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A Plastic Surgeon’s EvolutionDr. Sherrell J. Aston, MD FACSThe importance of change and evolution with thepassage of time in a plastic surgeon’s thinking,concepts and techniques is Darwinian. Those whoare amenable to change and adaption will not onlysurvive but also thrive. Those who continue topractice what they were taught in their residency,or cling to techniques and procedures just becausethey have done it that way for a number of years willbecome obsolete at best. The only way a practicingplastic surgeon can avoid making changes is to dieor to cease being relevant in our great specialty.As the years pass, a surgeon has the opportunity tolearn from the experience of his own practice, and heor she has the opportunity for shared wisdom fromdirect contact with colleagues, symposia, books,journals, videos etc. Every surgeon learns a greatdeal from his patients, who voice their experienceswhile under his care. A plastic surgeon mustaccommodate the requests and desires of patients,and be adaptable to the influence of trends. In manyinstances, patients request smaller procedures withfaster healing times, even when they are informedthat it is not possible to get the same result that canbe achieved with a more extensive procedure.The experience I have gained from colleagues andpatients has helped me evaluate my own surgicaltechniques and results. Over the years, I havespent a great deal of time in the late evening hoursstudying pre and post operative photographs ofmy patients, critically evaluating the results I haveachieved and trying to figure out how to make thembetter. In doing so I have been able to formulatemodifications in my thinking and procedures, whichhave helped bring about a variety of changes. Forinstance, I perform more short incision faceliftstoday than earlier years. Also, I perform moreimbrication of the underlying foundation than yearsago. I still perform SMAS flaps and extended SMASflaps in patients whose anatomy, I feel, warrantssuch. I am more conservative in fat removal duringboth upper and lower lid blepharoplasty; while, inmy practice, coronal forehead browlifts are rarenowadays. Endoscopic browlifts are more frequentand, in some patients, I use a trampoline browliftwith only 4 incisions of approximately 5 milliliterseach in length. Essentially all of my rhinoplastiesare performed closed, but I have modified mytechniques to where spreader grafts, strut grafts, andsuture contouring of the alar cartilages are routine,just as in open rhinoplasties performed by others.Although somewhat resistant years ago, I haveembraced fillers and neurotoxins and I use them tocompliment surgical procedures, or to treat patientswho do not need a surgical procedure. I could listall the operations I perform, and note modifications Ihave made, but that is not the purpose of this editorial.The real purpose is to remind us that a surgeon’sevolution is never finished. He or she can neverrest on their laurels or their recent great results. Weneed to constantly evaluate new information, newideas, and new technology. While some of it willwind up in the pile labeled, “bad ideas”, a portionwill become time proven for delivering benefits forsurgeons and their patients. There is little questionabout the fact that, the science of stem cell biologyand autologous fat grafting is producing a paradigmshift in both aesthetic and reconstructive plasticsurgery in all areas of the body.In addition, some of the new non-invasive andminimally invasive procedures for facial rejuvenationand body contouring are showing promising results.Sculpting individual anatomic regions, including thebuttocks and genitalia are areas that patients are nowrequesting to have improved. A practicing plasticsurgeon must have extensive knowledge in treatingthese sites.Issue 6 www.ipras.org IPRAS Journal 33