Plastic Surgery Research, Our Involvement and Its Implications for the Future of Our Specialty

Friday, April 12, 2013
Alexandra Condé-Green, MD, FICS.1, Leigh Ann Price, MD2 and Stephen M. Milner, MD, FACS2, (1)Plastic and Reconstructive Surgery / Burn Surgery, Ivo Pitanguy Institute, Rio de Janeiro, Brazil / Johns Hopkins Bayview Medical Center, Baltimore, MD, (2)Plastic and Reconstructive Surgery / Burn Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD
Goals/Purpose: After our years of residency in General Surgery, and after completion of our training in Plastic Surgery, many programs require that residents present a thesis on a project of their choice to obtain their final diploma, amongst other assignments. The innovative topic of stem cells derived from adipose tissue and fat grafting discussed extensively in Plastic Surgery meetings the last 5 years caught our attention notably in the Aesthetic meeting in San Diego in 2008, and we embarked in the adventure of research in that field.  

Methods/Technique: With the help of residents, the encouragement of attendings, this subject was chosen as our thesis for the obtention of the Plastic Surgery diploma. We pioneered a project, in which we studied the most practical methods of preparation of fat to obtain less resorption and better fat grafting results overtime. This study led to several publications in peer-reviewed Plastic Surgery journals and many presentations at international and national meetings. When we start writing and publishing, at first our main goal is to add a long list of publications on our curriculum vitae, second comes the desire to be recognized by our peers, then we wish to contribute to the Plastic Surgery literature and ultimately make a significant difference in our field, by being useful to other plastic surgeons in their daily practice and to residents/fellows in training.  

Results/Complications: Conducting Research, brings us close to Plastic Surgeons around the world, their ideas and allows us to make valuable exchanges through meetings, publications, fellowships. Most importantly research makes us question our choices and actions, compare our procedures with others, have our peers criticize our work, or serve as a bridge for other projects. Reporting series of hundreds of patients with descriptive images, sharing what we do in a country is advantageous to the surgeons, authors, the hospital, city, country where the procedures are performed and of course the ultimate goal, the field of Plastic Surgery. The industry also benefits from these studies as surgeons are encouraged to make more informed decisions on product choices. Research is demanding; it requires lots of paperwork, institutional review board and animal committee’s approvals, grant applications, dedication and time. All research is good, even reporting negative or unexpected outcomes, as all we know is still infinitely less than all that remains to be known. Journals and meetings are not only looking for new things per se, as almost everything has been written. They are looking rather for interesting approaches to conditions, improvement of procedures and most importantly Evidence based practice. It’s so interesting to see how we have evolved over the years. At a certain point in our career, we feel comfortable, when we obtain good results with a procedure, we like stability and consistency, and fear change. But nowadays, we are faced with constant changes with the advances in technology, we must accept them and adapt as some procedures are becoming easier with technology. Information flows quickly with social media, our society is internet-driven and we need to keep pace.

Conclusion: Overall, we Plastic Surgeons are all Creators, Innovators. Yes, in our operating room, clinic, when we stay up late at night thinking of patients or procedures, the difference is that some of us have time or make time to actually report the results. History has come full circle, we recently find ourselves going back to bench research with basic sciences and animal studies, to understand our clinical results, establish guidelines of care and open horizons working with other specialists (biochemists, physicists). It is the plastic surgeon that can commonly make the transition of bench research into a in vivo established procedure, rendering research more translational, more practical. The world no longer needs to dream about face transplant as a possibility in the future, as these efforts are in the present, with hand transplantation being almost routine in some institutions. Stem cells are at the forefront of our specialty with many registral trials around the world.We are living the golden age of plastic surgery again and again. We are fortunate to be practicing a specialty that has so much diversity and allows us to be creative, inventive and adventurous.