You can work with nature or you can work against nature. I heard a skilled Japanese wood craftsman say that a while back and while plastic surgery and wood working are different, I realized there was something in that philosophy that resonated with me. I also realized that many of my past breakthroughs toward better surgical results were in large part because I found new or different ways of working with nature.
This may sound mystical or new-age, but there is quite a bit of science behind it.
Let’s take the Plus Size Tummy Tuck ® as an example and look at it from a mathematical standpoint (oh no math!). Don’t worry, I will keep it brief.
Like ninth grade algebra, we have variables and we have constants.
Variables: anatomy (A), physiology (P), surgery (S)
Constants: time (T), gravity (G)
For me to get the best result I have to manage what I do during surgery as much as I can to make the most of the patients anatomy and physiology. Since time and gravity are constants, I have to juggle maximizing A+P+S while working as much as possible with T+G as opposed to against them. The more balanced this equation is the better the final result will be.
Ok, thats enough math. Let’s have a look at an example of what happens when we get closer to balancing the above equation.
In order for this patient to get from where she started (left) to where she is now (right), the variables and constants that we discussed above must be balanced. Too much one way or another on any of the factors will result in an unbalanced equation and ultimately either in a suboptimal result or in poor healing issues. The body can do great things, but it cannot go beyond its limits of anatomy (A) and physiology (P) and certainly not for a long time (T) or significantly against gravity (G).
The journey continues of course, because we strive for perfection. The constant search for ways to manage surgery, but also to help guide the patients’ anatomy and physiology before, during, and after surgery, are what drive me toward higher learning. Every small breakthrough adds to my understanding of plastic surgery and to my ability to create results that I once thought impossible—and in turn to better help my patients.
Remus Repta, MD