Gee technology must have changed plastic surgery a lot since you started. Of all the questions I’m asked, this is one of my favorites. It shows how good, bad marketing can be.
Cosmetic Plastic Surgery has always been a knife and fork specialty. It’s low tech work, by a low tech human, like me. That bias may seem a bit counter intuitive, but then so is cosmetic surgery. What I’m suggesting is that a well done cosmetic surgical operation is the best shot at success, better than any high tech machine. And you can’t give up your shot.
But is it true?
Am I better at taking fat than any or all high tech fat melting machines?
I am. Well not just me, but any trained plastic surgeon.
We’re talking the rise of the High Tech Cosmetic Machine. We got your freezing machines, heating machines, burning machines, laser machines ultrasound machines, robotic machines, even an injection or two, and some we haven’t thought of yet. It’s a triumph of man’s dominance over man.
LUDDITE LOW TECH
This is not some anti intellectual Luddite thinking. Nay, nay! I like machines. I use machines! But they’re a low tech species, and need a lot of human tending. There are anesthesia monitors, a suction machine, a dermabrasion machine, a cautery machine, a liposuction machine, a staple machine, and things like that.
These are easily recognized by their small number of moving parts. Low tech machines are to surgery what electric cars are to driving: just better.
My job is to chase perfection. Hand that over to a cosmetic machine, casualty is often the work. I know, the mere suggestion of “surgical perfection” is a bit oxy, but hey….
Sure, if I’m going to lunch on Mars, I want a well machined machine to get me there. But if I want a smooth youthful face, give me a cosmetic surgeon any day.
A machine that can do the human thing, may happen some AI day, but until then perfection in the cosmetic game is still ad hominem. It’s different for each patient. It’s personal. It’s all personal. Cosmetic plastic surgery is about as intimate and personal as you can get outside the sheets.
PERFECTION AD HOMINEM
It’s common for patients to introduce the problem telling me…. I’m not looking for perfection, but…., but that’s exactly what they wants. And why not?
Please don’t throw me in the briar patch. Chasing perfection is my metier. It’s what I do. There’s no other way to do this work. Human perfection is idealized, part fantasy, part perception, and parts unknown. It’s sort of Potter Stewart’s I’ll know it when I see it.
Cosmetic surgery is about design, and touch, and instant adjustment, do overs, and talking, and stitching, and closing, and things like that.
The Design that comes out of the consultation room, is a bit foggy around the edges. That’s only because language fails. It can’t really define or communicate the design; but that’s a story for later.
It’s my job to see through the fog, and no one gets into my operating room until I do. Machines don’t seem to do all that well with fog. But there’s no “maybe” in the OR. It’s true there’s no maybe with a machine, but it’s a different “maybe”, related more to the machine than to the patient. I come to that final design in the consultation room when language fails, but that’s another story.
CONTROL, THIS IS AGENT 90291
Ok, so I suckered you in. This is not really about perfection at all. It’s about getting there. And getting there is all about control. Without control, your chances drop like a bad date on Jewish Mingle. I’m suggesting that surgical precision – a bit oxy I admit – is the best way to get the best cosmetic result. It’s not that high tech machines don’t work. They do! But to come out of the procedure with a victory, you need control. Control is everything. It’s winning.
CONTROL, GET ME OUT OF THIS
Digital computing does things faster and better than the human can; but it’s only a tool with human control at the keyboard. Even if the high tech cosmetic machine came with a keyboard, it would still be blind to what’s actually under the skin. The machinist makes a few settings, pushes a few buttons, and after a few, oops, settles down to a nice protocol that continues to roll the dice every so often. I’m a little uneasy about giving all that over to a machine.
DETAILS AND CONTROL
Control embraces details; and details in cosmetic surgery, isthe work. There’s no devil in my details, only the gods, and they don’t have all that much empathy. Expecting details ex machina, is much like expecting Cleveland to win the Super Bowl. It could happen but that’s a bit cavalier.
Cosmetic details have always lived with the surgeon, with a glint in her eye, and a knife In her hand – an otherwise scary picture.
True enough, for a reasonably consented human, the machine can sculpt and tighten… by cooling, heating, burning, or sounding. Usually once set, the machine can’t change direction, or innovate, or fix unseen problems. I can! I can change my mind. I can change cannulas during liposuction, I can tighten the Superficial Musculo apponeurotic System, (Smas) during a facelift. I can put in filler after the face is done, and not before. I can reduce or augment the size of the breast, and things like that.
There’s one particular quality about the best cosmetic results: smoothness. Sure the machine can get rid of fat, and tighten skin, but asking for a smooth result, is a bit like asking the IRS for a break. You may get it, but it’s a crap shoot.
Once set, the machine has a problem. The setting is really an educated guess, if you’re lucky. But skin and fat are uneven. It’s only the outside that may look smooth. So how do you tell the machine to go unevenly, and go there, or take this much, and no more. It’s a puzzle.
During an operation, I can see or feel problems right away, and make adjustments. Even with some intelligence, machines will have difficulty with that sort of thing.
After the operation when a human was on the stick, the results can be seen right away. Sure some swelling and bruising needs to be gone, but that doesn’t take all that long. The machine makes you wait a few months, to see the results, and by that time you’ve forgotten you even had the machine.
But this is the real world, and it has a marketplace, for ideas, goods and services. Here, the human is no match for the machine. Any time the human tries to push back, it sounds a little like “pick me, pick me”. You can’t sell “no”. Sure you can make a reasonable person, hesitate, but persons do things emotionally.
And doctors aren’t supposed to be “selling” in the first place. They’re professional.
Oh that, It’s just a small billboard announcement, reminding folks that UCLA is the best, no, wait, that’s SC, or was it Cedars, and that’s only LA.
A final thought, or two. High tech machines breed like rabbits at bible study. The poor human is left trying to raise money for planned parenthood, while searching for another “pill” to slip by the churchmen. The surgeon has no chance against the glitter of a new machine. That’s the way it is when things want to change. New, can be better and run the “old’ out of Dodge. Look at what the Endoscope did for surgery. But the current spate of cosmetic machines are just ok, and “ok” will surely lower the bar, and after a while, no one will notice, and I’m ok with that. But that means no surgery…drat!
The rise of the machine is just an interregnum, until the dawn of the Molecular Age, where cells can fix other cells. Now that’s perfection! The medical graduate won’t go into Plastics, but Cosmetic Biologics.
With a few more nails to go, this is still the land of the free, and folks can choose what they choose. But the notion that cosmetic machines are non invasive, is just myth information. It’s not true. Machines have to be invasive to get the work done. They don’t usually cut, that’s all. It’s really surgery, in witness protection.
This might be appealing to some, but there is no Lemon Law for faces and bodies. The machine is a real threat to the human touch, and the human touch seems to be important. Maybe even a survival tool. A trifling notion with Robo Touch, coming soon to your local hospital.
It’s always been understood that a surgical operation is often an expression of our biologic ignorance. Set a cell to kill a (cancer) cell and no more mastectomy, prostatectomy, or bowel resection. What will take the place of cancer on the wanted poster, I don’t know, but probably the rise of the virus. And it’s the virus, albeit in a spot of trouble, that’s still a transport for the DNA needed to make a shaky Stem Cell out of a Somatic Cell. In that time cosmetic surgery will be reserved for special cases. But this is now!
Thanks for listening