Showing posts with label Plastic Surgery. Show all posts
Showing posts with label Plastic Surgery. Show all posts

Sunday, June 7, 2015

That Ugly Truth

That Ugly Truth



I answered a question on Quora yesterday – in the plastic surgery section-about the importance of beauty in our society and our double standards we show in our daily life. The question asked, although I am paraphrasing it here as short as possible, pretty bluntly “why do ugly people live? why don’t they kill themselves off? Or at least get plastic surgery to make themselves look normal?” I will come to my answer on quora later in this post. Right now I wish to discuss a bit more about this question here.

The first thing I checked when I read the question was the person who asked it and I was not surprised to see that the doubt had come to a girl, all of 19 years and living in India’s most cosmopolitan city Bangalore. Why I wasn’t surprised is because I know men, ugly to them is just another categorization- men will check out, wolf whistle, oogle at any girl regardless of her beauty or lack of it- she just has to be a girl, any size, colour, frame will do.  Men mostly are fair in giving every women a chance with zero discrimination and still getting panned for low standards and lack of taste.  Women on the other hand. Have you ever heard any man rejecting a girl who proposed to him by giving the reason that she was too ugly and he couldn’t show her off to his friends? Its women who can be so forthright and downright cruel when they shrug advances off ugly men by telling them so pointblank.

Of all my years practicing the fine art of esthetic surgery I have never had ( I am just sharing my own experiences here) any man bring in his wife and requested me to do plastic surgery on her because he is not satisfied with her, the way she is. But I have had lots and lots of women who bring in their (looking like lambs to the slaughter) husbands and ask if I could do “anything” for them to make them look more presentable, as if they were stuck with defective products which they were now giving for servicing. If there is something that my profession has shown me in all these years it is just that when it comes to relationships people give lip service to things like compatibility, kindness and all that gooey stuff people share as internet memes. The real wants of women when it comes to prospective partners are  - being good looking and handsome in early twenties, being at least ok looking in end twenties and ok eyes closed someone to marry in their early thirties to I just want a baby the man doesn’t matter in their late thirties. With men their wants are simplicity itself - it’s just a girl in girls clothing- be it early twenties or late fifties- that will do for all men. 

And as for my quora answer I told the girl to basically “go f**k herself off” in as polite a way as I could before she demands that 90% of the worlds population die off just to satisfy her esthetic senses.  There are not enough plastic surgeons in the world (or for that matter surgeons) if everyone who is dissatisfied with the way they look wanted to be better looking than nature made them. Do you for instance think that I would look the way I do given what I do if there was indeed a practical way of doing it? I know for a fact that I don’t intend to spend the next fifteen to twenty years and spend all of my fortune (and my ancestral fortune thrown in) just so some random person on the street will judge me as good looking. That will be madness. Compared to that looking ugly is a better option. At least I get to call out everyone who worships beauty as the only thing in life as shallow, mean minded persons, don’t I?

It’s the ugly truth, but there, it is the truth.


Monday, September 22, 2014

The Art of Plastic Surgery



The Art of Plastic Surgery



How do you teach art to students? You can teach science but how do you teach the nuances of art? How for example do you teach someone to look beyond the lump of stone in front of them; at the beautiful statue it is going to turn into at the end of your chiseling? This question – the how-to communicate the excitement of the end result at the initial start is something which has been plaguing me ever since I got to teach a bunch of interns the nuances of plastic surgery work. 

Let me confess- I am a bad teacher. I just don’t have the inclination or patience to stand by watching people mutilate tissues in the name of learning while I, the expert am standing there hands tied behind, itching to take the knife in my hands- my expert hands- to finish the case and get a beautiful result. But working in a large teaching institution means I have to bear these crosses and trials everyday – to stand by and just watch and direct – all in the name of teaching. And I have found by empirical study of the students that although surgery can be taught- plastic surgery cannot be taught- at least not that easily. It not only requires good, make that “great” surgical hands and tissue handling skills it also requires a fantastic imagination to see the end result before you even start- to stare at clay and see the statue. I don’t know how art teachers do it- how they inspire sculptors or painters to exceed their limitations as students and learn to produce masterpieces and I for one, would certainly like to learn the secret of how-to-teach imagination, a bold rethinking from mundane objects- if anyone who knows can share it with me.

And all these weeks of teaching has shown me only this- most people, make that the majority aspire to just mediocrity- if I can do such and such as a basic minimum that’s enough to earn a comfortable living kinda mentality. It’s very, very rare to find someone who wants to go beyond this morass of mediocrity and aspire to be a great surgeon- someone who can compete with the best internationally- like I aspired to do when I was younger and in training to be a surgeon. That kinda ambition, that hunger, that pride is absolutely not there now and I don’t know why- is it the educational system or is it individual drive which is lacking. But till now- all I have seen are also-rans. I am still looking forward to gaining a thoroughbred as my apprentice- someone worth teaching all my techincal skills to. Am waiting guys….

Thursday, June 26, 2014

Last Minute Decisions and Iffy Results



Last Minute Decisions and Iffy Results



So this morning I made an error. I call it an error, say of judgment, rather than a mistake, because split semantics aside, it came off a gamble I took which didn’t pay off as it should have because of unexpected circumstances beyond my anticipation.  There was this case we had posted for surgery a week (10days?) ago and back then we had reviewed the case and had decided to go for a full thickness (epithelium+ connective tissue+ periosteum) flap. But today when the patient turned up for surgery and was prepped, anaesthetized and ready to be operated on, I took a long, long look at the operating site and my surgical judgment (my intuition?) telling me that with a split thickness flap (a half-way flap) will give better results and also help in preserving the donor site from where I was going to harvest the graft and then stitch it to the new (deficient site), I made the split-second decision to go for the tougher to do split thickness flap instead of the agreed on protocol and proceeded to raise a beautiful split flap. And then came the anti-climax. 

The theatre staff handed me 3-0 sutures which is what they had ready for a full flap while I prefer to use a 5-0 suture (thinner one) to stitch a thinner split flap. Although the theatre IS  supposed to have all sizes of sutures at all times (for all surgeries) somehow they did not have what I wanted right then and I had to make do with the had – a 3-0 size only which dint really fit the thin flap I had taken. So I wasn’t really satisfied with the end result of my surgery and will eagerly wait for next week when the sutures come off to see the result – fingers crossed. 

The thing is I am still in a dilemma about whether I should have stuck to my original surgical plan frozen a week ago or should I have made the call to change the design at the moment of surgery. Do good intentions excuse an error of judgment? What if the gamble had paid off, as it would have if the nurses had properly stocked the operating theatre? There are so many “IF’s” but no clear cut answers. The only thing of certainty is I took a risk and it didn’t come off as it should have – maybe a 70% success rate only- which may be good enough for the patient but still is kinda hurting to my ego. So was I justified in giving precedence to my surgical skill over the team decisions by invoking my privilege as the operating surgeon? The jury’s out till the sutures come of…and till then feel free to pop in with your views on what I should or should not have done.

Thursday, June 19, 2014

No Shame In Saying I Don’t Know, Is There?



No Shame In Saying I Don’t Know, Is There?



So they called me today all of a sudden in the middle of my canteen break (for those of my readers from countries which were never under the shadow of the British Empire – a canteen break is a midmorning visit to the in-house cafeteria – say around 11am- for a coffee/tea) with an emergency call and unlooked for appearance of a postgraduate student standing beside my cafeteria table, staring morosely down at my tea before saying “they want you back at the department sir, something not right with the laser”.

So I leave my half drunk tea on the canteen table with a look of longing and hurry back to the surgery room screaming “What? What? What? What happened?” to find the two guilty persons who tried to use the laser unit in my absence (temporary/tea break) adopting an unconcerned “we are not responsible” look. Seems they had tried to do a case (a surgery) all by themselves and the laser had malfunctioned and they tried to lay the blame solely on me saying that “you were the last person to use it” to which I replied irritably “yeah and I left it in good working condition just a few minutes ago”. For I knew they were trying to pin the blame of the malfunctioning unit on me and try to appropriate my next month’s salary towards repairs for the at-fault laser unit- on the principle that the last person gets blamed and foots the bill. 

So I went up to the unit and checked it and found it was working fine. Surprised I asked them to demo to me what they were doing with the laser. So they sat there the two of them and applied the laser to the anesthetized patient and waited for it to start cutting and then after a few minutes they turned towards me and said “See, its not cutting”. Whereupon I asked one of them to vacate the seat and sat down took the laser in my hand put it near the surgical site, operated the foot switch, cut the tissue and showed them “see, it works now, by magic”. The poor fools had not realized that the laser operated with a foot switch which they had comfortably left all alone between the two of them and neither of them operating it and they had thought that you just need to point a laser at something for it to start working. And of course they had thought they could do it in my absence in the mistaken belief that what he does we can do too- without learning at least the basic functions of the machine. 

Which shows once again that people would pretend anything except to accept their ignorance of something. I hope they all realize soon that it’s never too late or too much to ask for help and its definitely no shame to say those three magic words “I don’t know”.

Tuesday, June 17, 2014

Lasers Vs Conventional Surgeries



Lasers Vs Conventional Surgeries

For those who ask me why lasers, well I got a one word answer for you (well, actually two words) – no sutures. Remember those sharp curved long needle things with threads attached to them which doctors poke into your body umpteen times and use weird contortionist positions to tie them into knots (knot after knot after knot?) well those stitches or sutures are “gone with the wind” baby when it comes to laser surgeries. Now coming to the other side of the argument that lasers are expensive to use and why surgeons are pushing lasers more than scalpel surgeries all the time and is it because it’s convenient for them and not for the patient. Well, I agree that surgeons more and more prefer to use lasers nowadays for even the simplest and shortest of surgeries. But it’s not only because of its convenience given that a laser surgery is done in a clean and bloodless field for laser automatically coagulates (clots) the blood vessels- thereby preventing bleeding and thereby allowing the surgeon to see what actually he is doing with sharp instruments and voila you get great results, which is what you want right?. And because the surgeon can work calmly with no blood and clear vision of the operating site – even in extremely bleeding sites like, for example, the tongue which is notorious for its rich blood supply and for bleeding excessively even for minor injuries and hence tongue injuries are a real bitch to treat (sample case below of a tongue tie patient -with a pronounced lisp- being treated by me with a laser during a tongue release surgery). And of course the USP of lasers – no stitches. Now tell me isn’t a laser worth the price?

The Tongue-tied patient


Me using the Laser to cut

Pulling back the tongue with a temporary stay suture to expose the undersurface

The End. Finis. Bye-bubyee


Sunday, November 17, 2013

Last Minute Wisdom ????



Last Minute Wisdom ??? Or Blues ????

Disclaimer: This post is a work of fiction and any resemblance to any person or incident in real life is strictly imaginary and no way involving any professional trust issues.


This morning I was left completely free of any work, quite unexpectedly if i may add. And no it was not of my own volition for I would much rather have been busy doing some surgery but my only patient for the day canceled her surgery and walked away without looking back. And that is the story I am going to share with you now. There i was all bright and early in the morning, with a strong filter coffee inside me and entering the operation theater for my morning surgery when I heard a mild commotion near the operation table at the far end of the room - near the anesthetic apparatus. I walked over to see what the heck was going on and that too right on my surgical time and was surprised, well shocked would be a better word - to see my patient still on her feet when by rights she should have been flat on the table conked out by the anesthesia and ready to be cut open.

As i neared the group surrounding the girl(the patient) and arguing with her- the girl shook off the nurse who had a restraining hold on her arm and saying "I don’t want the operation" she walked out of the theater leaving us all flabbergasted with her insouciance. There was nothing we could have done to stop her- she had every right to decide on the surgery- right up to the last minute and she had obviously exercised her right to walk out at the very last minute possible. My mind working overtime on the why, I hurried back after her to catch her before she left and ask her if she could at least tell me her reason for canceling at the last minute.

And as I came out through the swing doors of the theater I could see my patient arguing vehemently with her mother who was waiting outside the operation theatre and just as I neared them her mother turned towards me and said "doc, give her anesthesia and just do it, don’t listen to her, she is just afraid". I shook my head sadly at her and said "now listen Mrs. So-and-so, she is a major and she has every right to decide what’s good for her. I never treat people who are unwilling for treatment" and as soon as I said that the girl pulled her mother along by the arm and they left without a backward glance- ruining my day effectively.

A few minutes later as the entire surgical staff got back together in the empty operation theatre to discuss what had just happened there was an immediate attempt to lay the blame on me as the admitting surgeon for not getting the patients wholehearted willingness before the surgery. I immediately defended myself by taking out the case notes to show that the patient had met me thrice over the past ten days and had done all the necessary investigations promptly which showed she was willing to undergo the surgery till she had come in and I wanted to know from the operating staff nurses and the anesthetist what made her change her mind just before anesthesia.

As a matter of fact no one really could say why for sure but we all could make a guess- some patients, in fact most patients rarely realize the seriousness of what they have signed up for until the moment they are lying on that operation table staring into the overhead light and waiting for the anesthetist to start injecting. Its then that they have a profound realization that this is IT- I am undergoing a surgery involving my body parts and a lot of blood. If it’s a case of where the patient has been suffering from pain or disease for a long time then they actually welcome the surgery as the last step towards a permanent cure for their disease. But most cosmetic surgeries are not for pain relief- but just for vanity's sake. Hence second thoughts when they are on the verge of changing something they might not have liked but had been born with and accepted till now.

And later on as I sat in the canteen sipping an insipid cup of tea I went over the various visits of that girl (before today) for consultation and I could have kicked myself as I realized that the patterns fit. Right on the first visit she had said “my mother feels that I have so-and-so problem” when she described why she had come. And then later on during the second visit when I had complimented her on her punctuality she said the credit should go to her mom who had dragged her there on time. In hindsight I see now what I should have realized before - that the patient was not interested much but it was the mother who had pushed the girl to get it done to improve her chances in the marriage market and so the patient had gone along with her mother’s wishes up to a certain point and then had suddenly rebelled -causing a shock to the poor unfortunate doctors.

The trouble with doing cosmetic surgeries is most patients don’t realize themselves why they want the surgery. They are usually confused and act on the advice or more probably the taunts of their near and dear- usually a mother or a boyfriend or a husband. Many's the time when a young and good looking girl walks in to our cosmetic clinic and says straight off "My husband feels my nose is too large and wants me to reduce it". Whenever I hear this dialogue I am immediately tempted to advice her to go back to her husband and ask him how come he didn’t notice the large nose before the wedding and which body part of hers had captivated his attention so much that he was willing to marry her just to get his hands on it disregarding the obviously large nose staring right in front of his face. But of course I can’t tell the women patients that kind of truth can I? Or else I would be accused of breaking up families, god forbid. In fact, most nose surgeries are unnecessary in my opinion for every individual has a different shape and all of them have their own beauty- we don’t need to make it all the same boring type.

And this is the reason why for any cosmetic surgery we docs spend a long time counseling the patients against the  surgeries or at least make them wait and come back again and again until they are absolutely sure they want to undergo the treatment and not do it on a sudden whim. Especially when it is for young girls who  are about to enter into the marriage market and want to get things corrected beforehand- we always do counseling to make them understand that their self esteem is not affected by body issues and they are doing it for the right reasons. And as I personally keep saying every chance I get- for below 45 years of age- just diet and exercise will achieve all the results that surgery can give. It’s only in the late 40's and early 50's you need face lifts and wrinkle removal surgeries. A balanced diet and adequate exercise does wonders for your face and keeps you young forever.

And this is the respectable part of the profession I am talking about while in fact there is another less disreputable part of the profession we don’t usually talk about which involves unnecessary surgeries (from the surgeons point of view) but where the patients are willing as hell to get them done- things like breast enhancements, buttocks lifts and vaginal tightening and hymen reconstructions etc. Doctors are supposed to be non-judgmental when it comes to patients but that can’t stop us from thinking inside our own minds can it? Like itching to ask a patient "ok you get your breasts made big for one boyfriend who likes 'em big and then he dumps you and your next one fancies bigger butts and you sign up for it too..How far will you go? How many alterations will you make to all your body parts till you finally catch "that dream boy" for whom you have been holding out? Why don’t you marry an ordinary guy who will accept you as you are and not demand you get any of your body parts enhanced according to his fantasies?" That’s simple logic isn’t it? Instead of getting so many surgeries done just to impress the unworthy?

Call me old fashioned but some of the very worst/worthless surgeries in my opinion are the sexual satisfaction surgeries like vaginal tightening and new hymens for old surgeries.  The gossip in the change rooms of surgeons is about the several society ladies and businesswomen in their 40's who have had their vagina's tightened and hymens reconstructed post divorces – something which is becoming commonplace and routine over the past few years. But the worrying trend is of younger and younger ladies (even in their 20's) getting it done multiple times after every break-up just to act like a virgin for their new boyfriends and that sounds sickening to me. And in one extreme case I heard of recently -getting a new hymen every year (for the past three continuous years) after taking a nostalgic annual vacation in Goa with the ex boyfriend - who of course pays for it.  Even if it comes cheap at 30,000 bucks a pop for your cherry how many times will you get it popped? Is it that important to act a virgin/sexual innocent even if you are not and won’t it be much simpler to just find someone who accepts you as you are- even if he learns you have been around the block a few times? Hmmm, somehow I just can’t understand the logic behind some of these decisions people make. I don’t care much about the inner beauty/outer beauty concepts but the one thing I do believe is to learn to accept people the way they are.

Anyhow I guess that is enough ranting for one day and this post is getting too long and boring for you. Conclusion- lesson learned and never more a surgery scheduled unless the patient agrees multiple times in front of multiple witnesses...ok?