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COSMETIC MEDICINE

exploratory laparotomies, tracheostomies, etc. Once lifesaving ma- room or unfavorable outcomes post-operatively without the proper
neuvers were complete, general surgeons, orthopedic surgeons, neu- building blocks in place. Like any other medical specialty, experi-
rosurgeons, otolaryngologists, ophthalmologists and anesthesiologists ence is of paramount importance in surgery. The combination of
would get to the grim task of putting the victims (and sometimes the shortened training programs and a lack of hard-earned clinical ex-
assailants) back together. In most cases, this was a salvage operation perience is concerning.
designed only to stabilize the patients for the next echelon of care. I Then again, maybe I’m just old fashioned about these things.
would cover bowel in one room, bone in another, and brain in the When I finished my general surgery residency, my plan was to go
next, until all of the directly into a plastic
vital structures were surgery residency. The
protected and the dust Air Force had other
had settled. For those plans and I ended up
who were not being working three years as
shipped out in the next a general surgeon. I
six to eight hours, we was admittedly bitter
would often spend sev- and angry at the time,
eral weeks fine tuning but in retrospect,
the reconstructions, those three years as a
sometimes rebuilding staff general surgeon
lips, noses, ears and made me a sharper
anything else that was missing or damaged. plastic surgeon. I was better prepared for my residency and entered
During winter when fighting slowed, we would often direct our with confidence that I could tackle most anything. General Surgery
efforts to restoring local civilians to good health. This was an ex- may not have had a direct correlation with what most people would
cellent way to win the hearts of the resident population and was consider the core of plastic surgery, but it laid the foundation in
also a rewarding endeavor for the physicians. We typically corrected much the same way as reconstructive surgery laid the foundation
traumatic injuries, severe burns, or even congenital anomalies such for aesthetic surgery.
as cleft lip and palate. Suffice it to say that there is never a shortage As I move along this road, I am grateful for the struggles and
of people needing a specialty-trained surgeon in a war-torn country. conflicts that I have been privileged to experience. They have all
These were some of the most difficult cases that I have ever come played a role in shaping me into the surgeon that I am today. I make
across, but like most things in medicine, if you apply the principles it a point to share these experiences with my patients whenever pos-
that you were taught in the earliest stages of your training, you can sible, as I believe that it reinforces their confidence in my ability to
work through most any circumstance. handle any situation that may arise during their care. When they ask
It is the application of those general principles that brings me to me how many noses I have done, I also tell them how many I have
the broader point that I mentioned above: plastic surgery is a re- built from scratch. When they ask me how many breast augmenta-
constructive spectrum. Reconstructive surgery is just that, building tions I’ve done, I also tell them how many breast reconstructions
something out of nothing, or almost nothing. Aesthetic surgery is I’ve done. Patients appreciate that experience and perspective and
the enhancement of existing structures. Of the two, it is apparent our rapport is strengthened because of it.
which is the more difficult. I have no doubt that without my recon- We all like the compensation that comes with the cosmetic end
structive foundation, my comprehension of complex anatomy and of our craft, but hopefully we won’t forget the path that got us here.
the ability to integrate that knowledge into a successful cosmetic It is truly the most rewarding part of our profession.
outcome would be severely hampered.
We have entered into an era in which newly minted plastic sur- Earl E. Ferguson III, MD is a board-certified plastic surgeon
geons — as well as many other specialists — are choosing to who practices in San Antonio and a member of the Bexar County
forego the foundational years as a reconstructive surgeon to plunge Medical Society. He retired from the military after finishing his
headlong into the cosmetic realm. I question whether one can ef- career as Chief of Plastic Surgery for the Air Force and continues
fectively manage unexpected anatomic anomalies in the operating to do a mix of aesthetic and reconstructive surgery.

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