About Face

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About Face

Introduction The Surbery of Happiness Choosing a Surgeon Are You a Good Candidate

Complicated constructions have always appealed to me. A few years ago, there was a popular three-dimensional puzzle toy on the market called Rubik’s Cube that frustrated many people but delighted me. To solve a Rubik’s Cube, you must have an architect’s mind and see the three dimensions at the same time as you see their relation to one another. Nasal surgery - Rhinoplasty - is exactly like this. A three-dimensional jigsaw puzzle is the only way to describe it.

I loved otolaryngology, and during my four years of residency, I was lucky enough to study with two experienced Toronto men, Dr. Wif S. Goodman and Dr. T. David Briant, who loved it, too. They encouraged me to travel to the United States to a couple of otolaryngology conferences, as the field of study was much more advanced there than in Canada at the time. I found that facial plastic surgery, which is a subspecialty of otolaryngology, was just coming into its own. It was the new frontier, the leading edge of otolaryngology - a challenge I couldn’t refuse, it turned out. I has been married only five years, and my wife and I had a brand-new baby daughter, but we pulled up stakes, loaded everything we owned into a station wagon, and headed south in 1972 so I could study facial plastic surgery with the experts on a one-year fellowship.

I should explain that twenty years ago, when all this happened, public opinion about cosmetic surgery in Canada was a lot different than it is today. At that time, facial plastic surgery was almost exclusively devoted to the repair or reconstruction of faces that had been damaged, through cancer treatment or accident. The idea of indulging in facial plastic surgery for purely cosmetic reasons was considered suspect.

Sometimes I wonder if the simple correlation of the word “plastic” with surgery didn’t have to do with people’s attitudes at the time. Plastic came to mean something not natural or something fabricated during the 1960s, as in plastic chairs, or plastic people. But the true meaning of plastic, as in plastic surgery, comes from the Latin word plasticus, or the Greek work, plastikos. It means pliable, something that can be created by molding or be molded itself. Clay, for example, is plastic. So are the forces of nature, with their power to mold and shape the rock and stone or earth.

The trouble with harboring derisive ideas about plastic surgery, and its cosmetic use, was that it seriously impeded progress in the field. I used to hear stories about plastic surgeons dabbling in cosmetic surgery, in private clinics or their own homes, well removed from scrutiny or guidelines, or emergency facilities for their patients should anything have gone wrong. Bad things happened: mistakes were made. These doctors would do an operation and not tell anyone about it. Nor would they dictate any operative notes, even though it was required by law. Of course, they also refused to teach techniques to younger doctors.

One day, when I was still in resident training in Toronto and before I’d made the decision to go to the States, a patient with a very advanced cancerous tumor in his mouth came to see me. There was only one way to save his life and that was to remove part of his lower jaw, which I did, giving him what we called at the time an “Andy Gump deformity”. I doubt very much we described it that way to the patient. Some time later, I was sitting in a bar near Women’s College Hospital on Grenville Street, having a few drinks with some friends, other medical residents, when this brave fellow walked in and ordered a beer. He used a large syringe to squirt the beer into what was left of his mouth. I told my friends that he’s bee a patient of mine just as he noticed me and waved. He came over to our table and insisted on buying us all a drink.

What struck me, hard, was the obvious discomfort of my friends. I imagine they were horrified by the man’s appearance, but I couldn’t help thinking that if one of them were to suffer from a similar form of advanced cancer, I’d have to do exactly the same thing to them. There was no art to it, just the cruel fact of carving a chunk out of someone’s face, end of story. My patient was not reconstructed nicely enough to function well in society, and it filled me with great sadness. But in those days, it was all we knew to do. (Thankfully, reconstruction techniques have been much improved sine then.) Shortly after, I left for the States to study as a fellow of the American Academy of Facial Plastic and Reconstructive Surgery.

The Academy had been formed in 1964 by the amalgamation of the American Otolaryngological Society for Plastic Surgery and the American Society of Facial Plastic Surgery. The two groups were determined to lift all aspects of facial plastic surgery, including cosmetic surgery, out of their clandestine status and into the bright light of progress and shared learning. Their unofficial motto was “Knowledge is Free”. I was selected as the first fellow to spend a full year traveling to different surgeons in the U.S. for the sole purpose of additional training in facial plastic surgery.

My small family arrived in Houston first and rented a one-bedroom apartment with a large-enough closet to serve as a nursery for the baby. While there, I studied with Dr. William Wright. After that, I spend time with a surgeon named Jack Anderson in New Orleans. I was supposed to go to California, but unfortunately there was some big domestic brouhaha when the doctor’s wife ran off with one of his partners, so I never did go. Finally, I spend my last three months in Boston with Dr. Richard Webster, a superb teacher of facial soft tissue techniques.

Much has changed since I trained in the U.S. in 1972, especially with regard to inter-State licensing. I doubt I’d be able to move around so freely today. The Academy’s fellowship program is more formalized now, which is a good thing. A fellow has to get a license, complete one year of apprentice training, and then show evidence of this good, solid training by passing an exam at the end of the year. The Academy experience instilled in me a respect for the value of sharing information, and I have taught countless numbers of young surgeons my craft through positions at The Toronto Hospital and Toronto Western Hospital over the past two decades.

You might think by now that I am belaboring my education as an otolaryngologist, but I’m being as explicit as I can be for some very good reasons. The first reason has a lot to do with my motivation for writing this book, and that is, I want people interested in under-going facial cosmetic surgery to have a better understanding of what they’re getting into. I spend a great deal of time talking to patients, giving them the facts about what they might undergo: the good points, the bad points and, most important, a realistic view of what they can expect to accomplish with surgery. Still, many of them, I know, nod and plunge ahead without a clear idea of what they’re doing. So the first thing someone interested in facial cosmetic surgery should know is: does the surgeon have the proper training for the job that’s to be done?

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