Rotation Recap: Plastic Surgery

PLASTICS! The moment we’ve all been waiting for! (Just kidding, it’s the moment I’VE been waiting for since I discovered shows like Nip/Tuck, Extreme Makeover, and Dr. 90210 as a kid and developed an obsession). Disclaimer: I understand that these shows are not always an accurate portrayal of the plastic surgery world and are often criticized for being harmful to body image, particularly for young viewers. However, it’s been a lifelong guilty pleasure and I was counting down the days until I was actually seeing consults and scrubbing in! My experience did not disappoint and I was able to first assist a variety of procedures including 10 hour TRAM flap cases, breast reductions and augmentations, liposuction of almost every area of the body, upper and lower blepharoplasties, abdominoplasties, and countless injectables.. Botox, Juvederm, Voluma, you name it!

My experience was unique because I spent the first half of the month in a large university hospital setting with a microsurgery-certified plastic surgeon who specializes in difficult breast reconstruction cases, typically with transverse rectus abdominis muscle (TRAM) flaps. The last half of the month, I was with a surgeon who had a gorgeous private practice, complete with a fully-accredited operating room and posh recovery suites for patients. It was there that I learned all about injectables and other non-surgical options (like laser and CO2 treatments) and also got a Spectra peel for myself (which I highly recommend!)  


How To Prepare

Review Facial Anatomy – Since injectables have become such a large part of plastic surgery practices, it’s critical to remember the many muscles of the face and their innervation and blood supply. We have all seen botched botox (drooping lip, perpetual look of surprise) and you do NOT want to be responsible for that. Of course, this knowledge is helpful during facial surgeries too. I really liked this facial anatomy workshop for injectors that I stumbled across on google. It reminds us that “There are no safe areas to inject on the face, only low risk areas and high risk areas.”

Practice Your Suturing –  This one is obvious but the cosmetic result of a procedure is everything. Sutures need to be as close to perfect as you can make them! A good rule of thumb that my preceptor told me is that if you think a stitch may need redoing, take it out and do it again. They also encouraged me to learn to palm instruments as it gives you much more freedom and fluidity to sew. One of my surgical skills instructors at school told us to carry around our needle drivers and palm them open and closed while walking to class, watching tv, etc. I started doing it while binging Netflix and it really did help me (or at least that’s what I told myself to make it okay)!

Brush up on your Botox – I know I keep coming back to this but competency with injectables is a serious resume-booster, especially for people interested in cosmetic surgery. I had no experience with injectables prior to this rotation and I struggled to understand the units and how to reconstitute it with saline. As with most things, a quick YouTube videocleared it all up for me and made things at work much easier.


What to Expect

Importance of Language – As much as you may want to, you cannot walk into the room and say, “Tell me what you don’t like about yourself” a la Dr. Christian Troy from Nip/Tuck. Many patients are considering cosmetic surgery to address areas of insecurity about their bodies and it can be emotional. It is never your job to say “You look amazing, you don’t need XYZ procedure.” Try to understand why your patient isn’t satisfied and what outcomes they are hoping for. Be kind and understanding, deciding to undergo cosmetic surgery is a very personal decision and minor changes can make giant differences in self esteem.

Dressings and bandages – Plastic surgeons are notoriously picky about how their cases are dressed and bandaged after the procedure. Be sure you know exactly what your preceptor likes in terms of what materials to use (there are literally hundreds of options), if they like any antibac added, how often the dressings should be changed, etc. After the procedure, it will most likely be your job to get the patient all bandaged up and ready for PACU. Make an effort to make the dressing look neat, clean, and intentionally placed. One of my favorite studies shows that among patients who underwent the exact same procedure who had nice, neat dressings reported less pain and higher satisfaction with their experience than those who had sloppy or overly large dressings with lots of tape.

OR Etiquette – Much of what was covered in my General Surgery Rotation Recap is applicable to plastic surgery, especially the bits about not being in the way, spatial awareness, and sterile technique. One thing you DO NOT want to do is touch an implant of any kind. In fact, many surgeons use sterile funnels to insert breast implants so that the implant itself is never touched, therefore reducing risk for contamination and therefore reducing risk of capsular contracture. I only drive this bit home because I was assisting in an augmentation and wanted to know  what the implant felt like so I touched it. Big mistake. (It happens).

Thanks for spending time in my little corner of the web when you could be anywhere (like Netflix!) If you have any questions or comments drop me a line or DM me on Instagram @coutureinclinic! If you have more rotations coming up, check out my recaps on Emergency Medicine, Inpatient Medicine, Pediatrics, General Surgery, Psyche, Trauma ICU, Cardiothoracic Surgery, OBGYN , and Family Medicine

Love and light,