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H O N O R A R Y E D I T O R - I N C H I E F ’ S M E S S A G E
Ôhe past, the present and the future
of the Plastic Surgery
Ricardo Baroudi
The subject of these comments is not to bring the History
of Plastic Surgery to our readers, which has been already
reported in many text books with extreme detail regarding
authors, dates and contributions.
It is common knowledge that Plastic Surgery has
continuously evolved since ancient times into the modern
era, being that the First and the Second World Wars were
great “contributors” to major surgical improvements in
this Specialty. This crescent curve, also noted at the end
of the 20th century, with its consequent yield of new
technologies and research results will allow for future
generations to obtain incomparably better results than we
could achieve in the recent past and today. There is no
limit to human imagination and creativity.
Although the information I am writing in this report
is well known by the vast majority of plastic surgeons
around the world, I believe it may be useful for the new
generation as well as for the senior surgeon, in which
category I am included.
Plastic Surgeons around my age will remember that
in the ‘50s there was a reduced number of Plastic
Surgery National Societies as well a limited number
of professionals dedicated to our Specialty. The Latin-
American Society was founded in Brazil by our pioneers
in 1941, and the Brazilian Plastic Surgery Society was
founded in 1949. At that time, there were no more than
70 members in the entire country. By that time, surgeons
in the United States were already well organised, with
surgeons performing all sort of plastic surgery procedures
and publishing their results in specific journals, as well as
pioneering several programs.
Even in those days, for one to become a member of a
National Society, there was a mandatory requirement for
specific training in General Surgery, followed by two
to three years of training in Plastic Surgery in specific
departments. What we now call Reconstructive Surgery
was an integral part of any training program. Like today,
training in this area included all the malformations, hand
surgery, burns, dermatological procedures, and later on,
craniofacial surgery – only after this training would the
surgeon be allowed to perform aesthetic procedures,
although when one considers the aesthetic plastic surgery
results of that time, one could not really compare them to
what is done today.
Plastic Surgery procedures were usually sought after by
high economical class people, most frequently by those
who lived by the ocean areas and/or tropical regions where
more frequently there would be a desire for exposure of
one´s body. As a sign of the times, the reverse occurs today
in many countries where religion or cultural reasons will
forbid it, despite improvements in global communication.
Also, aesthetic plastic surgery was then considered with
a certain taboo – frequently, when one was asked about
having had facial surgery, the reply would be that it was
done for cosmetic reasons. Regardless, vanity has always
been present in human culture.
Expressive changes have slowly but continuously
occurred in the Plastic Surgery World as well as in other
specialties as a consequence of a progressively higher
consuming world population. In these present times, I
consider that we could summarize these new behaviors
as follows:
1. Medicine and Surgery have evolved to socialization
in many countries, with governments handling care
directly to patients – Plastic Surgery was not included
in these programs, so there was a boom in the number of
Plastic Surgeons, as a natural consequence. The World
Health Organisation determines that there should be a
plastic surgeon for every 50,000 inhabitants. In Brazil,
in general, we are now 1: 41,000 – in reality the overall
distribution is extremely disproportional. In the city
where I live, in the inland of the State of São Paulo,
there is 1 plastic surgeon for every 9,500 inhabitants (
1:9,500 ). Market law is pretty obvious and ubiquitous:
when there is a larger offer of a product, the price will
drop. Currently, one can even find a plastic surgeon
whom will receive payment in ten or more monthly
installments…
2. The secretive attitude of patients of the past, maintaining
the fact that they had a plastic surgical procedure almost
Issue 13 www.ipras.org IPRAS Journal 9