Haideh Hirmand, M.D.

The word "plastic" is derived from the Greek word "plastikos" which means "to mold" or "to give form". Plastic surgery is the surgical means by which to mold or to shape the body. Plastic surgery consists of both reconstructive and aesthetic (commonly referred to as cosmetic) surgery. The former restores physical form and function after disease, accidents, or congenital defects whereas the latter enhances appearance of body features- both can have grave emotional and psychological impacts on the lives of people undergoing them.

At times there is an overlap, and some types of plastic surgery could be considered to have both reconstructive and aesthetic components such as breast reductions, eyelid ectropian, and ptosis repairs.

The most common misconceptions that I encounter are that plastic surgery can make things perfect, make scars disappear, and can make anyone look young and beautiful.

Plastic surgery, like most other surgical specialties is still male-dominated. I do, however, believe that it is different to be a woman plastic surgeon than a woman surgeon in other surgical specialties, save breast oncologic surgery and obstetric/gynecology. The majority of our patients are comprised of women who, by all accounts, communicate differently with a surgeon of the same gender. A female plastic surgeon has an immediate connection with a majority female gender patient base, their issues and concerns and thus can have a large impact on issues relating to women’s well being.

By and large for the same reason, excluding some exceptions, patients are very accepting of a woman plastic surgeon and perhaps more so compared to a woman surgeon in another subspecialty. This could also be due to the fact that women are traditionally viewed as more sensitive, detail-oriented, and communicative- all characteristics viewed as necessary in the practice of plastic surgery.

Male and female psyche and their relationship to body image, aging, and aesthetics are different. Women have historically been more under pressure to follow "norms" of beauty and youth. Even though men are more and more concerned with appearance, they are in general more accepting of aging, imperfections, and limitations. They also feel more guilt in general about wanting to enhance their appearance.

It is an approach that defines the role of plastic surgery, reconstructive and aesthetic, in the overall health and well being of an individual as only one part of a larger picture. Plastic surgery can be most effectively utilized in conjunction with other important variables such as good nutrition, medical and dental care, physical and mental fitness, emotional well-being, and personal growth among other things. The goal is not to deny one’s age or obsess over imperfections, but to feel and look one’s best at any age. In this way the goal is not to strive for an unrealistic body image or shape but to integrate all elements of a healthy lifestyle and utilize the appearance to convey an inner sense of health and confidence.

I initially got involved with doing plastic surgery on children abroad during my training period and through my activities in health and human rights. I have traveled to Latin America several times on reconstructive missions as part of the host country’s health development programs, and this has added the most rewarding component to both my personal and professional life. I have been involved with volunteer work for a very long time and it is in this type of work that I often feel I have the largest impact. The beneficiaries are those most in need of services with the least access. The physical changes, such as those after lip or palate repair or burn reconstruction have a life long effect on each person’s quality of life.

In a less commercial way. As a surgical subspecialty, I would like to see a substantive and realistic approach to plastic surgery in improving the quality of life for our patients, and less of a commercialized quick anti-dote to aging and such.

The most challenging aspects of practice in today’s environment are patient education, and effective communication with patients. The other great challenge is surgical innovations and clinical research.

Yes, these patients benefit most from behavioral and psychological evaluation and treatment. More studies need to be conducted to see what role, if any, plastic surgery may play in dealing with these patients’ issues.

These would include breast reconstruction, body contouring comprising of breast surgery of various kinds as well as abdominoplasties and liposuction, redefinition of features including correction of congenital conditions such as microgenia, prominent or deformed ears, nasal septal deviations to name a few. Also included are excision of lesions including suspicious moles and skin cancers and reconstruction after such removals, and aesthetic procedures rejuvenation such as blepharoplasty, facelift, browlift and skin resurfacing.

As a clinician with a deep interest in women’s health concerns, I believe that plastic surgery can have a profound and potentially positive impact on the lives and health of women. I have essentially responded to this question at some length above. The role of plastic surgery should be an integrative one together with all the other important factors that ensure well-being. As such it can enhance confidence and play a positive role.

Both groups of patients should be realistic in their goals and expectations. They should research the topic at hand and make sure they feel comfortable with their surgeon’s credentials and expertise (certification by the American Board of Plastic Surgery is a pre-requisite), as well as with her or his approach and time spent discussing their concerns. In addition, life crises are not good times for elective surgery of any kind. They should be wary of commercial articles and advertisements for plastic surgery in the lay media and instead look for informative articles where research and thinking has gone into writing the piece.

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