Plastic Surgery: Staying inside the Lines

Do not quench your inspiration and your imagination; do not become the slave of your model. —Vincent van Gogh Recently, while waiting in a restaurant with my family, I was showing my three-year-old son how to draw neatly inside the lines of the figure that he was coloring. Thankfully, his mind is not clouded with the rules and regulations of authority that demand we stay “within the lines.” The visual image of his figure transcended the lines and was all over the page. Yet, as my wife pointed out, his picture actually looked better and was far more original than the one I had done as an example for him. Much of one’s life is spent trying to stay inside the lines; however, to really be innovative, one must be allowed to transcend the lines. Our children are bound only by their imaginations—a principle that becomes a dichotomy as one progresses through life and standard teaching requires us to conform. One of the major challenges of parenthood is to teach one’s children core values and some level of conformity, but, simultaneously, not squelch their sense of innovation and creativity. How does one teach the concept of going outside the lines without creating problems? The philosophy of staying within the confines of the lines when coloring a picture can be compared to the lifelong quest for learning. It is, for example, a major component of the challenge we face when teaching our residents. Where is the middle ground, and how do we teach our residents to stay within the lines when conformity is necessary? At the same time, how do we also teach them to allow their creativity and imagination to go outside the lines for advancement of the art and science of plastic surgery and medicine? The great innovators of our specialty are constantly painting pictures outside the lines. We have all met an individual who is different, creative, and the nonconformist who has strayed significantly outside the lines. Plastic surgery has greatly benefited from these creative endeavors. How do we teach these concepts to residents and also become more sensitive to our own creativity? Part of the process is innate; the other part is environmental. At meetings, we underscore the fact that there are many different techniques for accomplishing the same process or procedure—all of which may be correct. Individuals who espouse only one way of performing certain procedures and no other are trying to confine people within the lines. . . the very lines they have chosen to box themselves into, which limit their own imaginations. Trying new techniques and technology requires not only tolerance and open-mindedness, but also the ability to be self-critical, facilitating a change in attitude. In most cases in plastic surgery, new concepts are abstract and subjective, and the innovator must prove that a new technique or technology is better. This tenet has been typified in cosmetic surgery during the past decade by innovations such as ultrasound-assisted lipoplasty, laser dermabrasion, and endoscopy. Colleagues who were not afraid to go outside the lines instigated these new techniques; they assumed the role of nonconformist and accepted that there would be criticism from individuals who do not handle change well. Their new technologies and techniques challenged each of us to reassess our current methods. Why would we continue to perform a transcoronal browlift if an endoscopic browlift could obtain the same results using minimally invasive technology? Why would we continue to use traditional methods of liposuction when the new ultrasound-assisted lipoplasty could provide better results, teach us to better analyze our patients preoperatively, and enhance our results for male and secondary liposuction patients? The response in cosmetic surgery to the introduction of ultrasound-assisted lipoplasty was mixed and very emotional; however, because of this innovation, we have become better three-dimensional, circumferential body contour surgeons. Within our training programs, we expose our residents to many different methods for accomplishing the same procedure rather than allow one individual to dictate a set method for a certain procedure. Exposure to both academic and clinical faculty is an excellent environmental mix for stimulating innovation in residents as well as in practicing plastic surgeons. Hopefully, no two plastic surgeons will ever perform the same operation or procedure exactly the same way, yet both methods are perfectly acceptable. This is the innovation and beauty that is plastic surgery. This is one of the reasons most of us chose plastic surgery as our specialty. We should allow ourselves to think and act outside the lines, just as we encourage our children and residents to be creative, innovative individuals. Hopefully, this attitude will stimulate a lifelong quest for learning in everyone. So the next time you sit down to teach a child, paint a picture, write a story, or plan your lifelong goals, think of the world of possibility. . .outside the lines! An idea is salvation by imagination. —Frank Lloyd Wright