The truth about plastic surgeons

Dr Mark Steinmann is a full member of the Association of Plastic and Reconstructive Surgeons of South Africa, having completed his training at the University of the Witwatersrand and obtaining his fellowship from the College of Plastic Surgeons of South Africa. Dr Steinmann performs both reconstructive and cosmetic surgery in his private practice in Rosebank and has completed a cosmetic Mentorship with Dr Saul Braun, one of South Africa¡¯s most prominent plastic surgeons.

The words ¡°Plastic Surgery¡± often elicit many thoughts from people, thoughts such as glamour, wealth and sex appeal. But plastic surgery delves a lot deeper; it is not all about enhancing oneself to be aesthetically beautiful. Plastic surgeons are highly specialized and exceptionally well trained doctors, ¡°exceptionally well trained¡± being the operative words. The training and time that plastic surgeons endure express true passion for their chosen career. The knowledge from an academic perspective, practical training and motivation in their art is thus completely tangible. Tangible, in the sense that a patient will most likely see positive results in what ever reason they have been to a plastic surgeon, unlike other professionals that claim to offer a similar service without the knowledge, back up and appropriate training.

15¡­The absolute minimum number of years to become a South African plastic surgeon. It takes nine years to register as a general practitioner in private practice after six years in medical school and three years of community service. After that, two years of general surgery training in a university accredited teaching hospital whilst writing several exams on advanced anatomy, physiology, intensive care and general surgery principles will make you legible to apply for a training post in plastic surgery. A waiting list of almost two years usually follows, during which successful candidates will train in other surgical specialities and publish papers, giving them the edge for that coveted plastic surgery registrar post. Four years of studying some of the world¡¯s longest texts in academic history and more than 10 000 hours of practical training in plastic surgery will entitle you as a Plastic Surgeon.

Best selling author, Malcolm Gladwell states in in his book, Outliers, that it should take on average 10 000 hours for an individual to master their vocation. With regards to plastic surgeons, this is a conservative statement, based on the time spent in the operating room mastering the skills of plastic surgery. However you still need to pass a grueling exam and gain acceptance by the Association of Plastic Surgeons, an elite society consisting of just over 100 members that recognize only qualified and highly skilled plastic surgeons in South Africa.

Cosmetic or Aesthetic Surgery is a division of Plastic and Reconstructive Surgery. It is not a separate entity, and it is not taught in other specialities. Cosmetic surgery is the application of important plastic and reconstructive surgical principles that are taught during our training. Many of the dreaded complications of cosmetic procedures are treated and managed by principles taught only in our speciality and fortunately, mortality is extremely rare in cosmetic surgery when performed by a qualified plastic surgeon.

Untrained surgeons and general practitioners also perform cosmetic procedures without the appropriate knowledge of dealing with surgical complications that can occur either during or after the procedure. The potential fatality or disfigurement of a patient as a result of such complications is indefensible. As a common cosmetic procedure, a breast augmentation is not without risk.

In South Africa, the very best breast implant manufacturers do not supply implants to untrained surgeons, in fear that their status as a reputable manufacturer may be compromised. As a result, untrained surgeons may use implants that are not well known or are not commonly used. An implant is a surgical device that must adhere to strict manufacturing methods, a fact known by plastic surgeons and therefore offered to our patients. Despite this, our fraternity is inundated with patients having complications from breast augmentations being performed by untrained professionals.

Professional bodies in South Africa, recognize specialities in the health profession. These bodies are The College of Medicine of South Africa, The Health Professions Council of South Africa and any one of our universities. These professional bodies do not recognize the self-proclaimed ¡°aesthetic physicians¡± or ¡°aestheticians¡±. In fact, there is no university degree or diploma that offers a course in aesthetics or aesthetic medicine, at least not one that is recognized by our professional institutions. Nevertheless, these doctors can attend short informal courses on the usage of basic cosmetic procedures and receive a certificate stating their attendance without complete understanding of the risks and limitations involved.

As the number of non-surgical procedures increases worldwide, sadly complications are too. This is a result of these procedures being done by untrained professionals. It is not plausible to administer an injection containing foreign material into a patient¡¯s face without understanding or having the full knowledge of everything to offer the patient. Many ¡°aestheticians¡± will offer ¡°liquid face-lifts¡± and ¡°chemical brow lifts¡±, terms used to sometimes trick patients into believing that these are much safer and cheaper alternatives to surgery. They are not without risk and if not performed correctly can lead to permanent deformities. Sadly, many of these patients have spent a fortune on ¡°injectables¡±, without ever being offered all the options.

There are many new and exciting injectable products that plastic surgeons will use to enhance or restore the youthful appearance of the face, however they cannot be used in every patient. Botox is an excellent example. It will reduce wrinkles in the appropriate patient, but it will not work for every patient. Every health care professional in a speciality must utilize his or her full armamentarium and must have the professional capacity to say no, or to refer to another specialist when necessary. The ¡°armamentarium¡± is the medicines, equipment and techniques available to a medical practitioner to treat a patient. Dermatologists, for example offer certain non-surgical cosmetic skin treatments and appropriate referral systems are in place between the two specialities.

Plastic Surgeons, worldwide, are the first professionals to be offered new products and equipment that claim to be ¡°wonderful alternatives¡± to standard cosmetic practice. A classic example is laser liposuction. Very few plastic surgeons in South Africa offer this as an alternative to traditional liposuction and although there have been some good results in experienced hands; it is by no means a safer or more reliable technique. 

Laser liposuction has fallen into the hands of ¡°Aesthetic physicians¡± and general practitioners who will claim that laser liposuction is less invasive, less painful and ¡°more gentle¡± than traditional liposuction. Unfortunately, these statements are not backed up by any scientific evidence and in fact a lot of non-sense. There are no controlled studies to prove that laser liposuction is better than traditional liposuction. While advances in cosmetic surgery are exciting and welcoming to our fraternity, these should be reserved for experienced plastic surgeons who have the knowledge of all the techniques available and how to deal with complications should they arise.

So, the truth about plastic surgeons is that we are a proud group of specialists, having surpassed the ¡°10 000 hour¡± mark. We approach all patients¡¯ expectations with realistic, safe and reliable options using comprehensive knowledge and experience with a solid back up from our Association. We continue to see a multitude of patients with complications as a result of cosmetic procedures being performed by untrained doctors. Should you consider any cosmetic treatments, ensure that a fully certified Plastic and Reconstructive Surgeon performs it. 

Dr. Steinmann has published and presented several clinical papers at local and international congresses and has received numerous awards during his training for research and clinical trials performed at academic hospitals in South Africa. Dr Steinmann worked for two years in several surgical disciplines in the United Kingdom and was actively involved in the Nelson Mandela Smile Foundation as part of a team that helped many patients with facial deformities.

Dr Steinmann¡¯s clinical interests include both surgical and non-surgical rejuvenation of the face as well as holistic anti-aging strategies.

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