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Master Techniques in Facial Rejuvenation

Dr. Azizzadeh is the author of the preeminent facial plastic surgery textbook "Master Techniques in Facial Rejuvenation", which is currently in second print. Surgical techniques are described in detail through text, photos, illustrations, and two comprehensive DVD's.

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Facial Plastic & Reconstructive Surgery

Dr. Azizzadeh Course Director for Advances in Facial Plastic & Reconstructive Surgery October 25-26

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The Value of Cosmetic Surgery

In Beverly Hills and serving the Los Angeles area

Guest Editorial
By: William M. Kuzon, JR., M.D., FACS
(Professor of plastic surgery at the University of Michigan, Ann Arbor)

Although cosmetic surgery is widely recognized as a growth industry that has spawned intense competition for prospective patients, most surgeons are likely unaware of the schism created within plastic surgery over this area of practice. Here's my view of what has happened within our specialty over the years.

In the past, most plastic surgeons performed a mix of cosmetic and reconstructive procedures, with reconstructive surgery being perceived as the core mission of the specialty. Plastic surgeons were almost always on hospital staff, took call at hospitals, and performed most of their procedures in hospital-based operating rooms. Beginning in the 1970s, as reconstructive surgical technology rapidly advanced, procedures became long and arduous. Insurance reimbursement failed to keep pace with the true cost-personal and professional-of the procedures, so many plastic surgeons increased their volume of aesthetic cases.

At the outset, I believe, plastic surgeons often saw this trend as a way to pay the bills while performing reconstructive surgery. They continued to do reconstructive work in hospitals, but many began building luxurious office suites and free-standing ORs for cosmetic surgery. Eventually, reconstructive surgery became secondary in these practices, and some plastic surgeons became wholly office-based practitioners. Those who remained on hospital staffs or with academic centers bore substantially more reconstructive cases, sometimes giving up aesthetic surgery altogether.

Today, residents commonly arrange to set up an independent office facility; some of them never apply for hospital privileges. What was once a relatively homogenous specialty has split into two discrete groups of surgeons-primarily cosmetic or primarily reconstructive-who clash on many levels, notably over the use of resources to advance the specialty's financial and academic interests.

The American Society of Plastic Surgeons has done a remarkable job of supporting both reconstructive and aesthetic surgeons, recently enacting a change in governance to enhance the service, educational, and research agendas for plastic surgery. Still, the fact that major action have been taken and the issue continues to be an agenda item for our specialty is an indication of how wide the gap has grown.

While watching this evolution, I have been struck by the fact that most physicians, most surgeons, and even many plastic surgeons cannot answer this question: Why should aesthetic surgery be valued by medical schools, by large medical centers, by the Centers for Medicare and Medicaid Services (which, by the way, pays the salaries of residents in multiple specialties as they learn to do cosmetic procedures), and by the entire medical enterprise?

Think about it. What's your answer?

Here's mine: Aesthetic surgery is the ultimate reconstructive surgical challenge. To undertake a cosmetic procedure, a surgeon must have the enormity of ego, and the skills to support it, to believe that "normal" can be made "better." The surgeon must have a keen eye for surface anatomy and for aesthetics, be sure about every detail of the procedure, and be attentive to the patient's psyche. Management of a complication requires a master surgeon who can resolve the physical problem and cope with the emotional turmoil that invariably surrounds it.

A reconstructive procedure intended to make a physical deformity vanish may be perceived, in a societal sense, as more noble or valuable than an aesthetic case, but reconstructive surgery cannot exist without cosmetic surgery, and vice versa. In order to fulfill the mission of restoring "form and function" to patients, plastic surgeons must continually strive for technical virtuosity and aesthetic perfection. Aesthetic surgery pushes the surgeon to accept nothing but perfection, and aesthetic surgery skills pay enormous dividends for reconstructive patients.

Cosmetic surgery makes reconstructive surgery better, and the two should remain conjoined as the specialty that is plastic surgery.