi, or making
small flaps. Mohs’ removals called for the de-
velopment of complicated surgical corrections.
More complex procedures were formulated as
a result of newer and unsuspected technolo-
gies.1,2,4
A physician with a high sense of ethics
A good clinician
A skilled dermatopathologist
A dedicated surgeon
sides many other advances, was one of the first
great surgeons who emphasized that humane
behavior toward patients is an integral part of
the medical profession. Paré was also very care-
ful with the cosmetic results of his surgeries.7–10
Great surgeons and extraordinary advances
in the development of surgery occurred in the
following centuries. But these were also dark-
ened by constant attacks against it. The history
of Semmelweis is particularly clarifying in this
respect. An obstetrician at the maternity hos-
pital in Vienna, Semmelweis noted a lesser in-
cidence of deaths by puerperal fever when sur-
geons washed their hands before attending
their patients. Although facts confirmed his
theory, Semmelweis was severely attacked and
he was prohibited to treat his patients.8,9 Inno-
vators seem to attract resentment, hatred, and
rejection.
In the twentieth century, there were surgeons
who gave us or developed chemical peels (Lit-
ton, Baker), hair transplants (Orentreich), laser
surgery (Goldman), cosmetic reconstruction post-
Mohs surgery (Stegman), liposuction (Illouz,
Fisher, Fournier, Klein), rhinoplasty (Newman),
simplification in rhytidectomy (Saylan), and mi-
crodermabrasion (Hopping).2,4
The real, effective, and incomparable renais-
sance of cosmetic surgery as a part of the med-
ical sciences began in the twentieth century. As
a specialty, plastic surgery had its formal recog-
nition up to the second half of the 1940s.2,4,5 Its
primordia in Germany, Austria, and Italy, in
connection with the treatment of burns, were
masterly described by Hebra and Kaposi, a sur-
gical concept initially unified by dermatology.2
During its beginning, plastic surgery was fun-
damentally oriented to reconstruction since, in
the government hospitals where the residents
were trained in this specialty, patients were
COSMETIC ENHANCEMENT, SELF-
ESTEEM, AND NARCISSISM
The World Health Organization (WHO) de-
fines health “not only as the absence of sick-
ness, but like a state of full well-being: physi-
cal, mental and social.”11 Here is where the
concept allows us to look at the individual as
a person whose psyche and self-esteem deserve
all our respect. Paul Valery said, “Health is the
silence of the organs,“12 and should not be lost
or diminished in self-esteem.
When we are going to operate on a patient
for aesthetic purposes, it is self-esteem, which
TABLE 2. QUALITIES THAT THE COSMETIC SURGEON
MUST POSSESS
A profound and cultivated sense of aesthetics
seen as a consequence of trauma, burns (the re- The sensibility of an sculptor
constructive area), or congenital defects, and
not for cosmetic purposes. In the preface of his
The scrupulousness of a goldsmith
The refinement of a poet