FROM HEAD TO TOE
Fig. 1
Fig. 3
FUSION OF AESTHETIC AND RECONSTRUCTIVE
PRINCIPLES IN PLASTIC SURGERY
O
Gordon R. Tobin, MD
ne of the great pleasures and re-
sponsibilities in plastic surgery
practice is the process of using
both aesthetic and reconstructive
principles in combinations that
best meet the needs of each pa-
tient. Thus, educational programs
must teach both aesthetics and reconstruction,
irrespective of the practice goals of individual residents or fellows.
The public notes and appreciates the outcomes of well-done plastic
surgery, but there is little general insight into the fusion of aesthetic
and reconstructive principles behind these admired outcomes. Some
information about this process is described herein.
AESTHETIC PRINCIPLES USED IN RECONSTRUCTIVE SURGERY
Facial aesthetic units are surface planes, with borders defined by
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LOUISVILLE MEDICINE
changes in contour or by an adjacent feature. Examples include
the planes of cheeks, nose and lips, with defined borders between
them (fig. 1, 2). These were recognized in the mid-1950s by plastic
surgeons D. Ralph Millard Jr., MD, for the upper lip and nose (fig.
1) and Mario Gonzalez-Ulloa, MD, for the entire face (fig. 2). In re-
constructing facial features after burns, trauma or cancer resections,
outcomes are much better in appearance when done in aesthetic
units with scars placed in the border lines, and we strive to do this
in our reconstructive designs. These principles have also become
the basis for facial recognition technology (fig. 3).
CLEFT LIP RECONSTRUCTION IMPROVED BY AESTHETIC
PRINCIPLES
Dr. Millard revolutionized cleft lip repair in the mid-1950s by
applying aesthetic principles to design new lip reconstruction tech-
niques. Previous techniques closed the clefts, but ignored aesthetic