We're Not In Kansas Anymore | Pulling back the curtain on the limitations to high BMI plastic surgery
Change is the only constant…and that applies to all aspects of life. It applies to what we think we know and therefore to what we think is reality.
The current statistics indicate that 50% of what a new medical school graduates learn is obsolete or wrong in 18-24 months. Let that sink in for a bit…..
Extrapolating from that, some meaningful percentage of what a plastic surgeon learns during plastic surgery residency is obsolete or wrong in a comparable timeframe after finishing training. One step further from that is the realization that what a plastic surgeon learns while in practice, from medical journals and conferences, is also obsolete in some relatively short length of time.
Yet here we are, nearly the year 2023, and we are still using data from the 1980’s to judge the safety of plastic surgery in the high BMI patient. Thats almost half a century folks. You think some of that data may be obsolete?
Accepting that our knowledge is either incomplete or temporary is important to life-long learning. It has also been the key to my ongoing evolutionary development of the plus size tummy tuck®. Along the last fifteen years that I have been in practice (yes I am old), I have strived for progress, I’ve hit plateaus, and then found new levels of understanding of how to get better results for the high BMI patient.
I was inspired to write about this partly because I feel I have perhaps finally accepted the idea that there is no final limit or plateau of understanding. And I say perhaps because it seems that a part of our ingrained human nature is to “arrive” at understanding. I think we like to create an intellectual box of what subject we are studying and when we have filled it up we seal it and store it away—rarely and only begrudgingly returning to it to rummage and reassess whats inside to see if it’s still relevant or true.
So I try and ask myself, with respect to surgery, what do I currently think can’t be done? And is this actually the case or is it obsolete knowledge that I picked up along the way and stuffed in that intellectual box, never to be reassessed again. Constantly reassessing what you think you know is not an easy thing to do but it is fundamentally important for progress. How I do my plus size tummy tuck® surgery now is different than how I used to do it five years ago. The more I have accepted this idea of temporary knowledge, the more innovations I have been able to discover, and the more impact I have been able to make with the plus size tummy tuck ® procedure.
The wonderful part of making peace with the idea that what we know is temporary is two fold. First, it is ok to be wrong. In fact, it is a guarantee that we will all be wrong, probably about everything, if we wait long enough. Second, we should always be searching for a new and better understanding of whatever we are trying to learn, knowing full well that even that will be temporary.
In this way, not only will we foster a better relationship with knowledge, but also a better relationship with reality. I am grateful to be able to help so many people who would otherwise have no where to turn for help. At the same time, I am excited to see the progress we have made with the plus size tummy tuck ® and liberated at the idea that there may be no limit to how good we can make it.
It feels like I’ve pulled back the curtain….the limitations that I thought were there were not limitations after all—just opportunities to ask better questions and the freedom to learn new realities about plastic surgery and indeed myself.
Remus Repta, MD