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On the occasion of ASAPS' 36th annual meeting, Vancouver, British Columbia
Scientific Forum
Editorial
On the Occasion of ASAPS’ 36th Annual Meeting, Vancouver, British Columbia
I
t is indisputable that the founding of the American Society for Aesthetic Plastic Surgery (ASAPS) in 1967 was the pivotal event in the shaping of aesthetic surgery education as we know it today. Here was a group of well-trained and fully qualified plastic surgeons joining to form an organization devoted to the sole purpose of furthering aesthetic surgery knowledge and education, in defiance of the prevailing prejudice of organized plastic surgery against this subspecialty. ASAPS spearheaded the rapid development of aesthetic surgery as a bona fide specialty by promoting a national meeting devoted exclusively to aesthetic procedures, educational courses, regional symposia, a journal devoted exclusively to aesthetic surgery, and visiting professorships to further enhance residency training in aesthetic surgery. More recently, the formation of the Aesthetic Surgery Education and Research Foundation (ASERF) has helped ensure directed research in aesthetic surgery. All of these activities have greatly facilitated the training of the young plastic surgeon in the techniques of aesthetic surgery and helped remove the veil of secrecy that existed in the pre-ASAPS era. During the years preceding the founding of ASAPS, obtaining the necessary knowledge and training leading to expertise in aesthetic surgery was difficult and required considerable effort, persistence, and ingenuity on the part of the young surgeon who wished to hone his or her skills in this fascinating and challenging area of plastic surgery. Back then, residency training in specialized fields of surgery (and, indeed, in specialized fields of most medical disciplines), was the exception rather than the rule. Within the field of plastic surgery, training programs emphasized reconstructive surgery; aesthetic surgery was marginalized or not covered at all. The educational tools and opportunities available to the practicing aesthetic surgeon were likewise limited. Relatively few papers on aesthetic surgery were pub-
142
AESTHETIC
SURGERY
JOURNAL
~
March/April
lished. Even fewer papers on the subject were selected for presentation at national meetings. Only a limited number of continuing education courses in aesthetic surgery were offered, regardless of the heavy demand. I distinctly remember teaching a course on rhinoplasty at a Thomas D. Rees, MD, Santa Fe, NM, is a life national plastic surgery meeting member and past president in the mid-1960s at which there of ASAPS. were only 3 other teaching courses on aesthetic surgery offered in the curriculum. Drs. Tom Baker and Howard Gordon offered the first aesthetic surgery symposium in 1967. That symposium was an instant success, became an annual event, and is still going strong, drawing aesthetic surgeons from all over the world. The annual symposium on aesthetic surgery sponsored by the Manhattan Eye, Ear, and Throat Hospital in association with the National Foundation for Facial Reconstruction at New York University began in 1968 — 1 year after the founding of ASAPS — and subsequently became an annual event as well. These two symposia set the stage for similar forums, and eventually many of these were cosponsored by ASAPS. The first ASAPS scientific meeting was in 1969, but ASAPS’ first cosponsored symposium with the American Society of Plastic Surgeons was on rhinoplasty, and did not take place until 1977, in Palm Springs, CA; this event was cochaired by myself and Dr. John Williams. Initially it was surrounded by controversy and was vigorously opposed by many in “organized” plastic surgery. It survived these objections and proved a great success, leading to a second symposium on Problems in Aesthetic Surgery at Lake Tahoe, NV, in 1979. Like aesthetic surgery meetings, textbooks on aesthetic surgery were scarce in the pre-ASAPS years. Before the
2004
Scientific Forum
publication of Cosmetic Facial Surgery (Saunders, 1973), authored by myself and by Dr. Donald Wood-Smith, there was only one book of relatively recent vintage that dealt exclusively with aesthetic surgery: Fomon’s Cosmetic Surgery, Principles and Practice (Lippincott, 1960). All other books on the subject were outdated and often presented imaginative but impractical and sometimes even dangerous techniques reflecting the fantasies of the authors. Learning aesthetic techniques by reading was indeed difficult in the face of such a paucity of written material. To learn more than one technique for most aesthetic procedures, it was necessary to travel and visit surgeons in the United States and abroad who specialized primarily in aesthetic surgery. Although most of these surgeons welcomed young visitors, it was often difficult to gain access to their operating rooms unless one was sponsored by a close friend or colleague of the host surgeon. For instance, world-renowned rhinoplastic surgeon Dr. Gustav Aufricht was definitely on the visiting list of anyone interested in rhinoplasty. He was a gentle and generous man; however, his operating room was open only to a select few who, preferably, did not practice in the United States or Canada. One was not allowed to speak or ask questions while Aufricht operated; only in the locker room after the surgery could one do so. It should also be noted that more than a few aesthetic surgeons of that time were eccentric, often colorful, individuals who were frequently isolated from the mainstream of plastic surgery, adding to the difficulty of gaining access to them. Aufricht was an exception, being one of the founders of the American Board of Plastic Surgery. Some of these surgeons were subject to criticism and scorn by many of their colleagues in plastic and reconstructive surgery. Despite these obstacles, it was well worth the effort to overcome them if one wished to broaden one’s horizons and learn aesthetic techniques that often were not to be found anywhere in print. It is notable that Aufricht, like many rhinoplasty surgeons of the day, learned rhinoplasty from Dr. Jacque Joseph in Berlin, who charged observing fellows several thousand dollars to watch him operate. Selective fellowships under a single mentor continued to exist in limited numbers for many years. Postresidency organized fellowships in teaching programs that included hands-on surgical experience for fellows were pioneered at the Manhattan Eye, Ear, and Throat Hospital in New York City, the oldest such program in the United States. They were an integral part of the residency training pro-
On the Occasion of ASAPS’ 36th Annual Meeting, Vancouver, British Columbia
gram of the Institute for Reconstructive Plastic Surgery at the New York University Medical Center. This program began in 1970 as a 3- to 6-month fellowship that Dr. John Marquia and I initially directed, and which Dr. Sherrell Aston and I now direct. It has evolved into a 1year program with positions for two fellows. Such aesthetic fellowships have the advantage of being an integral part of the framework of an ongoing residency training program. This structure has been implemented in other residency programs and by practicing aesthetic surgeons. Aesthetic surgeons today live in a world very different from the one I knew 40 years ago. Aesthetic surgery has not only evolved into an acceptable pursuit for serious physicians but has become the driving force within the field of plastic surgery and an influence on the techniques and conceptual approaches of practitioners in allied fields. Evolving concepts of beauty, aging, and health, as well as the development of safer, less traumatic surgical and nonsurgical techniques, have contributed to public acceptance of what we do as aesthetic surgeons. We can point with pride to the role that ASAPS meetings, symposia, and support of resident and fellow training have played in advancing aesthetic surgery among practitioners and the public alike.■ Reprint requests: Thomas D. Rees, MD, 1236 Bishops Lodge Rd., Santa Fe, NM 87501; e-mail: [email protected]. 1090-820X/$30.00 Copyright © 2004 by The American Society for Aesthetic Plastic Surgery, Inc. doi:10.1016/j.asj.2004.01.004
AESTHETIC
SURGERY
JOURNAL
~
March/April
2004
143
Editorial
On the Occasion of ASAPS’ 36th Annual Meeting, Vancouver, British Columbia
I
t is indisputable that the founding of the American Society for Aesthetic Plastic Surgery (ASAPS) in 1967 was the pivotal event in the shaping of aesthetic surgery education as we know it today. Here was a group of well-trained and fully qualified plastic surgeons joining to form an organization devoted to the sole purpose of furthering aesthetic surgery knowledge and education, in defiance of the prevailing prejudice of organized plastic surgery against this subspecialty. ASAPS spearheaded the rapid development of aesthetic surgery as a bona fide specialty by promoting a national meeting devoted exclusively to aesthetic procedures, educational courses, regional symposia, a journal devoted exclusively to aesthetic surgery, and visiting professorships to further enhance residency training in aesthetic surgery. More recently, the formation of the Aesthetic Surgery Education and Research Foundation (ASERF) has helped ensure directed research in aesthetic surgery. All of these activities have greatly facilitated the training of the young plastic surgeon in the techniques of aesthetic surgery and helped remove the veil of secrecy that existed in the pre-ASAPS era. During the years preceding the founding of ASAPS, obtaining the necessary knowledge and training leading to expertise in aesthetic surgery was difficult and required considerable effort, persistence, and ingenuity on the part of the young surgeon who wished to hone his or her skills in this fascinating and challenging area of plastic surgery. Back then, residency training in specialized fields of surgery (and, indeed, in specialized fields of most medical disciplines), was the exception rather than the rule. Within the field of plastic surgery, training programs emphasized reconstructive surgery; aesthetic surgery was marginalized or not covered at all. The educational tools and opportunities available to the practicing aesthetic surgeon were likewise limited. Relatively few papers on aesthetic surgery were pub-
142
AESTHETIC
SURGERY
JOURNAL
~
March/April
lished. Even fewer papers on the subject were selected for presentation at national meetings. Only a limited number of continuing education courses in aesthetic surgery were offered, regardless of the heavy demand. I distinctly remember teaching a course on rhinoplasty at a Thomas D. Rees, MD, Santa Fe, NM, is a life national plastic surgery meeting member and past president in the mid-1960s at which there of ASAPS. were only 3 other teaching courses on aesthetic surgery offered in the curriculum. Drs. Tom Baker and Howard Gordon offered the first aesthetic surgery symposium in 1967. That symposium was an instant success, became an annual event, and is still going strong, drawing aesthetic surgeons from all over the world. The annual symposium on aesthetic surgery sponsored by the Manhattan Eye, Ear, and Throat Hospital in association with the National Foundation for Facial Reconstruction at New York University began in 1968 — 1 year after the founding of ASAPS — and subsequently became an annual event as well. These two symposia set the stage for similar forums, and eventually many of these were cosponsored by ASAPS. The first ASAPS scientific meeting was in 1969, but ASAPS’ first cosponsored symposium with the American Society of Plastic Surgeons was on rhinoplasty, and did not take place until 1977, in Palm Springs, CA; this event was cochaired by myself and Dr. John Williams. Initially it was surrounded by controversy and was vigorously opposed by many in “organized” plastic surgery. It survived these objections and proved a great success, leading to a second symposium on Problems in Aesthetic Surgery at Lake Tahoe, NV, in 1979. Like aesthetic surgery meetings, textbooks on aesthetic surgery were scarce in the pre-ASAPS years. Before the
2004
Scientific Forum
publication of Cosmetic Facial Surgery (Saunders, 1973), authored by myself and by Dr. Donald Wood-Smith, there was only one book of relatively recent vintage that dealt exclusively with aesthetic surgery: Fomon’s Cosmetic Surgery, Principles and Practice (Lippincott, 1960). All other books on the subject were outdated and often presented imaginative but impractical and sometimes even dangerous techniques reflecting the fantasies of the authors. Learning aesthetic techniques by reading was indeed difficult in the face of such a paucity of written material. To learn more than one technique for most aesthetic procedures, it was necessary to travel and visit surgeons in the United States and abroad who specialized primarily in aesthetic surgery. Although most of these surgeons welcomed young visitors, it was often difficult to gain access to their operating rooms unless one was sponsored by a close friend or colleague of the host surgeon. For instance, world-renowned rhinoplastic surgeon Dr. Gustav Aufricht was definitely on the visiting list of anyone interested in rhinoplasty. He was a gentle and generous man; however, his operating room was open only to a select few who, preferably, did not practice in the United States or Canada. One was not allowed to speak or ask questions while Aufricht operated; only in the locker room after the surgery could one do so. It should also be noted that more than a few aesthetic surgeons of that time were eccentric, often colorful, individuals who were frequently isolated from the mainstream of plastic surgery, adding to the difficulty of gaining access to them. Aufricht was an exception, being one of the founders of the American Board of Plastic Surgery. Some of these surgeons were subject to criticism and scorn by many of their colleagues in plastic and reconstructive surgery. Despite these obstacles, it was well worth the effort to overcome them if one wished to broaden one’s horizons and learn aesthetic techniques that often were not to be found anywhere in print. It is notable that Aufricht, like many rhinoplasty surgeons of the day, learned rhinoplasty from Dr. Jacque Joseph in Berlin, who charged observing fellows several thousand dollars to watch him operate. Selective fellowships under a single mentor continued to exist in limited numbers for many years. Postresidency organized fellowships in teaching programs that included hands-on surgical experience for fellows were pioneered at the Manhattan Eye, Ear, and Throat Hospital in New York City, the oldest such program in the United States. They were an integral part of the residency training pro-
On the Occasion of ASAPS’ 36th Annual Meeting, Vancouver, British Columbia
gram of the Institute for Reconstructive Plastic Surgery at the New York University Medical Center. This program began in 1970 as a 3- to 6-month fellowship that Dr. John Marquia and I initially directed, and which Dr. Sherrell Aston and I now direct. It has evolved into a 1year program with positions for two fellows. Such aesthetic fellowships have the advantage of being an integral part of the framework of an ongoing residency training program. This structure has been implemented in other residency programs and by practicing aesthetic surgeons. Aesthetic surgeons today live in a world very different from the one I knew 40 years ago. Aesthetic surgery has not only evolved into an acceptable pursuit for serious physicians but has become the driving force within the field of plastic surgery and an influence on the techniques and conceptual approaches of practitioners in allied fields. Evolving concepts of beauty, aging, and health, as well as the development of safer, less traumatic surgical and nonsurgical techniques, have contributed to public acceptance of what we do as aesthetic surgeons. We can point with pride to the role that ASAPS meetings, symposia, and support of resident and fellow training have played in advancing aesthetic surgery among practitioners and the public alike.■ Reprint requests: Thomas D. Rees, MD, 1236 Bishops Lodge Rd., Santa Fe, NM 87501; e-mail: [email protected]. 1090-820X/$30.00 Copyright © 2004 by The American Society for Aesthetic Plastic Surgery, Inc. doi:10.1016/j.asj.2004.01.004
AESTHETIC
SURGERY
JOURNAL
~
March/April
2004
143