The thing that blows me away about plastic surgery

[jophe]

How are you guys able to visualize what the end result of a procedure is going to be? Some of the procedures look brutal, and messy, at times - its hard to believe it (whatever is being operated on) will end up aesthetically sound. Can anybody, with enough training, become a good plastic surgeon? Or do you need talent within the realm of visual aesthetics - kind of like a graphic designer, architect, fashion designer, etc? Or in other words, have an "eye" for it?

---

Members don't see this ad.

 

[jophe]

73 views and no replies? Did I break one of the forum guidelines with this question? I would really like to hear people's opinions on this post.

 

[martyshka82]

I don't think the medical students on this forum really have the experience to answer this, and I doubt there's too many experienced plastics attendings browsing...

 

[PlasticMan]

I'm only an MS1, but the only reason I've entered medical school is the intention on becoming a plastic surgeon. I think it probably requires some of both - ability to visual and technical skill. Automatically for the longest time, whenever I see people I always instinctively picture what they would look like if they had a rhinoplasty or a chin augmentation,etc. I don't think you have to be an artist to do it. I've never been able to draw or paint, b/c I have a problem converting 3D to 2D on paper, but I have no problem visualizing things in 3D.

As for being a plastic surgeon or any surgeon for that matter, I would think one would need to be good with and enjoy working with their hands. I've always worked on cars alot and continue to do so even while I'm in medical school. If you like working on cars, fixing things like plumbing, taking things apart, etc. I would think that's a good indication that you're good with your hands.

 

[MOHS_01]

While not a plastic surgeon, I probably perform more facial reconstruction following skin cancer extirpation than >90% of plastic surgeons. During my fellowship year I performed >1300 facial reconstructions. Granted, most of them were not overly complicated, but greater than half required some form of graft or flap repair.

To answer your question -- you need to have some natural ability to imagine what things will look like in the end. This is what separates the average from the good -- it is easy to "close the hole", but a good reconstructive surgeon does much more than that. Experience will make you better, but if you are unable to conceptualize what someone wants/needs, you will never be as good as the doc who can.

This carries over to the cosmetic side of things as well. One of the more difficult problems is dealing with the early aging mid and lower face -- you know the person that is starting to show their age but is not quite ready for a face lift yet. A good pair of lips require some artistic ability, and good Botox jobs also are an art. It is easy to paralyze the musculature with Botox, but it is much more difficult to merely weaken the musculature proportionately with regard to other muscle groups in an effort to maintain a degree of facial expression.

 

[naegleria brain]

i talked to a few plastics guys with that same question; i can't draw for crap, but i liked the concept and the field seems cool.

he told me that no matter what you do, the point of residency is to beat the procedure into your head so many times that you can do it in your sleep. his words were "if you still think it's cool, you haven't done it enough times, and i don't want you operating on me"

altho a unique perspective, and debatable; he does have a point. 6 years of operating, at least half of those on just doing plastics every day for 1000 days, and you'll be good at it. of course, having an intrinsic ability is what draws most people into the field in the first place

analogy - if i played basketball 100 hrs a week for 5+ years, i'll be pretty darn good; if i grew a few more inches, maybe i'd get into the NBA. i'd never be as good as, say, michael jordon. but the thing is, not everyone can be the best, and somewhere along the way you have to be content with being more than competent. if i had a brain tumor, i'd like the best neurosurgeon in the world to take it out, but so would we all, and if i can't get him, i'll deal with the best of what i got. i guess that's a more philosophical question of accepting the best you have as your resources and working with it. off topic.

in the end, if you love it, go for it. theyll make sure you're trained so you can do it, whether you go in having memorized the entire textbook on plastic surgery, van gogh, picasso (tho i'd be a bit afraid of him), or just a guy/girl who loves changing people's appearances

 

[msl2007]

One of my attendings on the PRS service had to sculpt something, anything, out of a bar of soap at his residency interview. This was years ago of course. I don't know if that type of thing still goes on, or matters. I am going into general so I only have to be able to draw a straight line for the incision!

 

[cdql]

i talked to a few plastics guys with that same question; i can't draw for crap, but i liked the concept and the field seems cool.

he told me that no matter what you do, the point of residency is to beat the procedure into your head so many times that you can do it in your sleep. his words were "if you still think it's cool, you haven't done it enough times, and i don't want you operating on me"

out of curiousity, where do you go to school? i had a plastics attending tell me the exact same thing when I rotated thru as an elective

 

[naegleria brain]

its in philadelphia

your profile says boston - i guess they all just think alike?

 

[jaydoc07]

One of my attendings on the PRS service had to sculpt something, anything, out of a bar of soap at his residency interview. This was years ago of course. I don't know if that type of thing still goes on, or matters. I am going into general so I only have to be able to draw a straight line for the incision!

That still happens.

 

[cdql]

its in philadelphia

your profile says boston - i guess they all just think alike?

i guess so. yeah, I'm in Boston. my roommate from college went to UPenn for med school though. how do you like it there?

 

[Moravian]

I'm just finishing a two year fellowship after 5 years of general surgery. To this point in my fellowship, I have logged over 1,100 procedure codes on 600 plus patients. Many of the procedures I had trouble with I can now do easily because of repetition.

I agree with the basketball analogy to some extent. Everyone can learn to play, but not everyone gets to the pros. There are a lot of community plastic guys out there doing good things, although their results may not be on par with Guys like Scott Spears, Greg Jelks, etc. And, sorry to say, there are folks that just don't make it that far. We recently lost a fellow when they decided they couldn't make the leap to from general to plastics.

That being said, I also think you tend to gravitate to what you can do best. I love craniofacial surgery and micro/reconstruction. I had the hardest time with cleft lips, but I persevered, read constantly, reviewed videos, went on a mission trip and I finally got it. On the other hand, I'm not such a great breast surgeon. Whatever it is that gives my attending the ability to look at a hunk of abdominal muscle/skin and turn it into a fine looking breast mound is beyond me. Since I don't intend to be a breast surgeon, it doesn't bother me.

I think that, in order to even consider surgery, you probably already have an inclination and talent toward dexterity and visualization, with some small exception. You'll tend to gravitate toward what you do best no matter what the field you subspecialize in.

One of my attendings in general surgery once told me that he could teach a monkey to operate, he couldn't teach them to care or to possess enough insight to learn from mistakes and make better judment calls. In other words, it's easier to train (and to trust) someone with good judgement and who cares about their patients and their outcomes than someone with great hands who does neither.

 

[jophe]

Wow, I forgot I even posted this! Thanks to everyone who responded