Which Plastic Surgery Technique is Best?

Plastic surgeons are creative people. We use our creativity to solve problems. There’s a joke amongst us: if you ask five plastic surgeons to develop an operation to solve a given problem you’re going to get five different solutions. Assuming all five operations solve the problem how does a plastic surgeon know which operation is the best?

In the old days, most plastic surgeons used the technique they learned in residency. However, every great plastic surgeon always looks to improve their result. I trained at Stanford University – arguably the finest plastic surgery program in the United States- but I recognized that no single institution could excel in every discipline.  So, after completing my basic residency training, I traveled worldwide for an entire year to study with the best plastic surgeons in each of the cosmetic surgery specialties.  I spent anywhere from a few days to a few months with over 30 surgeons, and I have maintained contact with them throughout my career.  Now, if someone develops a new technique, I’ll contact them, chat with them, and frequently travel to observe them in person.

How to Choose Between Techniques

What do you do if there are two techniques which work, and are similar in terms of safety, cost, and recovery time?  The answer is – you do the one that gets the best result. Right, simple… but who determines which result is best?

Here’s an example: When I do a tummy tuck I need to recreate the belly button (called the umbilicus). The lower tummy skin is usually excessive and wrinkled.  The upper tummy skin is smoother. In a tummy tuck, I remove the excess lower abdominal skin and fat, lift the upper abdominal skin and fat, and advance it down to close the opening created by removing the lower skin.   When I do that, I preserve the belly button but have to create an opening in the upper abdominal skin to allow the belly button to show through.  That step is called the umbilicoplasty. And – drum roll please – there are about 6 different ways to create an opening.

I’ve tried them all – and they all work.  I have one technique that I like the best, for the average patient, but I keep all the techniques in my “toolbox” and use the one for each patient that I think is best for that patient. The results are slightly different for each technique.

Who Knows Best?

In a recent article in the Plastic Surgery Journal (where many of my techniques have been published), plastic surgeons from Harvard and LSU sent a questionnaire to 14 plastic surgeons (11 men, 3 women), showing photographs of results using three different umbilicoplasty techniques and asked them to rate the results. They also sent the questionnaire out to 500 regular folks (non-surgeons). Here’s the interesting result: the plastic surgeons were evenly split amongst the various techniques but the non-surgeons (the “crowd”) showed a strong preference for one of the techniques. In other words, Crowd Sourcing (using the public) said if you can use one specific technique, this is the one we prefer.

Find a Doctor Who Listens to You

What does this mean? Simple – listen to your patients!  Surgeons should show patients a variety of results and let them tell select what they like best. That’s why I spend so much time in consultation with my patients BEFORE the surgery – it’s time well spent!