The importance of change and evolution with the passage of time in a plastic surgeon’s thinking, concepts and techniques is Darwinian. Those who are amenable to change and adaption will not only survive but also thrive. Those who continue to practice what they were taught in their residency, or cling to techniques and procedures just because they have done it that way for a number of years will become obsolete at best. The only way a practicing plastic surgeon can avoid making changes is to die or to cease being relevant in our great specialty.
As the years pass, a surgeon has the opportunity to learn from the experience of his own practice, and he or she has the opportunity for shared wisdom from direct contact with colleagues, symposia, books, journals, videos etc. Every surgeon learns a great deal from his patients, who voice their experiences while under his care. A plastic surgeon must accommodate the requests and desires of patients, and be adaptable to the influence of trends. In many instances, patients request smaller procedures with faster healing times, even when they are informed that it is not possible to get the same result that can be achieved with a more extensive procedure.
The experience I have gained from colleagues and patients has helped me evaluate my own surgical techniques and results. Over the years, I have spent a great deal of time in the late evening hours studying pre and post operative photographs of my patients, critically evaluating the results I have achieved and trying to figure out how to make them better. In doing so I have been able to formulate modifications in my thinking and procedures, which have helped bring about a variety of changes. For instance, I perform more short incision facelifts today than earlier years. Also, I perform more imbrication of the underlying foundation than years ago. I still perform SMAS flaps and extended SMAS flaps in patients whose anatomy I feel warrants such. I am more conservative in fat removal during both upper and lower lid blepharoplasty; coronal forehead browlifts in my practice are rare today. Endoscopic browlifts are more frequent and, in some patients, I use a trampoline browlift with only 4 incisions of approximately 5 milliliters each in length. Essentially all of my rhinoplasties are performed closed, but I have modified my techniques to where spreader grafts, strut grafts, and suture contouring of the alar cartilages are routine, just as in open rhinoplasties performed by others.
Although somewhat resistant years ago, I have embraced fillers and neurotoxins and I use them to compliment surgical procedures, or to treat patients who do not need a surgical procedure. I could list all the operations I perform, and note modifications I have made, but that is not the purpose of this editorial. The real purpose is to remind us that a surgeon’s evolution is never finished. He or she can never rest on their laurels or their recent great results. We need to constantly evaluate new information, new ideas, and new technology. While some of it will wind up in the pile labeled, “bad ideas”, a portion of it will become time proven for delivering benefits for surgeons and their patients. There is little question about the fact that, the science of stem cell biology and autologous fat grafting is producing a paradigm shift in both aesthetic and reconstructive plastic surgery in all areas of the body.
In addition, some of the new non-invasive and minimally invasive procedures for facial rejuvenation and body contouring are showing promising results. Sculpting individual anatomic regions, including the buttocks and genitalia are areas that patients are now requesting to have improved. A practicing plastic surgeon must have extensive knowledge in treating these areas.
Change is good and necessary. A surgeon’s evolution can never be finished. And to quote Dr. Thomas Biggs, “Youth is the capacity to adapt to change. I like getting younger!”