There are a massive number of books helpful to master the topics required to succeed in medical school and residency. Each medical specialty has their own sources, which range in size from large multi-volume texts to small clinical reference guides that include brief summaries of what are considered the most important, or high-yield, information “pearls.” Facial plastic surgery clinical reference guides exist as a valuable, though insufficient, source for clinical information for training residents and fellows.
Surgical “Pearls” in Facial Plastic Surgery
Dr. Jeffrey Harmon
Pearls Communicate Important Medical Knowledge Succinctly
Residents of all specialties attend at least weekly lectures with experts in their field. Medical “pearls” include information distilled into bullet point form for these presentations. The purpose of medical pearls is to succinctly communicate the most salient information to new physicians who are often overwhelmed with clinical and administrative work during the day. The breadth and depth of information required to learn is so significant that most residents study late at night or early in the morning when their roommates or loved ones are sleeping. For example, I studied at night after my wife and son had fallen asleep. I found these clinical reference guides and presentations by attendings useful but insufficient. I always felt that the excluded context made it difficult to fully understand a topic. I also wonder whether some residents are less inclined to dive into the medical literature to confirm and expand on the information communicated because of the availability of these guides.
Facial Plastic Surgery = Eliminate the Dog-Ear Deformity
A friend and head and neck surgery co-resident at the University of Cincinnati who is an incredibly intelligent and insightful individual also recognized the limitations in depending on these “pearls” of knowledge as the basis for learning medical information in residency. He would joke that the knowledge required to understand each subspecialty in head and neck surgery could be distilled to a single sentence. His summary of the field of facial plastic surgery was “eliminate the dog-ear deformity.” A dog ear deformity is a fold of skin than can develop at the edge of an incision after orienting and closing that incision. A dog ear deformity can occur with any plastic surgery procedure in which the location and/or orientation of skin and subcutaneous tissue is re-arranged. An example includes the repair of a defect on the face after skin cancer is removed. A dog ear deformity can also occur with cosmetic procedures such as facelifts as well if the dissection is not performed properly. I told my friend and colleague that I would have a book bound for him titled A Complete Overview of Facial Plastic Surgery with only one page. That page would include the sentence “eliminate the dog-ear deformity.”
This simple sentence does explain a great deal of plastic surgery. The practice of facial plastic surgery largely involves the creation and movement of tissue from one area of the face to another against the force of gravity. Proper incision and tissue flap design is key to allowing skin closure that is flush. Prevention and/or elimination of a dog-ear deformity reflects appropriate, considerate movement of tissue. However, it is also an incomplete description because plastic surgery involves the complex multi-vector movement of tissue in different layers requiring detailed knowledge of the surrounding superficial and deep anatomy to perform safe, effective surgery. There are also many other patient-specific considerations that require both exposure in training and experience performing to fully understand. Facial plastic surgeons are always learning and improving their craft.
Surgical Pearls Are Valuable but Insufficient
No ability to memorize pearls can replace the knowledge gained from experience in head and neck surgery residency, facial plastic surgery fellowship, and clinical practice. From the way to troubleshoot and address problems peri-operatively to the ability to evaluate a patient pre-operatively to determine the most appropriate treatment course for them, facial plastic surgery is filled with nuance. New information is coming out every day in the medical literature that may contradict what was previously assumed to be true and/or may complicate the picture of what is true, making decisions more difficult. In my opinion, the value of these pearls is as an exercise in analyzing and distilling information. They are a skeleton on which to flesh out the nuances of clinical practice. Our training and experience allow us to have a flexible mind when dealing with each individual patient because the answer to many clinical questions is not available in the textbook or in a scientific paper.
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This blog post is for educational purposes only and does not constitute direct medical advice. It is essential that you have a consultation with a qualified medical provider prior to considering any treatment. This will allow you the opportunity to discuss any potential benefits, risks, and alternatives to the treatment.