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Symposium on problems and complications in aesthetic plastic surgery of the face
593
BOOK REVIEWS The shortcomings of the text for a plastic surgeon are the inadequacy of information on dressings and their effect on wound healing, what contributes to the quality of a scar or influences pigmentation. Scar hypertrophy and keloid formation are inadequately covered as is the effect of irradiation on healing. There is a good index. The bibliography offers plenty of relevant further reading. ROY SANDERS
Symposium on Problems and Complications in Aesthetic Plastic Surgery of the Face. ASPRS Vol. 23. Edited by Bernard L. Kaye and Gilbert P. Gradinger. Pp. xiii+ 377. Over 400 illustrations (photographs and line drawings). (St. Louis, Toronto: The C. V. Mosby Company, 1984). Price&85.50. In the preface to this volume the editors define problems “As those conditions that the patient brings to the surgeon prior to surgery” and complications “As those unfavorable conditions that result after surgery”. They express the hope that study of these may reduce the latter. They also aim to describe some of the latest techniques in aesthetic facial surgery. It must be admitted that they largely succeed and the distinguished contributors to this symposium have given freely of the fruits of their experience. Inevitably in a multi-author work there is some unevenness but not sufficient to spoil the overall effect. The first section on patient selection and patient dissatisfaction is perhaps the most tantalising and in some ways the most disappointing. Herein lies the key to success in this type of surgery and the opening chapter on “learning to say no” is potentially the most important. Important not only in setting the tone of the book, but as a contribution to the management of the patient whose aspirations are incompatible with reality. Regrettably this chapter is too superficial in its exposition and is marred by the use of aphoristic jargon beloved of advertising agencies, for example “Beauty is skin deep but ugly is down to the bone”. This is followed by the startiing observation that “We can recall certam unattractive yet charming, talented and prominent women of the world such as Eleanor Roosevelt, Golda Meir. Indira Gandhi and Margaret Meade, who became truly more attractive as they grew older.” This is gratuitously offensive. untrue and irrelevant. There seems to be a generahsed confusion amongst some aesthetic surgeons and their patients that the surgical amelioration of ageing of the skin is synonymous with the creation of beauty. If any should harbour this misconception, perusal of the excellent photographic records produced in this book will expose the fallacy of their views. One is reminded of the backhanded compliment paid by a husband to his w&e after attending a large social function “My dear, you were the most beautiful woman there-my God they were an ugly lot”. Nonetheless it would be wrong to condemn entirely the opening section and indeed. one can only agree with the editorial comment at the end of it: “The younger surgeon will benefit from reading and rereading it (Part one) as he gains more experience in handling aesthetic surgery patients. The experienced Plastic Surgeon will benefit from this section by comparing his techniques with those authors, broadening or modifying them as he sees fit.” It is to be hoped that there will be a future sym-
posium which will discuss more fully this aspect of aesthetic facial surgery. The sections that follow deal with forehead and brow; procedures in mid and full face, which includes useful accounts of the piatysma-SMAS cervicofacial rhy~idectom~. blepharoplasty, surgery of the neck, earlobes, chin and finally “surface surgery”. The latter section describes chemical peel and dermabrasion and a combination of these two methods. The range of techniques described and discussed is far greater than those undertaken by the majority of plastic surgeons in this country. Nonetheless it is a commonplace that what America does today Britain will do tomorrow and that the undoubted explosion of interest in this type of surgery will result in a wider application of techniques, medico-legal problems and commercialism. This volume will be a valuable contribution to the literature. It will. hopefully, caution and calm the over enthusiastic beginner and will interest and support the established practitioner. In the midst of this maelstrom of “aesthetic” activitychapters of surgery, cosmetic surgery clinics. beauticians, protile plastics, bustography and all the rest. it is worth quoting the words of the famous art critic Eric Newton, .. ..I beauty cannot be described, therefore it cannot be defined. It cannot be measured either in quantity or quality, therefore it cannot be made into the basis of a science. It has always proved impregnable to the frontal attacks ofthe aestheticinns."
Reference E. Newton (1950). The Meuning o/‘Beuuty. Longmans Green & Co. London. 1. P. BENNETT
Manual on the AO/ASIF Tubular External Fixator. By G. Hierholzer, Th. Riiedi, M. Allgiiwer and J. Schatzker. Pp. 100 with 104 figures. (Berlin. Heidelberg, New York and Tokyo: Springer-Verlag, 1985). Price DM 86. This well illustrated book is, as the title states. a manual of the A0 external fixation system. Although it lists chapters on biomechanics and biological principles, it is essentially a book describing the techniques used to apply this tubular system in which there are essentially three confi~uralions: a single bar, a frame and a trapezoidal system. The book itself is clearly laid out with figures of excellent quality. I found the text sometimes a little dithcult to follow and this may be a result of t~dnsIation, There are a number of interesting points raised by the authors. particularly the use of an interfragmentary screw in conjunction with the single bar to ensure accurate fracture reduction. Also the authors recommend removing the system at 6 to 8 weeks and then applying a patella tendon bearing plaster or internally fixing the patient-s fracture. Consensus is apparently being reached that external fixation devices should be left for a nlininlum of 6 weeks and then removed. although there are strong dissenters from this view. The authors recommend as close an application as possible of the device to the bone in order to ensure stability. In plastic surgery. in which a flap is to be raised, this idea may just not be possible and hence some degree of stability must be compromised. This book certainly fulfils its main purpose of describing in
BOOK REVIEWS The shortcomings of the text for a plastic surgeon are the inadequacy of information on dressings and their effect on wound healing, what contributes to the quality of a scar or influences pigmentation. Scar hypertrophy and keloid formation are inadequately covered as is the effect of irradiation on healing. There is a good index. The bibliography offers plenty of relevant further reading. ROY SANDERS
Symposium on Problems and Complications in Aesthetic Plastic Surgery of the Face. ASPRS Vol. 23. Edited by Bernard L. Kaye and Gilbert P. Gradinger. Pp. xiii+ 377. Over 400 illustrations (photographs and line drawings). (St. Louis, Toronto: The C. V. Mosby Company, 1984). Price&85.50. In the preface to this volume the editors define problems “As those conditions that the patient brings to the surgeon prior to surgery” and complications “As those unfavorable conditions that result after surgery”. They express the hope that study of these may reduce the latter. They also aim to describe some of the latest techniques in aesthetic facial surgery. It must be admitted that they largely succeed and the distinguished contributors to this symposium have given freely of the fruits of their experience. Inevitably in a multi-author work there is some unevenness but not sufficient to spoil the overall effect. The first section on patient selection and patient dissatisfaction is perhaps the most tantalising and in some ways the most disappointing. Herein lies the key to success in this type of surgery and the opening chapter on “learning to say no” is potentially the most important. Important not only in setting the tone of the book, but as a contribution to the management of the patient whose aspirations are incompatible with reality. Regrettably this chapter is too superficial in its exposition and is marred by the use of aphoristic jargon beloved of advertising agencies, for example “Beauty is skin deep but ugly is down to the bone”. This is followed by the startiing observation that “We can recall certam unattractive yet charming, talented and prominent women of the world such as Eleanor Roosevelt, Golda Meir. Indira Gandhi and Margaret Meade, who became truly more attractive as they grew older.” This is gratuitously offensive. untrue and irrelevant. There seems to be a generahsed confusion amongst some aesthetic surgeons and their patients that the surgical amelioration of ageing of the skin is synonymous with the creation of beauty. If any should harbour this misconception, perusal of the excellent photographic records produced in this book will expose the fallacy of their views. One is reminded of the backhanded compliment paid by a husband to his w&e after attending a large social function “My dear, you were the most beautiful woman there-my God they were an ugly lot”. Nonetheless it would be wrong to condemn entirely the opening section and indeed. one can only agree with the editorial comment at the end of it: “The younger surgeon will benefit from reading and rereading it (Part one) as he gains more experience in handling aesthetic surgery patients. The experienced Plastic Surgeon will benefit from this section by comparing his techniques with those authors, broadening or modifying them as he sees fit.” It is to be hoped that there will be a future sym-
posium which will discuss more fully this aspect of aesthetic facial surgery. The sections that follow deal with forehead and brow; procedures in mid and full face, which includes useful accounts of the piatysma-SMAS cervicofacial rhy~idectom~. blepharoplasty, surgery of the neck, earlobes, chin and finally “surface surgery”. The latter section describes chemical peel and dermabrasion and a combination of these two methods. The range of techniques described and discussed is far greater than those undertaken by the majority of plastic surgeons in this country. Nonetheless it is a commonplace that what America does today Britain will do tomorrow and that the undoubted explosion of interest in this type of surgery will result in a wider application of techniques, medico-legal problems and commercialism. This volume will be a valuable contribution to the literature. It will. hopefully, caution and calm the over enthusiastic beginner and will interest and support the established practitioner. In the midst of this maelstrom of “aesthetic” activitychapters of surgery, cosmetic surgery clinics. beauticians, protile plastics, bustography and all the rest. it is worth quoting the words of the famous art critic Eric Newton, .. ..I beauty cannot be described, therefore it cannot be defined. It cannot be measured either in quantity or quality, therefore it cannot be made into the basis of a science. It has always proved impregnable to the frontal attacks ofthe aestheticinns."
Reference E. Newton (1950). The Meuning o/‘Beuuty. Longmans Green & Co. London. 1. P. BENNETT
Manual on the AO/ASIF Tubular External Fixator. By G. Hierholzer, Th. Riiedi, M. Allgiiwer and J. Schatzker. Pp. 100 with 104 figures. (Berlin. Heidelberg, New York and Tokyo: Springer-Verlag, 1985). Price DM 86. This well illustrated book is, as the title states. a manual of the A0 external fixation system. Although it lists chapters on biomechanics and biological principles, it is essentially a book describing the techniques used to apply this tubular system in which there are essentially three confi~uralions: a single bar, a frame and a trapezoidal system. The book itself is clearly laid out with figures of excellent quality. I found the text sometimes a little dithcult to follow and this may be a result of t~dnsIation, There are a number of interesting points raised by the authors. particularly the use of an interfragmentary screw in conjunction with the single bar to ensure accurate fracture reduction. Also the authors recommend removing the system at 6 to 8 weeks and then applying a patella tendon bearing plaster or internally fixing the patient-s fracture. Consensus is apparently being reached that external fixation devices should be left for a nlininlum of 6 weeks and then removed. although there are strong dissenters from this view. The authors recommend as close an application as possible of the device to the bone in order to ensure stability. In plastic surgery. in which a flap is to be raised, this idea may just not be possible and hence some degree of stability must be compromised. This book certainly fulfils its main purpose of describing in