When most people hear about plastic surgery, they think nose jobs, breast augmentation, botox, etc. Mental references to Dr. Christian Troy from Nip/Tuck may come to mind - the cash, the cars, the glory, and the girls.  Even among premeds and medical students, plastic surgery can often be viewed as a superficial specialty with a cushy income. Is this general perception accurate? Based on my exposures, I'd have to say no.

To quote Dr. Borschel, "The goals of plastic surgery are threefold: (1) to alter surgically the form and function of anatomy - either normal or pathologic; (2) to improve quality of life; and (3) to preserve life itself. Just to get a sense of the breadth of the field, the following sub-specialties all fall into the realm of plastics surgery:

1) Cosmetic surgery

2) Burn surgery

3) Craniofacial surgery

4) Hand and Upper Extremity Surgery

5) Microvascular surgery

6) Pediatric plastic surgery

As you can see, plastic surgery does NOT equal to cosmetic surgery. On the contrary, it is only one of six sub-specialties within the discipline.  The scope of plastic surgery is extremely vast in that it deals with so many regions of the body - head, neck, chest, abdomen, lower and upper extremities, breast, and hand. No other surgical specialty can even be compared in terms of the scope of the operative fields. Therefore, plastic surgeons are often referred to as "the surgeon's surgeon". 

My first exposure to plastic surgery was in Ecuador in 2006, when I shadowed a prominent local plastic surgeon for a week. He worked in the cosmetic business, so I saw my fair share of rhinoplasty, breast augmentation, face lift, and liposuction.However, my true exposure to academic plastic surgery had been during my 1st year medical school where I shadowed a hand surgeon. Although this occurred more than a year ago, the memories of that day are still well-etched into my mind because it was my very FIRST time scrubbing in on a surgery.

So the day went like this:

8 am - Checked in with the plastic surgeon, changed into scrubs, and was eager to step into the operating room. In fact, I was so eager that I walked into the OR without putting on a mask; an action that was not very well received by the nurses. The staff immediately instructed me to leave the OR. Since I've never actually "scrubbed in" for a surgery before, I didn't know what that term entailed. Luckily, the resident was there to help me out. Basically it involved a systematic and thorough way to clean your hand and arms. So I did that, re-entered the OR.... and was told to leave again! What did I do this time? The problem was that I didn't keep my hands above my waist. This was to make sure that the hands are aseptic when entering the operative field. Once the hands fall below the waist, it's assumed that they have been contaminated.

9 am - So my second attempt at scrubbing in was flawless. The nurses helped me putting on a gown and gloves, and I was ready to rock and roll. So the first operation was to remove the fibrosis from a Dupuytren's constracture, a condition where the pinky and ringer finger are naturally flexed due to the tightening of the underlying connective tissue. This can be hereditary of alcohol induced. The surgeon gingerly made the incision on the palm, and meticulously worked around the nerves and vessels. It was amazing to see such delicate surgery up close. The surgeon jokingly said to me, "Hey Kevin, hold on to these retractors, I'm way too important to be doing this." It gave everyone a good laugh and made the environment quite friendly and collegial. I guess with such a low risk surgery, none of the staff members needed to stress over anything.  So I grabbed onto the retractors (NB.  a retractor is an instrument that holds open the superficial tissue to allow the surgeon to access deeper tissue) and was glad to be able to take an active role in the operation.

10 am - The second operation was on a tumor located just underneath the nail-bed of the index finger. I've never heard of this type of pathology and was quite intrigued by it. The operation involved removing the entire finger nail, cutting into the nail bed, and resecting the mass. Ultimately a small piece of tissue (approx. 5mm in diameter) was removed, and the finger nail was placed back onto the nail bed. Quite fascinating.

11 am - The third surgery involved the repair of a torn flexor tendon of the index finger. I don't quite remember the details of this particular surgery, but I distinctly remember that my role as a retractor operator had lost it's novelty. Holding retractors in a fixed position for an hour was no easy feat. But fortunately, my role stepped up a notch when I was asked to hold the scissors to cut sutures (I know, hardly an upgrade, but I still loved it).

After that, there were two more operations on Dupuytren's contracture, so I won't bother mentioning them. Overall, I was thrilled with this experience mainly because it was my first actual participation in an operation. Remember, I was still an eager 1st yr med student back then, so the bar was not set so high.

Although I did not have the opportunity to discuss with my preceptor regarding the plastic surgery as a specialty, my impression was that hand surgery is very low stress (i.e no emergencies or life-threatening scenarios), has short operations (most were 30 min - 1 hr in duration), offers very good life-style (the surgeon was done in the early afternoon), and somewhat repetitive in the procedures (specializing in just the HAND does not offer too many exciting procedures). However, this exposure was a good change from my previous experiences with cosmetic surgery.

So would I go into plastic surgery? Definitely! It's an AMAZING field in that it really offers an array of incredible and creative surgical procedures. A good plastic surgeon needs good aesthetic sense and impeccable manual dexterity.  Unfortunately, it's one of the most (if not the most) competitive specialties out there. Last year the match rate was a bit short of 50%, meaning less than half of the people who've selected plastic surgery as their first specialty choice actually got into a plastic surgery residence program. Therefore, I've elected to remove plastic surgery from my list of specialty choices. I'm not afraid of competition; I just believe that there are too many great specialties out there for me to take the risk of committing to a specialty with such a horrific match rate.

Why do so many people want to be plastic surgeons? I think some of the biggest motivators sadly are financial gains and prestige. Many cosmetic surgeons can make over $1 million per year. A rhinoplasty (2 hr surgery) from a reputable surgeon can cost tens of thousands of dollars. Who wouldn't want to be reaping in that kind of dough? But if you can look past the Hollywood glamour associated with plastic surgeons, then you will realize and be able to appreciate the legitimacy and vastness of plastic surgery as a true medical specialty