With the great football finals in 2022 still fresh in my memory, I am reminded of what happened on a Friday evening almost 25 years ago in England. We, a big bunch of young doctors in training comprising specialist trainees were watching a tough match between England and Netherlands. The Netherlands scored a goal. The match was on. Sometime later as the climax and the end of the game was approaching, I got a beep from the emergency department. Those days we had pagers you see, which beeps and we have to phone the emergency department. As I got up to the phone, a psychiatrist asked me, “What emergency does a plastic surgeon DO? Are you going to perform an emergency nose operation or a beautification of the face, a facelift?” He did mean it and was not meant as a joke. He had no idea what emergency a plastic surgeon does. Such was the ignorance even among the doctors. Anyway, it turned out that one of the fans had bitten off the ear of a nearby football fan in the bar where they were drinking and watching the match. A plastic surgeon gets summoned for that. Injuries of any form including burns, road traffic accidents, domestic, or industrial injuries to the head and neck, hands and foot need a thorough knowledge, evaluation and skilled hands to repair, restore and rehabilitate these vital structures.
The face has vital structures, four of the 5 sensory organs are there in the face. The face is an important organ reflecting our inner well-being.
அகத்தின் அழகு முகத்தில் தெரியும்.
Beauty apart, it is the most important organ responsible for major nonverbal communication and facial presentation is so vital for self-image and self-confidence. It is a huge misconception that any injury or damage to the face, hands and feet has to be done as quickly as possible. As plastic surgeons we would like everybody to take home this message that “The first time is the best time”, meaning modern plastic surgeons believe that the best has to be done at the time of injury. There used to be a notion and sadly sometimes prevalent even today also that – “get the first aid done and the plastic surgeon will set things right”. Nothing can be far from the truth. Again would like to emphasise” First time is the best time”.
The hands are the important organs for the breadwinner of a family. Again a large number of vital structures are compactly and efficiently packed in a comparatively small structure like a finger. First consultation and intervention by a plastic surgeon are vital for the normal looks and function of the hand. Delay and inappropriate first treatment leads to loss of function and loss of a job in many instances. This can cripple the family.
While in Paris, I had the opportunity to interact with a legend of a Surgeon Paul Tessier. He was contemplating on how to correct malformed faces and skulls. He was obsessed with the problem but there was no prescribed solution. That's when he said “pourquoi pas? I say “WHY NOT?”
In children with grotesque-looking faces, when there was no recommended surgical procedure, he devised procedures saying “why not”. A plastic surgeon is a unique animal. He not only needs a wide and deep knowledge but also a deep sense of imagination and technical skill to execute his imagination. After all the first kidney transplantation was done by a plastic surgeon. When the kidneys had failed he thought why not replace the kidney? Dr. Tessier managed to move eyeballs placed in different locations and bring them back to a normal-looking face. The bitten ear mentioned above needs several options to reconstruct. The best and most reproducible option has to be performed. We had instances where the thumb was crushed, and at the same time, the foot had been amputated, the big toe was used to reconstruct the thumb. Such is the possibility. In the picture below, the middle finger has been used to replace the index finger that was badly damaged. The hand is restored to a useful workable hand. A factory worker is rehabilitated to become an auto driver and still earn his livelihood. Another phrase a plastic surgeon often echos is “there are no MAJOR or minor surgeries, there are only major and MINOR surgeons”. Even a small cut or an injury has to be dealt with as meticulously as a major one.
40% of the work of a plastic surgeon is to correct problems arising out of delayed or improper and hurried procedures done in less than optimal circumstances and not by skilled plastic surgeon. This includes the scars arising after healing. Scars can be unsightly by themselves but also have a lot of undesirable effects. Scar correction for beauty is necessary and is essential. This common surgery thankfully is well known by the patients. However emphasis will be to make sure this major complication be avoided by seeking plastic surgery as the first choice. Subsequent surgeries have lesser and lesser chances of successful outcomes, another phrase comes to my mind “diminishing returns with further procedures”.
In summary, I would like to bring out a few salient features, which will make a plastic surgeon happy, and thus the patient too.
The first time intervention is the best time in an injury of the face, hands and the foot. Otherwise there are diminishing returns subsequently.
Skilled surgeons and places with the ideal infrastructure give predictable results.
A plastic surgeon is very versatile, has to be imaginative and call out “why not” and have a never give up attitude to give the best results to the patients.
Contrary to popular belief, a plastic surgical intervention will turn out to be a cheaper option. A common response by a patient on being referred to a plastic surgeon is that plastic surgery is going to be expensive.
In conclusion, at Kauvery Hospital, the emergency department is well-versed in the spectrum of care provided by plastic surgeons. The first line health providers here do not delay calling for help and for continuity of treatment.
This article is to debunk some of the myths about plastic surgery. Early, skilled, appropriate plastic surgery always turns out to be cost-effective and remember there are no minor surgeries. A plastic surgeon looks at even the so-called minor surgery his utmost care and attention.
A patient’s good outcome and best results shows and are there for all to see.
This boosts the impression of the surgeon and the institute.