A Stitch in Time Saves Nine
In our modern fast-paced world, we have evolved to find ways to reduce the amount of time and energy we spend on any one thing—with the possible exception of social media. This “time and energy saving” mentality is part of our human nature. We subconsciously take the short cut. It’s only when we apply ourselves fully both mentally and physically to a task that we and the result of that task become great.
Despite all of the technological advances of modern medicine, plastic surgery, believe it or not, is still dependent on labor done by hands. It’s in fact part of the name: Plastike Chirurgia. Plastike: to mold. Chirurgia (Cheir: hand): by hand. Surprise! It has nothing to do with the use of plastic material. Why is this important? Because it takes time to do great work. About one third to one half of the time that I spend doing a Plus Size Tummy Tuck ® for example, is spent placing sutures. Hundreds and hundreds of sutures at various levels of the tissue. They are used to repair abdominal muscles, to re-attach the tissue to the abdominal wall, to contour the waist shape, to lift the pubic area, to secure the drain, to inset the belly button, and finally to close the tummy tuck incision as close to perfect as possible. To accomplish all of this takes time and equally important it takes a commitment to fight the human tendency to cut corners.
A stitch in time saves nine. This is certainly true. It also saves the patient from wide scars, loose muscles, and a variety of other things that take away from a great result. The work of plastic surgery is still “old school”. Just my hands and some basic instruments that have been around for decades. The evolution or advanced part of the plastic surgery that is done today compared to what was done twenty or thirty years ago is in the visualization and understanding of how to work with the tissues to get the result that is desired (see prior article on working with nature).
The fact that time is a factor in, and related to, better results is common sense. Having someone paint your house in one hour is not going to be as good as someone taking the whole day. Some things that we do in surgery are “time bottle-necks”. You can become more and more efficient at doing them but at some point the only meaningful way to spend less time doing them is to….you know it…cut corners.
I remember early on in my career hearing some senior plastic surgeons brag about how fast they could do a tummy tuck and thinking that maybe I wasn’t that good since I took longer. In retrospect, I now understand that I was simply doing more. More liposuction, more checking and double checking, more sutures, more removing and replacing sutures that I didn’t think were up to par, more of everything. Over the last fifteen years of me being in practice, all of that has made a big difference. My understanding of human anatomy and physiology improved. My ability to get safe and effective results from more challenging cases including higher BMI patients grew. And from it all, the plus size tummy tuck ® was born, refined, and then born again many times over.
So what’s the point of all this? Well, if you’re going to have your house painted, be weary of someone offering to paint it for you in one hour—its not likely to be top notch work. The same should at least apply to your plastic surgeon. The second part is simply unsolicited advice to plastic surgeons and young people in general. It takes time to learn and do good work. This is still my north star in surgery. My hands my hurt and surgery may be long, but the time to excellence is set—it can’t be cheated.
My sincere gratitude to all my patients past and present for allowing me to be part of their journey while being on mine. The last few years have been particularly mind-expanding.
Remus Repta, MD