FROM HEAD TO TOE
THE CONUNDRUM THAT IS AESTHETIC MEDICINE
“P
Donn Chatham, MD
lastic surgery” (from the
Greek word “plastikos”,
meaning “to mold or change
the shape of ”), inhabits two
worlds: (1) reconstruction
and repair, and (2) aesthet-
ics, focusing on beauty.
Mankind has for centuries sought beau-
ty and health, and there would be little virtue in a world devoid
of beauty. Plastic surgery has a long and rich tradition. Following
World War I, many horrendous injuries led to the development of
dramatic reconstructive procedures, and surgical innovation and
technique continually advance. In 1999 here in Louisville, sur-
geons performed the first hand transplant that achieved prolonged
tissue survival.
Certain reconstructive surgeries led to advances in aesthetic
procedures: some techniques combine aesthetic improvement
with functional reconstructive improvement. One example is sep-
torhinoplasty following a broken nose. The goal here is to improve
aesthetic form and function.
It is not uncommon for patients to request a procedure de-
signed solely to enhance attractiveness. Examples: smooth the
bump on the nose, strengthen a weak chin or improve texture of
skin. Procedures to ameliorate the signs of aging are common-
place, even though aging is a normal and (usually) wished-for
experience.
Deciding who is a good candidate for a procedure is not always
a straight path. The patient with the deformed nose might seem
like a clear decision. But what if the patient whose deep desire is
to look like one of the “Real Hollywood” celebrities? Or the pa-
tient requesting injectable fillers to make their lips three times the
normal size…with cash in hand. Some of our aesthetic surgeries
entail taking a healthy person and subjecting them to anesthesia
and incisional trauma and healing, with some imponderables and
possible complications along the way to a finished result. They re-
quire thoughtful decision-making and a primer in realistic expec-
tations for the patient.
Offering aesthetic procedures to enhance appearance is world-
wide, and generally acceptable. There is nothing wrong with this.
And when principles of ethics guide physician decision-making,
the potential to make a positive difference in the life of individual
patients is great. Having engaged in the practice of facial plastic
and reconstructive surgery for the past 35 years, I have had time
to develop a personal perspective on my specialty.
I have been witness to primary medical care as my father
practiced family medicine in a small town for 40 years, providing
“cradle to grave” medical care to many. While aesthetic medicine
and surgery are no longer considered “fringe medicine,” I under-
stand that this specialty might be viewed by members of both the
medical and lay community as often providing some frivolous and
unnecessary service, prompted by the prospect of earning an out-
rageous sum of money but bereft of ‘‘real’’ doctors who truly seek
the best option for their patients.
So, is aesthetic medicine and surgery a frivolous subspecialty
or does it provide a real and much needed service to a wide range
of patients? And is it ethical?
In 1979, Beauchamp & Childress 1 published “Principles of Bio-
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APRIL 2020
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