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This information is adapted from a presentation given to physician groups and a series of videos available online. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Source: Martin, Paula J. Suzanne Noel: Cosmetic Surgery, Feminism and Beauty in Early Twentieth-Century France. Burlington, Vermont: Ashgate, 2014. Print. Timeline The history of facial plastic surgery is a story of heroes and charlatans who navigated a nascent subspecialty developing shortly after the invention of anesthetic agents. While its true origins are ancient, its modern origins begin in the late 19th and early 20th century, immediately before World War I. The best way to understand the modern history of facial plastic surgery is to visualize a timeline extending from a "pre-war" period through World War I, an "inter-war" period, World War II, and the immediate "post-war" period. This timeline is the skeleton on which the history can be fleshed out. Advancements in cosmetic facial plastic surgery developed gradually over this period. World War I and World War II were punctuation marks during which the reconstructive side of facial plastic surgery made great, rapid advancements because the war wounded were surviving increasingly severe facial trauma. The field of facial plastic surgery became medicalized – crystalized into its own coherent field of medicine with its own philosophies and techniques – from the pre-war period to World War II. Facial plastic surgery professionalized – formed a governing body, formal inclusion and exclusion criteria, and a formal delineation of the boundaries of the practice of the field – during World War II and the post-war period. The history below was gathered from reading the referenced books and combining this information into a story of a field of medicine I am proud to be a member of. The individuals discussed here are only a small fraction of those practicing facial plastic surgery at the time. Their stories simply exemplify the evolution of the field in a coherent way. Early History - Reconstructive Surgery The earliest facial plastic surgery procedures were developed to repair the nose. The Italian physician Gaspare Tagliacozzi wrote the first textbook on plastic surgery in the Western world in 1597. Called The Surgery of Defects by Implantations, the book includes instructions on a procedure used to reconstruct the nose of patients who contracted syphilis, which destroys the supporting cartilage of the nose. It was a tortuous procedure requiring multiple operations over the course of 3 to 5 months. The procedure utilized skin from the inner arm and forced patients into an uncomfortable, contorted position during the entire reconstructive period. The caste of potters on the Indian subcontinent developed a much more elegant technique hundreds of years prior to reconstruct the noses of individuals who had theirs removed as punishment for crimes utilizing tissue from the forehead. This technique remained unknown in the West until the early 20th century. Joseph Constantine Carpue, a British army officer, introduced the technique to the West in 1914 and published An Account of Two Successful Operations for Restoring a Lost Nose from the Integuments of the Forehead in 1916. World War I and II would accelerate advancements on the above techniques by necessity. Source: Meikle, Murrary C. Reconstructing Faces: The Art and Wartime Surgery of Gillies, Pickerill, McIndoe & Mowlem. Otago University Press, 2013. Print. World War I - Reconstructive Surgery There was a rapid innovation in the field of reconstructive facial plastic surgery during World War I when approximately 15% of the soldiers who survived trench warfare experienced facial injuries. Ernest Hemmingway wrote eloquently about these survivors: There were other people too who lived in the quarter and came to the Lilas, and some wore Croix de Guerre ribbons in their lapels and others also had the yellow and green of the Medaille Militaire, and I watched how well they were overcoming the handicap of the loss of limbs and saw the quality of their artificial eyes and the degree of skill with which their faces had been reconstructed. There was always an almost iridescent shiny cast about the considerably reconstructed face, rather like that of a well packed ski run, and we respected these clients more than we did the savants or the professors. World War I made heroes out of many surgeons, including the New Zealand-born Ear, Nose and Throat (ENT) surgeon Harold Gillies. Initially stationed in France, he returned to England, where he attended medical school, to Cambridge Hospital in Aldershot then to Queen's Hospital in Sidcup, Kent when Aldershot was of insufficient size to care for the number of wounded. The hospital at Sidcup was founded specifically for those with facial injuries. In fact, it is considered the birthplace of modern reconstructive plastic surgery. Approximately 8000 maxillofacial procedures were performed during its busiest period from 1917 to 1921. The wards housing the most gruesomely injured soldiers were called the "chamber of horrors" by other patients. Mirrors were banned at the hospital during this time. Harold Gillies wrote Plastic Surgery of the Face in 1920 based on this wartime experience. His book describes multiple innovations including the tubed pedicle, which allowed him to transfer skin from one area of the face to another. However, he also made poor recommendations in his textbook. For example, Harold Gillies insisted on the value of the use of bovine (cow) cartilage for nasal reconstruction despite the discovery of transplant immunity. Source: Meikle, Murrary C. Reconstructing Faces: The Art and Wartime Surgery of Gillies, Pickerill, McIndoe & Mowlem. Otago University Press, 2013. Print. World War II - Reconstructive Surgery The need for plastic surgeons during World War II surged beyond the needs of even World War I. Unfortunately, the total number of plastic surgeons in the United Kingdom during World War II was only 4, including Harold Gillies. As a result, a plastic surgery hospital was built for each of them. Dr. Gillies settled in Rooksdown House during World War II where he founded The Plastic and Jaw Unit in 1941. They become very busy after the battle and evacuation at Dunkirk. Dr. Gillies was training a few new surgeons at a time during this period, mostly Americans and mostly informally. This is because there were no formal plastic surgery residencies at the time. Harold Gillies would not found the British Association for Plastic Surgeons until 1946. His influence on future generations would be immense, however, as exemplified by the Brazilian plastic surgeon Ivo Pitanguy, whose life will be discussed later. Harold Gillies was a practical joker. He would disguise himself to potential applicant physicians and chat with them in the hall prior to their scheduled interview as described by one of those applicants: At the outbreak of the Second World War a plastic and jaw unit was established by Sir Harold Gillies at Rooksdown House, Basingstoke. In 1954 I applied for a post in plastic surgery. The subsequent interview was held at the hospital, a strange looking building which had been the private block of Park Prewett Hospital. On inquiry at the porter's office, I was directed by an elderly gentleman to wait in the main hall along with the other candidates. Being last in line for interview I was left in glorious isolation until joined by the porter who proceeded to make conversation. His opening gambit was to inquire how much fishing I had done in Ireland, to which I replied in the negative. As to other sporting activities, I admitted that there were none at that particular time. There followed a few desultory questions about my surgical activities, which I thought were none of his business. Returning to the question of sport, he expressed further curiosity regarding my sporting interests in the past. Feeling slightly irritated and intimidated by the old man's persistence I announced that I had been a member of the Irish Olympic rowing team, which competed at Henley in 1948. He was most interested in this information and casually mentioned that he had rowed for Cambridge in the Boat Race. It emerged that he had also played golf for England and that painting and fishing were his main interests apart, of course, plastic surgery. Shortly afterwards I was called in to see the medical superintendents who, after a few perfunctory remarks, told me that Sir Harold Gillies had interviewed me in the hall and that my application was satisfactory. During the ensuing three years at Rooksdown House, Sir Harold made no reference to our unconventional interview. A second hospital – Queen Victoria Hospital – was assigned to Harold Gillies' younger cousin, Archibald McIndoe. Dr. McIndoe started working with Harold Gillies prior to World War II in the United Kingdom. Dr. Gillies facilitated his advancement, even relinquishing his role as a consultant physician for the Royal Air Force for him in 1938. Interestingly, Archibald McIndoe maintained his civilian status while working with the military to eliminate rank and other military formalities among the hospital staff to boost and maintain morale. He changed the color scheme of the hospital to brighter colors, believing the appearance of the hospital could affect the emotional health of patients. He even encouraged the local population to visit the hospital and the patients, which was very unusual at the time. His appreciative burn patients – those individuals whose burns were so severe they required surgical treatment – formed the "Guinea Pig Club" and met annually after World War II to toast the plastic surgeon who treated them. Dr. McIndoe would also teach and influence Ivo Pitanguy. Source: Martin, Paula J. Suzanne Noel: Cosmetic Surgery, Feminism and Beauty in Early Twentieth-Century France. Burlington, Vermont: Ashgate, 2014. Print. Cosmetic Surgery It is important to note that most plastic surgeons practiced both reconstructive and cosmetic surgery during this period. In fact, Harold Gillies developed a robust cosmetic surgery practice after World War II, partially because he could not otherwise retire comfortably. Archibald McIndoe also developed a busy cosmetic surgery practice, becoming known for his "McIndoe Nose" which distinguished those patients who underwent rhinoplasty surgery with him. Cosmetic plastic surgery was widely considered a "lesser" specialty and was ridiculed for focusing on largely healthy patients. The level of scorn directed toward the physicians who practiced cosmetic plastic surgery varied depending on their level of self-promotion as well as their level of engagement with the lay public. Facial plastic surgery in the late 19th and early 20th century was most often employed to "pass" in public, to blend in rather than stand out. This had both positive and negative connotations and may also have contributed to the fact that many of the plastic surgeons performing cosmetic surgery at the time were considered charlatans. John Orlando Roe, an ENT surgeon from Rochester, became known as the father of cosmetic rhinoplasty, publishing papers on modifying the nasal tip and bridge in the late 19th and early 20th century. He initially became known for treating collapsed nasal bridges, called a saddle nose deformity, in patients who contracted syphilis. There were severe legal restrictions in the United States to advertising as a physician at the time. He was considered one of the more noble cosmetic facial plastic surgeons because he did not advertise and was not ostentatious. The German plastic surgeon Jacque Joseph was a European contemporary of John Orlando Roe. Like Dr. Roe, Jacque Joseph espoused the psychological benefits of cosmetic plastic surgery. Dr. Joseph was initially allowed to operate only at Jewish hospitals due to the antisemitism prevalent in Germany during this time. In fact, Jacque Joseph maintained dueling scars on his face to better "pass" in German society and avoid this. He even had requests from others to create "dueling scars" on their face to better "pass" themselves. However, even the Jewish hospitals eventually banned him from operating because he was performing cosmetic plastic surgery. Professional opinions about him changed when World War I broke out and his expertise was required to treat the war-wounded. He was recruited to work as the Director of Facial Plastic Surgery at Charite Hospital in Berlin during the war. He transitioned to private practice after World War I to refocus on cosmetic plastic surgery. His innovations included techniques to reshape nasal bones during rhinoplasty (osteotomies). He also performed facelifts and body plastic surgery. He became internationally renowned, drawing even Americans to visit him. He was reportedly very secretive, having his nurse keep his instruments under towels to prevent visitors from copying his designs. His great contribution to the medical literature was the textbook Rhinoplasty and Other Facial Plastic Surgery published in 1931. This textbook was the first to include photos of post-operative patients smiling after their recovery. Another great European facial plastic surgeon of the early 20th century was the French physician Suzanne Noel. Born in 1878, she came of age in La Belle Epoque when the women's rights were improving in France, which likely influenced her drive. She married Henry Pertat, a dermatologist 9 years her senior, at age 18. He was able to start a dermatology practice with family money. French law at the time dictated that women needed permission from their husband to attend medical school. Laws even required husbands to be informed of where their wives were going and the "general spirit" of any conversation they had with others outside of the house. Fortunately for the world, Henry encouraged Suzanne to pursue medicine. Suzanne passed the externat to function as an extern at Paris Hospital in 1908 at age 30, the same year she gave birth to her daughter Jacqueline. After 2 years as an extern and earning high marks in her testing she started a 4-year internship as a resident physician. She worked in the public hospitals in the morning and at her husband Henry's dermatology practice in the afternoons. Her two most influential teachers during her internship were Hippolyte Morestin and Jean-Louis Brocq. Hippolyte Morestin was a French surgeon who became famous during World War I. He was especially concerned with reconstructive surgery and the concealment of scars. He taught Suzanne to be decisive and to take risks in the operating room. The Spanish flu would kill Dr. Morestin in 1919, a tragedy that would befall her daughter in 1922. Jean-Louis Brocq was a dermatologist who first exposed Suzanne to cosmetic plastic surgery. She developed an interest in cosmetic plastic surgery after being visited by the famous actress Sarah Bernhardt, who had undergone a brow lift by the plastic surgeon Charles Conrad Miller in Chicago. She felt she could have done a superior job. Dr. Brocq allowed her to perform cosmetic surgery procedures on volunteer patients during her internship. Suzanne ran her husband's dermatology practice when he left for the front lines during World War I. Unfortunately, he suffered from chlorine gas exposure while testing gas masks, which permanently disabled him. He was forced home from the front lines in 1918 where he died from respiratory failure. Suzanne married Andre Noel, her medical school classmate and close friend, in 1919. Like her first husband, Andre pursued dermatology. In fact, Andre took over Henry's dermatology practice after he died. This is partially because, at the time, a woman could only practice medicine under a male physician's license. Suzanne could run the dermatology practice but was not allowed. Suzanne gave her medical school thesis – a device that used air pressure to spray jets of medication impregnated water on the skin of patients – to Andre so he could run the dermatology clinic. The couple would later commercialize and sell the device. Andre became depressed after Jacqueline's death and committed suicide in 1924. Left with a dermatology practice she could not run because she never submitted a thesis (women could practice independently with a license now), Dr. Noel quickly wrote a thesis on the topic of the big toe, partially to slight the leadership at the University of Paris for previously restricting her practice of medicine. She would acquire her medical license in 1925, allowing her to run the dermatology clinic. Her cosmetic surgery practice quickly became popular, which allowed her to pay off the enormous debts Andre had accumulated during his depression. She operated out of her apartment in Paris near the Hotel George V, because cosmetic plastic surgeons were generally not allowed to operate in hospitals in France at the time. She eventually outgrew her apartment, moving her private practice to the prestigious Clinique des Bleuets. She also promoted the practice of cosmetic plastic surgery around Europe, advocating the psychological benefits of plastic surgery like Dr. Roe and Dr. Joseph. She travelled to Germany to advocate for the founding of a Department of Social Cosmetics at the Institute for Dermatology at the University of Berlin. Berlin was one of the few places in the world where cosmetic surgery was considered acceptable as a form of "mental hygiene." This was during the time that Jacque Joseph was becoming famous for his rhinoplasty techniques while practicing in Berlin. Dr. Noel published Aesthetic Surgery and its Social Significance in 1926. This textbook was immensely popular, being translated into other language and further establishing her reputation. Her contributions to the field of plastic surgery were numerous. They included the pioneering use of long, elliptical incisions along the hairlines during face lifting operations. She invented the craniometer, a device which allowed her to measure facial dimensions more precisely. She improved on a now-common approach to lower eyelid surgery and the facelift. Probably most importantly, she successfully combined local anesthetics with epinephrine to reduce bleeding and improve patient comfort during surgery, a generally accepted practice today. She also took a more patient-centered approach to practice and teaching. She was one of the first surgeons to include actual photos of the steps of her operations in her textbook. She discussed surgical options and expected results with her patients. She allowed her patients to decide between local and general anesthesia. She was obsessed with concealing the effects of surgery, going so far as to formulate tinctures matching various hair colors to dye the bandages she placed on patient's hairlines. She also provided tea and lunch to her patients after surgery. It was for her accomplishments that she was awarded The Order of the Legion of Honor in 1931, a rarity for women in France. In contrast with Drs. Roe, Joseph, and Noel, Joseph Sheehan was considerably showier and more ostentatious. He was born in Dublin, Ireland in 1885 and emigrated to the United States. Relegated to poverty after the death of his father, he managed to gain admittance to Yale Medical School and trained with Harold Gillies at Sidcup during World War I. He returned to the United States and practiced in New York City. He became enmeshed in bad press after inviting a New York Times reporter back to his office after a lecture he was asked to give to the New York City Police Department. The reporter described the extravagance of his office rather than the lecture he was being interviewed about. He also attracted considerable controversy because he was a supporter of the Spanish dictator Francisco Franco, helping to organize hospitals and train surgeons in Franco's army. Joseph Sheehan was deeply connected to the concept of the use plastic surgery to "pass" in society. Convicted criminals sought out facial plastic surgery in the early 20th century to escape detection by authorities. Dr. Sheehan was giving a lecture to the New York City Police Department about what could and could not be accomplished with plastic surgery at the time so that the police force could better detect individuals attempting to evade them. This panic is what led to European and American criminal authorities to tattoo convicted criminals. One of the most famous examples of a criminal undergoing facial plastic surgery to evade the police was John Dillinger, the leader of the Dillinger Gang which robbed banks and police stations during the Great Depression. John Dillinger was arrested and killed in 1935 along with the plastic surgeon who performed a rhinoplasty and facelift on him to conceal his identity. Even J. Edgar Hoover became involved, warning plastic surgeons of the risks in aiding criminals. A more modern example is the drug trafficker Richie Ramos who underwent rhinoplasty, liposuction, and excision of gunshot scars from his face to evade the police. He and his plastic surgeon, Dr. Jose Castillo, were arrested in 1997 for obstruction of justice. There was not only a concern in the early 20th century that criminals would undergo facial plastic surgery to conceal their identity. Some also theorized that one could change criminality by changing the appearance of criminals. In fact, some prisons offered to pay plastic surgeons to operate on jailed criminals. One example was a pilot project at San Quentin in 1927 examining the rehabilitative effects of facial plastic surgery which was initiated by the convicts themselves. As expected, this project would prove unsuccessful. Source: Simons, Robert L. Coming of Age: A Twenty-Fifth Anniversary History of the American Academy of Facial Plastic and Reconstructive Surgery. New York, New York: Thieme Medical Publishers, Inc., 1989. Print. Professionalization The professionalization of the field of facial plastic surgery followed World War II. The founders of the field remained marginalized from professional circles. As a result, they were forced to develop some the earliest standardized training programs of any subspeciality. And even within the field of facial plastic surgery there was conflict between those who felt the emphasis should be on reconstructive versus cosmetic surgery. That distinction is best exemplified by two individuals, Maurice Cottle and Irving Goldman. Both individuals were taught by Samuel Fomon. Samuel Fomon was not a surgeon but an anatomy teacher who nevertheless was operating. He compiled all known work on facial plastic surgery and taught it at a time when general plastic surgeons were excluding ENT/facial plastic surgeons from this knowledge. He gained this knowledge while traveling abroad, specifically to Germany where he visited Jacque Joseph. He confirmed Jacque Joseph's penchant for secrecy. He even paid Dr. Joseph's nurse to see his instruments, sketched the designs and returned to the United States to re-create these instruments for use during his course. He initially established the Fomon Course in the 1940s in Manhattan General Hospital, one of the few places where formal instruction in facial plastic surgery was available. Students would pay an "assistant's fee" to operate on the patients. Samuel Fomon's wife, who was a physician, assembled his textbook and functioned as the in-house artist who double-checked his work. He was initially ostracized from universities in the United States until Dr. George Coates of Philadelphia, a well-respected ENT and editor of Archives of Otolaryngology, started to encourage the University of Pennsylvania residents to attend his course. This endorsement, as well as the endorsement of the course by the chairman of the Department of Otolaryngology at the University of Iowa, Dr. Dean Leirle, legitimized the course in the eyes of other universities. Maurice Cottle and Irving Goldman both attended the Fomon Course. Maurice Cottle emphasized the importance of functional rhinoplasty over cosmetic rhinoplasty. He later created his own course on rhinoplasty. He was obsessive, reportedly dedicating an entire decade of courses to individual components of the nasal anatomy, starting with the septum and ending with the bony pyramid in the fourth decade of his course. He was reportedly a difficult teacher, but fair. In fact, he was as difficult on the chairmen of otolaryngology departments as he was on new trainees. He also always made sure that the nurses, janitors, electrician, carpenters, and anyone else who assisted in putting on the course received a gift of appreciation. He became known for his sayings, or "Cottle-isms" including "never do in nasal surgery something that you cannot undo" and "the best operation is one we don't have to do…we are second best." In contrast, Irving Goldman emphasized the cosmetic approach to rhinoplasty. Born in 1898 in New York City, he was initially trained as an ENT but then developed an interest in cosmetic rhinoplasty. Like other facial plastic surgeons at the time, he was excluded from the establishment by general plastic surgeons. It took time but he eventually established himself at Mt. Sinai Hospital in New York City. He was initially not allowed to perform cosmetic rhinoplasty surgery at the hospital; that is, until he performed the procedure on two of the daughters of the chief of medicine there. He eventually performed many of the revision rhinoplasty procedures of the general plastic surgeons who initially excluded him. He started a course emphasizing the aesthetic aspects of rhinoplasty in 1950. The Goldman course became the longest running course in rhinoplasty. Dr. Goldman would eventually become the first president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Source: Holzer, John. Plastic Surgery Obsession: Brazil's Dr Ivo Pitanguy Triggered it All. Houston, TX: Alto Press, 2011. Print. Ivo Pitanguy The Brazilian surgeon Ivo Pitanguy was a product of the development and professionalization of the field of plastic surgery. He was a pioneer in reconstructive and cosmetic facial plastic surgery, importantly outside of the traditional centers of Europe and the United States. Dr. Pitanguy's origins were modest, but his training was top notch. He started as a general surgery resident largely working out of an ambulance in the favelas of Rio de Janeiro. He won a scholarship to study reconstructive plastic surgery under John Longacre in Cincinnati at Bethesda Hospital in 1948. He then travelled to the United Kingdom to study under Harold Gillies and Archibald McIndoe under a British Council Scholarship. Dr. Gillies encouraged him to teach and perform research while McIndoe encourage him to perform cosmetic plastic surgery. The reporter Joan Kron reported in her book Lift: Wanting, Fearing, and Having a Face-Lift, that "once, while [Pitanguy was] watching Gillies do a facelift...Gillies said something inspirational: 'If I didn't think this had value, I wouldn't do it." He returned to Rio de Janeiro in 1952 where he started a burn unit to treat the direst patients. It was at this hospital that he mobilized his team to treat hundreds of patients who were severely burned during the Niteroi Circus Fire, the worst indoor fire disaster ever. He was a workaholic, practicing on cadavers at night. Interestingly, he was reportedly never mugged when walking the streets of Rio de Janeiro at night because the formaldehyde left him with the "smell of death." It was at this institution that he developed a training program for plastic surgery based on the American residency system for training new physicians. Dr. Pitanguy not only taught residents but also proselytized plastic surgery to other specialties. This differed greatly from other plastic surgeons like Jacque Joseph who hid their techniques. He followed up the founding of his clinic with the founding of the world's first plastic surgery hospital called Clinica Ivo Pitanguy in Rio de Janeiro in 1963. This hospital provided a luxurious experience for patients. It was through this hospital that Rio de Janeiro became a center for plastic surgery. The city was popular with jet setting royalty and movie stars at the time. Ivo Pitanguy's reputation spread from there. He was also a scholar. His contributions to the medical literature were immense. He published Aesthetic Surgery of the Head and Body in 1981, which is considered a classic textbook. He identified the Pitanguy Ligament in the nose, which is an important structure when performing rhinoplasty. He also identified Pitanguy's line, which follows a branch of the facial nerve up the forehead and is an important marker for head and neck surgery. One of the most fascinating things about Ivo Pitanguy was his personality. His skills and work ethic were legendary. He was ambidextrous and could operate equally well with his right and left hands. He would routinely operate 12 hours daily then go immediately to a black-tie event in the evening. He assembled an excellent team to facilitate this productivity. He was also very sociable and warm, another unusual trait for surgeons at the time. He spoke 6 languages fluently. His patients included movie stars such as Brigitte Bardot, Frank Sinatra, and Michael Jackson, whose scalp he repaired after it was burned while filming a Pepsi commercial. He treated royalty including empress Farah Diba of Iran. He also treated political royalty including Jackie Onassis and Rosalynn Carter. He was also unusually open with the press. This was partially facilitated by the fact that there were fewer legal and cultural restrictions against self-promotion in Brazil compared with the United States and Europe. An article in Time magazine in 1967 helped spread his fame internationally among non-surgeons. One of his patients wrote a book titled The Beautiful People's Beauty Book in 1971, which was the first public glimpse inside the world of plastic surgery. He earned the respect and, unfortunately, jealousy of many plastic surgeons because of his skills and fame. For example, many European countries recruited him to operate but subsequently withdrew his privileges because of his popularity. Joan Kron explained that "it would take years for the medical establishment to accept the fact that publicity and charlatanism didn't necessarily go hand in hand." In the end, Ivo Pitanguy had the last laugh. The institutions he built, the physicians he trained, and his contributions to the medical literature are inalienable. His life inspired Vinciciu de Moraes, the writer of the song "The Girl from Ipanema" to coin the new Portuguese verb Pitanguizar, which means to create beauty. According to Joan Kron, who had an opportunity to spend time with Dr. Pitanguy before he passed, he explained that his goal was "to give age a dignified expression, a frame the spirit can inhabit" while being "adamant that surgeons - or anyone else, for that matter - should not impose their vision on the patient." Conclusion Harold Gillies, Archibald McIndoe, John Orlando Roe, Jacque Joseph, Suzanne Noel, Joseph Sheehan, Maurice Cottle, Irving Goldman, and Ivo Pitanguy stood on the shoulders of giants. Now giants themselves, newer generations of facial plastic surgeons are advancing on their discoveries and innovations. Among the major lessons about the lives of these individuals is that the reconstructive and cosmetic side of facial plastic surgery are both important and essential. Each area of focus informs the other. A second major lesson is the importance of being inclusive. Suzanne Noel, Jacque Joseph, and Ivo Pitanguy were all discriminated against in some way, but they persevered and contributed immeasurably to the field of facial plastic surgery. Future advances will depend on identifying and supporting talented surgeons regardless of their background. Trust Your Face to a Facial Plastic Surgeon It is important to seek a double board-certified, fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us today to learn more! Contact Us References Gilman, Sander L. Making the Body Beautiful: A Cultural History of Aesthetic Surgery. Princeton, New Jersey: Princeton University Press, 1999. Print. Haiken, Elizabeth. Venus Envy: A History of Cosmetic Surgery. Baltimore, Maryland: The Johns Hopkins University Press, 1997. Print. Holzer, John. Plastic Surgery Obsession: Brazil's Dr Ivo Pitanguy Triggered it All. Houston, TX: Alto Press, 2011. Print. Martin, Paula J. Suzanne Noel: Cosmetic Surgery, Feminism and Beauty in Early Twentieth-Century France. Burlington, Vermont: Ashgate, 2014. Print. Meikle, Murrary C. Reconstructing Faces: The Art and Wartime Surgery of Gillies, Pickerill, McIndoe & Mowlem. Otago University Press, 2013. Print. Mendelson, Bryan. In Your Face: The hidden history of plastic surgery and why looks matter. Richmond, Virginia: Hardie Grant Books, 2013. Print. Simons, Robert L. Coming of Age: A Twenty-Fifth Anniversary History of the American Academy of Facial Plastic and Reconstructive Surgery. New York, New York: Thieme Medical Publishers, Inc., 1989. Print.

Angela Kowalski is the creative for the branding of Harmon Facial Plastic Surgery. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Tell us about your educational and professional background. I'm currently Creative Director for the brand Califia Farms where I oversee all creative efforts that show up in various global markets. This includes strategic brand identity development, packaging, advertising campaigns, and multi-media marketing. The work couldn't be done alone, so for the past 5 1/2 years, I've been building out a powerhouse of a creative team who exercises multi-disciplinary capabilities. I'm lucky that both the type of work and team have made my time at Califia most enjoyable. Before my stint here, I spent the core of my time at various big and small agencies that cultivated brands in a variety of industries. It was at these firms that I gained experience in brand development - from market entry strategy to brand identity, and further along, to packaging, experiential design, web design and all forms of marketing for both digital and print placements. Throughout my career, it's been important to always leave room for personal projects that allow me to put my personal passions into practice. Today still, I welcome projects that provoke my interest and push me creatively. There's nothing I enjoy more than to take the knowledge that I've gained in big brand settings and apply it to a young brand trying to get its feet off the ground, stand out from competition and make an impact in people's lives. It's been a rewarding and educational ride, and none of it would be possible if it wasn't for my teachers at Savannah College of Art and Design (SCAD) over ten years ago. Instagram @angkowal Describe your creative process when designing for brands. Simply put, I get curious. I get REALLY curious about the brand, it's purpose, the person/people that are brave enough to launch it, and even more inquisitive about the people the brand is for - it's critical to dig deep to understand the true value a brand offers and why it's unique to anything else in the market. You and I discussed our appreciation for the power of font design and placement as an expression of a brand. How did these concepts express themselves in the branding for Harmon Facial Plastic Surgery? Every element has a cognitive impact on an individual's perception. Therefore, individual elements in a brand system and all the minutia details matter - from type treatment, shape, color, tagline to negative space, images, texture, layout, etc. As a designer, it's my job to communicate on behalf of a brand. When it's done right, the perception of a brands value, personality, confidence is apparent. This was front of mind when looking at every detail of the brand identity for Harmon Facial Plastic Surgery. With an identity aesthetic that's relatively minimal, it was most important that certain elements, like spacing and typography, worked harder to convey the tone and confidence in the brand you see today. Instagram @angkowal How did the phrase and logo "Feel Good About Feeling Good" come about? What does it mean to you? This tagline was born from the unadulterated intention behind Dr. Harmon's practice. It's the true value of what his services provide someone. At the end of the day people want to be happy and feel good and there's no guilt in that. At Harmon Facial Plastic Surgery, it's not as much about plastic surgery as it is about helping someone feel good about themselves. Do you have an as-yet unfulfilled dream design project? I've been very fortunate to work on some amazing design projects. From branding wellness brands to designing packaging in the alcohol aisle. From grass root organizations that are driving big impact in small communities to branding restaurant concepts for top Los Angeles chefs. I will always welcome a project in those categories. Additionally, I think at this point I may be ready to paint a mural of all things - it's something I'm really intimidated by, but I think it would be a cool way to share another passion of mine on a larger scale. With a steady hand, it might just be enough to move people to feel something and at the end of the day, that's what motivates me in both the design and fine art spaces. Contact Information Website: akcreative.net (request access through one of the below links) Email: angkowalski@gmail.com LinkedIn Name: Angela Kowalski Instagram: @kowal_studio, @angkowal Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us

The following interview is with Christie L. Krazter, Principal at Reztark Design Studio. Reztark Design Studio developed the architectural and interior design plans for Harmon Facial Plastic Surgery. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Tell us about your educational and professional background and that of the team that worked on the Harmon Facial Plastic Surgery office. I am an Interior Designer with a Bachelor of Science in Interior Design from the University of Cincinnati. I have 35 years of experience in all areas of design: retail, hospitality, restaurant, multifamily, senior living, medical office, and workplace. The team for Harmon Facial Plastic Surgery was comprised of architects, interior designers, and graphic designers. They all have professional degrees with 10 plus years of experience. Instagram: @reztark Describe your team's creative process when designing the architecture and interiors for brands. At Reztark, we believe in a wholistic, egoless approach to design. We believe our clients are very much a part of team process. Most clients/ brands know who they are as a brand better than we do so we actively listen to our clients. If a client is not sure who they are, we go through a process of evaluating their brand and giving it definition describing what they are or want to be. Every project has its own specific requirements which direct us in our process for the design. No 2 projects are ever the same. How do you think an interior in a medical practice should make patients feel? In a medical office a patient and employee should be well taken care of, safe and calm. It is as important for the patients as well as the staffs feelings and emotions be considered in the final solution for the design. Instagram: @reztark How did you interpret the branding provided by Harmon Facial Plastic Surgery and translate it so beautifully into the design of the office design and interior? Every detail from the layout and flow of the office to the door frames, lighting and the furniture reflect the values and mission of the practice so beautifully. Dr. Harmon had a very strong passion for his practice. We took what had been developed as a Brand and listened to how the team at Harmon Facial Plasdtic Surgery felt about the practice. Dr. Harmon loves architecture and design which made it easy to communicate our passion for the interiors. They are all about the details as a facial plastic surgery center. The patients needed to know they would be taken care of with the same level of detail as the interior provided. It is very important to use color, finishes and light to make a patient look and feel wonderful about themselves. Does your team at Reztark have an as-yet unfulfilled dream design project? We are always looking for new ways to develop a design through construction technics to interior materials and new technologies. Active learning is the most needed part of our jobs. We are currently the firm responsible for the renovation and redesign of the Terrace Plaza Hotel. It will be a signature project once complete. We are also working on a very dense mixed-use project in Blue Ash, Ohio called the Blue. We love the Rubix cube of complex projects. Reztark Contacts Website: reztark.com LinkedIn: Reztark Design Studio Instagram: @reztark Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us

I inherited a physician examination table from my mother's family when I graduated from medical school. The table was a strange inheritance because there are no other physicians in my family. My mother explained that it was found in the attic of one of my great grandparents' homes in rural Central Kentucky. It is not clear how the table wound up in my mother's possession. It would become clear years later, however, that it is a historical piece fit for a museum. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. I Inherited a Very Old Physician Exam Table Despite Having No Physician Relatives The table is in moderately good shape for its – obviously old – age. It is broken off the larger base and the table itself has a long narrow fracture. Otherwise, it is intact. The wood is solid walnut. The drawers contain holders for small cylindrical vials. The metal handles of the drawers are intricately decorated with floral patterns, evoking a Belle Epoque attention-to-detail that has long been lost in the design of medical offices. Stirrups extend from an opening at the top of the base. A secret compartment at the back of the bottom drawer contains a wired barrier, the purpose of which is unclear. I imagine the local town general practitioner gave the table to my great grandparents after a long career caring for the local population, going on house calls, administering tinctures, and delivering babies. My grandmother described her experience with a similar practice as recently as my mother's childhood. I thought little of the table for years until the end of residency when my wife and I considered sending it to a carpenter for restoration. I found a reputable carpenter and emailed him, described the table, and asked for an approximate cost to repair. I explained that I believed the table was made in the early 1900s. He requested photos. The carpenter called me within only a few hours of emailing him the photos. He explained that, in fact, this table was likely made in the 1800s, possibly even during the Civil War, based on its appearance. The only clue I had to its age was a metal tag with the company name, Codman & Shurtleff Makers Boston, screwed to the side of the table. Codman & Shurtleff Makers Boston was Founded in the mid-1800s Information on Codman & Shurtleff Makers Boston is difficult to find and consists mostly of antique surgical instrument sales online. A quick scan of eBay found an example of the patented steam atomizer as well as Civil War-era dental instruments and a syringe. The most detailed company profile available is from a letter sent to a "Mr. Shurtleff" – of the original Shurtleff family, I assume – from the Product Coordinator of a subsidiary company to Johnson & Johnson: "In 1838, a mechanic in Roxbury, Massachusetts, designed a Pocket Cupping instrument for the application of Ether. The enthusiastic response of the Boston medical community encouraged Thomas Codman to apply his talents to crafting a number of medical and surgical items. Hence, the origins of Codman & Shurtleff, Inc. were well rooted in medical device innovation. Thomas' son Benjamin, graduated from Harvard Medical School in 1845. After purchasing the entire stock of dental supplies from druggist Joseph Burnett, Dr. Codman opened his Dental Depot on Tremont Street. Later, in 1853, he took Asahel Shurtleff on as his assistant and added surgical instruments and anatomical supplies to the line, establishing the Benjamin S. Codman & Company. In 1857, he was joined in partnership by Shurtleff and F.O. Whitney, and Codman & Shurtleff was established. Its line of medical, surgical, dental and veterinary instruments and supplies became more extensive; ear, nose, and throat instruments became a major portion of the business. With an increasing demand for a variety of atomizers used in the treatment of respiratory diseases, the Company began to produce its Patented Steam Atomizer in 1860. This product was an international best seller for over 20 years. During the same period, the Company introduced its General Surgery and Amputation Set, it designed to be used on the battlefield by Army surgeons during the Civil War. As a result, the Company prospered and its reputation grew significantly. Dr. Codman's death in 1894 dissolved the partnership and placed the Company into receivership." The Shurtleff family reportedly purchased the assets of the company and re-incorporated into Codman and Shurtleff, Inc. in 1904. This fits the timeline that carpenter gave me that the table was likely made in the 1800s, as the tag on the table refers to the original Codman & Shurtleff Makers Boston company that was formed prior to its dissolution in 1894. As a result, my research suggests the physicians table was manufactured between 1857 and 1894. The Dilemma: to Preserve or Restore The Department of Otolaryngology – Head and Neck Surgery at the University of Cincinnati Medical Center, where I completed my residency training, has a beautiful collection of antique ear, nose, and throat (ENT) instruments, most of which were donated by an alumnus of the residency program. I have wondered whether any of those ENT instruments were produced by Codman & Shurtleff Makers Boston, who gained a reputation producing instruments for the specialty. I have also wondered whether the table I inherited should sit behind glass windows in the department as well. The carpenter who evaluated the piece explained that there are two trains of thought regarding antique wood furniture. Some feel preservation is ideal, especially if we plan to donate the table to a museum. However, he recommended full restoration of the table. He explained it is worth displaying it in our home due to its history and personal meaning. My conversation with the carpenter was eight years ago. The table has moved with us from Cincinnati to New York City and back. We once considered selling it, believing the table would be useless in our house. However, we have grown to appreciate its meaning over time, due both to its historic and family value. It also fits with my interest in the history of medicine, of which I have written about on the blog previously. My wife and I now plan to fully restore this table and display it prominently in our house, a symbol of my life's calling and a connection to my extended family, however foggy. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching "plastic surgery near me." Get in touch with us to learn more. Contact Us

The following blog post is a series of book reviews and recommendations that reflect our mantra "Feel Good About Feeling Good." It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Clean: The New Science of Skin by James Hamblin, MD There is a tendency in skin scare to ere towards the maximalist approach, with more creams, ointments, oils, and moisturizers used more frequently. This is encouraged by the cosmeceuticals industry as well and modern wellness vendors as exemplified by the current trend towards multi-step skin care treatments as popularized by Korean skin care brands. But what if less – much less – is more? And what are the implications of shifting our understanding of clean, healthy skin? James Hamblin MD, an internal medicine physician turned journalist for The Atlantic Magazine, set out to understand the skin care industry, later broadening his reach to how we conceptualize what is "clean" and how this has changed in society, all through the eyes of cleaning products. He starts with soap. And he starts by explaining why he has not cleaned himself with anything other than water for the past 5 years while researching the book. The book is a tour de force of history, emphasizing the amazing strides that have come from the development of germ theory and the subsequent mass marketing of soap to the public to achieve a level of cleanliness/sterility that was meant to combat the infectious public health illnesses of the time. He also dives into the poorly regulated market of cosmeceuticals, concluding that the vast majority of what is placed in skin care products today has no evidence for its effectiveness. He calls into question the actual benefits of all the expensive skin care products people are encouraged to buy. I agree with Dr. Hamblin. Very few ingredients in marketed skin care products have demonstrated significant clinical effectiveness. The industry is filled with half-truths and outright lies. The worst part is that their behavior is legal, simply because it is such a poorly regulated industry. Dr. Hamblin pivots to the idea that much of our modern skin illnesses can be traced to an imbalance in the bacterial composition of the skin, called the microbiome. The act of exfoliating, washing, moisturizing, and toning the skin is chasing what our body does naturally. He meets individuals who are performing research on introducing bacteria to the skin to treat conditions such as eczema. In the end, he suggests that we are on the verge of a reconceptualization of our understanding of disease of the skin and how to maintain the health of our skin. He emphasizes the preliminary nature of business introducing "pro-biotic" skin care products into the market and suggests that simply embracing our natural propensity to interact with each other and to expose ourselves to "good" bacteria may go a long way in preventing pediatric dermatological illnesses. We at Harmon Facial Plastic Surgery are not ready to recommend any product or activity mean to introduce bacteria to the skin for the purposes of skin care. However, we strive to provide recommendations that are affordable and effective with the best available evidence. Eat a well-rounded diet, mostly plants, of food free of pesticides and antibiotics. Wear a mineral-based sunscreen of at least an SPF of 30. Exercise, preferably outside. Socialize with your loved ones, safely. Use a simple moisturizer of your choice, which can be inexpensive or not. And consider a retinol and/or Vitamin C serum for photoaging as tolerated. Healthy skin is as much a matter of how we live as it is a matter of what we put on it. I am Invincible by Norma Kamali I am Invincible by the famous fashion designer Norma Kamali is a fantastic book option. For those who are unaware, Normal Kamali got her start in a small clothing shop in New York City in the 1970s where she designed clothes inspired by the styles she saw in London in the late 1960s. She went on to design accessible, comfortable, high fashion clothing that evolved through the decades (think puffer coat). She explains her approach to style, which in summary is to have a "uniform." We here at Harmon Facial Plastic Surgery love this recommendation, as you will see Dr. Harmon in his "uniform" each day: brown loafers or oxfords, relaxed wool or thick cut chinos, a tailored white button down (usually from the wonderful team at Romualdo in Madeira) and his white coat. Now in her 70s, Norma Kamali is also a model for healthy living. This book not only discusses her fascinating personal and professional life, but also her philosophy of health, including her approach to eating a healthy, diverse, and well-balance diet, exercise, and sleep. The Blue Zones Solution: Eating and Living Like the World's Healthiest People by Dan Buettner and How to Eat: All Your Food and Diet Questions Answered by Mark Bittman and David L. Katz MD Though wildly different in style and structure, the information these books communicate reinforces each other. The Blue Zones Solution: Eating and Living Like the World's Healthiest People by Dan Buettner reviews the data gathered and lessons learned while studying populations of people throughout the world with a relatively large number of centenarians, or individuals who live to be at least one hundred. This research started as an assignment by The National Geographic Society. Located in Greece, Italy, Japan, Costa Rica, and Southern California, Mr. Buettner labeled these communities "blue zones." He derived the following 9 "lessons in longevity" from these communities: 1. Live in a physical environment that constantly and passively encourages movement 2. Live with a purpose beyond employment 3. Identify time to relax and wind down 4. Stop eating when your stomach is 80% full 5. Eat a primarily plant-based diet with little meat 6. Appropriate/moderate wine drinking 7. Create a social circle that supports healthy behaviors 8. Attend faith-based or other community services weekly 9. Place family first and keep parents/grandparents nearby Mr. Buettner highlights some of the healthy foods that are commonly consumed by each of the above communities, explaining their health benefits and how the macronutrients and micronutrients in these foods relate to each other despite the diets varying between the communities. He not only emphasizes the importance of what foods are eaten but also how the acts of acquiring, preparing, presenting, and consuming food are performed and respected as a significant daily event in the lives of these individuals. He moves on to discuss case examples of communities who changed their health by adopting behaviors like those adopted by blue zone communities, including small towns in Iowa. The book then moves on to present concrete ways we all can adopt "blue zones behaviors" to improve our health. These include moving our diet to a primarily plant-based diet with minimal dairy and meat as a small side dish or garnish eaten infrequently. Mr. Buettner emphasizes the importance of treating the act of preparing and consuming food as sacred and something that should be shared with family and/or friends in a distraction-free environment. He summarizes the dietary example of blue zones communities with an easy-to-understand list of 4 foods to always have available and 4 foods to avoid completely, such as sugar sweetened beverages, salty snacks, processed meats, and packaged sweets. Mr. Buettner recommends "de-conveniencing" the home to encourage more physical activity as a baseline behavior. His suggestions include using more non-mechanized appliances and a push lawnmower. He makes concrete recommendations for organizing the kitchen and bedroom to maximize health. Finally, he includes easy-to-follow recipes inspired by the meals consumed by members of blue zones communities that reflect the recommendations made earlier in the book. Mark Bittman and Dr. David Katz go into more detail about the science of nutrition in How to Eat: All Your Food and Diet Questions Answered than Mr. Buettner, including some of the misunderstandings and controversies associated with the field of nutrition. Not only does this book reference blue zones but Dan Buettner references some of Mark Bittman's recipes in The Blue Zones Solution. How to Eat is written as a long Frequently Asked Questions session that also feels like a back-and-forth conversation between two knowledgeable friends. Mr. Bittman and Dr. Katz demonstrate a wonderful ability to cut through the confusion about various fad diets and otherwise heavily restricted diets that have caused many to unwisely exclude broad categories of food. The idea of the relative benefit of individual foods is brought up frequently. For example, there is controversy as to whether dairy products should be a component of a maximally health diet. Mr. Bittman and Dr. Katz explain that, with every food, it really depends on what you are replacing that food with. For example, they explain that if an egg is replacing bacon for breakfast, then it may be good. However, if an egg is replacing plain yogurt with muesli and berries then it may not be good. How to Eat reinforces the stories in The Blue Zones Solution and fleshes out the reasons why the interventions made by Mr. Buettner in communities throughout the United States have been effective in improving population health in those communities. We at Harmon Facial Plastic Surgery are not dieticians. The nutrition recommendations provided in the above books do not necessarily reflect the opinion of Harmon Facial Plastic Surgery. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us

The two books reviewed below fall under the theme of longevity and aging well. The first book presents a broad argument for transforming how medicine is practiced by focusing on preventing the development of chronic disease rather than treating chronic disease when it occurs. The second book offers a practical guide to maintaining mobility with age, which can be associated with improved health in old age. As always, the purpose of these reviews is to entertain and not to provide direct medical advice nor to serve as replacement for appropriate medical advice. The opinions of the authors do not necessarily reflect the opinion of Dr. Harmon and/or Harmon Facial Plastic Surgery. Instead, we have found that these books ask interesting questions and are also entertaining. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Outlive: The Science and Art of Longevity by Peter Attia MD Dr. Peter Attia arrived at his current career as a clinician, author, and podcast host circuitously, leaving general surgery residency at Johns Hopkins University to work in consulting then returning to medicine years later. He is a fitness fanatic with a love for boxing and Formula 1 (F1) racing – Dr. Harmon never truly appreciated the athleticism required to drive F1 cars until he read this book – which is reflected in the pages of this book. His clinical practice model reflects his belief that medicine as it is currently practiced does not adequately address the core causes of poor health in our later years. Dr. Attia intervenes intensely with his patients as early as possible to maximize their healthy functionality for as long as possible. He calls this disease prevention model Medicine 3.0. He contrasts this with Medicine 2.0, which he argues was developed approximately one hundred years ago to treat infectious diseases as well as chronic diseases after they have developed. The book explains the purpose and goals of Medicine 3.0, discusses the causes of heart disease, cancer, and neurodegenerative diseases such as Alzheimer's, and proposes solutions to reduce our risk of such diseases. Dr. Attia advocates for more extensive testing for cholesterol abnormalities and problems with glucose management as well as more aggressive treatment of these conditions. He feels that, by the time lab values demonstrate there is a problem with cholesterol and/or glucose management according to current guidelines it is already too late to adequately treat and prevent future complications, which can include not only heart disease but also cancer and neurodegenerative diseases. He feels that an intensive exercise regimen and a focus on building muscle mass as well as maximizing an individual's oxygen use capacity (i.e., VO2 Max) are key to the prevention of chronic disease. He also feels that a finely measured, data-driven, individually optimized diet is also important focused on minimizing glucose spikes with meals. He also advocates for earlier screening for cancer (e.g., colon, breast) than current guidelines recommend. He argues that survival rates for cancer are so much higher when caught early that the cost of earlier screening is justified. Dr. Attia's arguments inspired Dr. Harmon to have a conversation with his primary care physician about advancing his screenings. It remains to be seen whether and when the medical subspecialty governing bodies and insurers will adopt new screening guidelines in the future. Among the most interesting information from the above sections of the book is the extent to which vascular disease as caused by high cholesterol, persistently elevated blood glucose, and high blood pressure contribute to the development of heart disease, cancer, and neurodegenerative diseases. For example, Dr. Attia explains that the relationship between vascular disease and neurodegenerative diseases such as Alzheimer's Disease is gaining increasing attention in the medical literature. Two of the most valuable chapters in the book discuss the importance of sleep and maintaining good emotional health. These two areas are the most personal for Dr. Attia, and he highlights significant stories from his own life that illustrate the importance of getting good quality sleep as well as addressing problems with emotional health. Dr. Harmon agrees wholeheartedly with the importance of both and hopes patients understand the importance of emotional self-care in addition to physical self-care. Overall, the book is a powerful argument for setting a goal of not only a long life but a healthy and functional life. Whether Dr. Attia's proposed solutions are the correct ones remain to be seen. For example, Dr. Attia sometimes deviates into topics that are much more controversial. For example, he places patients on the immunosuppressive agent tacrolimus – a medication commonly used in patients who have undergone an organ transplant – due to his review of data that he feels makes a strong argument that it can increase our functional lifespan. This is not something most physicians - or physician organizations - would recommend and is, in fact, not currently approved by the Food and Drug Administration (FDA) for the purpose Dr. Attia discusses. And while there are many other well-argued and potentially transformative methods of improving disease prevention in this book, most are dependent on involved and expensive testing and technological solutions (e.g., constant blood glucose monitor, VO2 Max testing) that would seem to be unlikely to be adopted by most without adequate financial resources and the intense engagement of a primary care provider who is well-qualified to provide such care. Built to Move: The 10 Essential Habits to Help You Move Freely and Live Fully by Kelly Starrett and Juliet Starrett Built to Move, a spiritual cousin to the previously reviewed book The Blue Zones by Dan Buettner, also complements the arguments made in Outlive. In fact, the authors of Built to Move reference Dr. Peter Attia's concept of a "Centenarian Decathlon" when discussing their primary thesis, which is that maintaining the ability to move fluidly in many positions is a core physical goal and predictive of maintaining good functional health in old age. For his part, Dr. Attia also includes a chapter in his book arguing for maintaining good mobility with age to prevent injury. Dr. Harmon had become interested in the above thesis prior to reading Built to Move. His interest originates from one of the most difficult choices he has made, which was to stop rowing in college. He was a nationally competitive rower in high school and was recruited to row lightweight crew at Cornell University. Rowing is one of Dr. Harmon's great passions, which is why it was so difficult for him to gradually lose that passion over time as the toll of the required weight loss and the need to work so hard to prepare for the MCAT and medical school weighed on him. He also noticed teammates struggling with chronic back pain, often taking long breaks from the team, never fully recovering prior to their return. And while Dr. Harmon did not injure his back, he had a sense that he was highly likely to if he continued. Somewhat strangely for someone his age, his primary concern was whether he would be able to hold his grandchildren in the future, an ability which is highly correlated with functional health in old age. The authors of Built to Move, Kelly and Juliet Starrett, list ten "Vital Signs" that are indicative of abilities that are predictive of good functional health. They recommend exercises to promote optimal performance with each sign. The Vital Signs include: 1. Getting up and down off the floor – Highly predictive of mortality in old age, the authors recommend sitting on the floor more often with the hips extended in order to encourage standing up from sitting. 2. Breathing – The authors recommend slow, diaphragmatic breathing through the nose. 3. Extending your hips – See Vital Sign 1. 4. Walking – The authors advise taking 10,000 steps per day. 5. Future-Proofing your neck and shoulders. 6. Diet – The authors recommend 800 g of fruit and vegetables per day as well as a weight-based approach to determining the appropriate amount of protein intake per day. 7. Squatting. 8. Balance. 9. Movement-Rich Environment. 10. Sleep – The authors recommend 7 to 9 hours of consistent sleep each night. The prescribed exercises are intended to anchor the regular cardiovascular and strength training multiple governing bodies recommend we get each week. The exercises are easy to perform at home with off-the-shelf or inexpensive products like PVC pipes and foam rollers. The authors also advise testing yourself to gauge your improvement and set goals. Their arguments appear sound – though Dr. Harmon is not a physical therapist and cannot speak professionally about specifics – and the prescriptions are easy-to-understand and implement. The exercises - which Dr. Harmon would only do in consultation with a qualified physical therapist - recommended in Built to Move may help Dr. Harmon maintain the high surgical standards he holds himself to for many years while also allowing him the functional capacity to enjoy playing with future grandchildren. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching "plastic surgery near me." Get in touch with us to learn more. Contact Us This blog post is for entertainment purposes only and does not constitute direct medical advice. Moreover, the above information should not be used as a replacement for appropriate medical advice. Dr. Harmon is not a primary care provider, physical therapist, or registered dietician. The views of the authors above do not necessarily reflect the views of Dr. Harmon or Harmon Facial Plastic Surgery. It is essential that you have a consultation with a qualified medical provider prior to considering any treatment for any reason. This will allow you the opportunity to discuss any potential benefits, risks, and alternatives to the treatment.

It is common practice to recommend vitamins and other supplements peri-operatively with the intention to help with recovery and healing. Arnica montana, a Swiss mountain shrub otherwise referred to as arnica, is widely used to reduce bruising and swelling after surgery. l evaluated the medical literature to determine the effectiveness of arnica, focusing on high-quality studies (see previous blog post "How (Thoughtful) Surgeons Think") that specifically evaluated its effectiveness for facial plastic surgery procedures. The first procedure I looked at was nose surgery (rhinoplasty) because, depending on the approach taken, some bruising and swelling around the eyes is expected. The first study, from 2007, was randomized and controlled (1). It evaluated the effectiveness of arnica taken by mouth. Unfortunately, no difference was found between the use of oral arnica and placebo (no intervention) on the extent and severity of bruising. This study used subjective ratings by researchers. In contrast, a meta-analysis from 2017 combining data from three other randomized, controlled studies comparing the effects of oral arnica with placebo found a significant decrease in post-operative swelling and bruising with the use of arnica during the recovery period (2). At least one of those studies utilized a more objective assessment of the bruising utilizing a computer program (3). My review of the literature suggests oral arnica could be effective in treating bruising after nose surgery. The second procedure I looked at was eyelid surgery (blepharoplasty). I found a placebo-controlled, randomized, double-blinded study evaluating bruising after upper eyelid surgery utilizing the oral arnica (4). No difference in the area or the severity of bruising was noted with the use of oral arnica. The third procedure I looked at was facelift surgery. I found one influential (i.e. frequently cited) paper from 2006 (5). This study was randomized, double-blinded, and placebo-controlled. Like the above studies, this study gave oral arnica to patients undergoing a facelift. One innovation of this paper was that the researchers not only collected data from a subjective scale completed by healthcare providers and the patients themselves, but also a more objective measurement of the change in color and extent of bruising as measured by a computer program. Neither the subjective nor the objective results showed a difference in the severity of bruising with the use of oral arnica. All of the above-cited studies utilized oral arnica. However, topical arnica is also available. There are many formulations of topical arnica that exist at different concentrations, including a popular patch placed under the eyes after surgery called Ocumend©. A single-blinded, randomized, controlled trial was performed and published in 2010 looking at the use of topical arnica. A bruise was induced on the arm by a laser and the treatment of these bruises with topical arnica was evaluated. The results were measured using a standardized scale previously published in the literature. This study demonstrated a significant improvement in bruising with topical arnica (6). I can attest to the effectiveness of topical arnica from my use of Ocumend© pads on the lower eyelid and upper cheek, which has an even higher concentration than the arnica used in this study. The Bottom Line Oral arnica may be effective in reducing post-operative bruising after nose surgery. Topical arnica can also be an effective treatment for bruising of the lower eyelids and cheek after lower eyelid surgery and/or some nose surgeries. As a result, I offer my patients arnica in these scenarios. The effectiveness of oral arnica for upper eyelid surgery and facelift surgery is simply not supported by the available data. As a result, I do not feel it makes sense to offer it at this time. That being said, this could change in the future as more and better studies are released. References: Totonchi A, Guyuron B. A randomized, controlled comparison between arnica and steroids in the management of postrhinoplasty ecchymosis and edema. Plast Reconstr Surg. 2007 Jul;120(1):271-274. Lee HS, Yoon HY, Kim IH, Hwang SH. The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. Eur Arch Otorhinolaryngol. 2017 Jul;274(7):2685-2694. Chaiet SR, Marcus BC. Perioperative Arnica montana for Reduction of Ecchymosis in Rhinoplasty Surgery. Ann Plast Surg. 2016 May;76(5):477-82. Kotlus BS, Heringer DM, Dryden RM. Evaluation of homeopathic Arnica montana for ecchymosis after upper blepharoplasty: a placebo-controlled, randomized, double-blind study. Ophthalmic Plast Reconstr Surg. 2010 Nov-Dec;26(6):395-7. Seeley BM, Denton AB, Ahn MS, Maas CS. Effect of homeopathic Arnica montana on bruising in face-lifts: results of a randomized, double-blind, placebo-controlled clinical trial. Arch Facial Plast Surg. 2006 Jan-Feb;8(1):54-9. Leu S, Havey J, White LE, Martin N, Yoo SS, Rademaker AW, Alam M. Accelerated resolution of laser-induced bruising with topical 20% arnica: a rater-blinded randomized controlled trial. Br J Dermatol. 2010 Sep;163(3):557-63. Trust Your Face to a Facial Plastic Surgeon It is important to seek a double board-certified, fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us today to learn more! Contact Us

Many patients can undergo more than one facial plastic surgery procedure in one surgical session. However, whether a patient can undergo more than one procedure in a single session depends on multiple factors. A detailed discussion with your surgeon is required to determine whether one or more procedures is indicated. A surgical and anesthesia plan is then developed that is safe and as effective as possible. This plan may involve one or more procedures. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. The Level of Sedation Required to Perform the Procedure is a Factor Some procedures, such as the extended deep plane facelift, neck lift, lateral temporal brow lift, lower blepharoplasty, and nose surgery (rhinoplasty) usually require some level of sedation, whether it is oral sedation, IV sedation, or anesthesia with the use of a breathing tube (see previous blog post). Sedation allows patients to sleep during longer, more involved procedures that otherwise could be uncomfortable. Patients often prefer to add other, shorter procedures during a single surgical session involving sedation to have one recovery period. This is a major convenience, because it not only limits the total number of days patients need to recover, but it also allows patients to achieve a more complete aesthetic result earlier. The Length of Time Required to Perform Each Procedure is a Factor Other patients prefer to separate multiple procedures. This may involve undergoing the longer procedures first, followed by the shorter procedures later. This also may be reversed. For example, a patient may elect to undergo upper eyelid surgery (blepharoplasty), a lip lift, buccal fat removal, and/or neck liposuction under local anesthesia prior to or after an extended deep plane facelift and neck lift. One benefit of this is that patients are sedated for less total time, which is preferable to some patients. The Medical History is an Important Factor Many patients are very healthy and tolerate longer operative times. Other patients have medical conditions with which shorter operative times would be best. This should be discussed in consultation with your surgeon and your surgeon with their anesthesia provider. It Can be Beneficial to Perform Some Procedures Together It is common to perform a lateral temporal brow lift and/or a lip lift with the extended deep plane facelift and neck lift. There are multiple benefits to adding these procedures. First, each addresses signs of aging that the extended deep plane facelift and neck lift do not address. Second, the lateral temporal brow lift allows a shorter facelift incision. Some Procedures Cannot be Performed Together Some procedures may require a stepwise approach; that is, it may be better to allow one procedure to heal prior to proceeding with the next. For example, it may be necessary to undergo a rhinoplasty and a lip lift separately because the surgical incisions are so close. The Surgeon and Anesthesiologist Develop a Plan A final surgical plan and a final anesthesia plan that reflect the considerations above are developed in conversation between the surgeon and anesthesiologist if sedation is required. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! CONTACT US

The author James Clear describes a system in the book Atomic Habits to identify activities in which one could excel by asking the following questions: What feels like fun to me but work to others? What makes me lose track of time? Where do I get greater returns than the average person? What comes naturally to me? Question 2 refers to the concept of 'flow,' which is a mental state achieved when you are so focused on a task that everything else fades away. James Clear argues that flow tends to be reached more often with activities that sit in a 'Goldilocks Zone,' neither too difficult nor too easy. He argues that it is in this zone that maximal motivation and focus can be achieved. I have routinely experienced flow during two pursuits, surgery and rowing. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. 'Flow' in Rowing Refers Not Only to the Water As written in Atomic Habits, the concept of 'flow' in athletics is commonly referred to as being "in the zone." This is especially appropriate when describing rowing because it describes the feel of a boat moving through water when the entire boat is in the zone. I rowed primarily in an eight-person racing shell, which is the term for a rowing boat. Four oars extend ten feet to the tip on each side of the shell. All eight rowers need to move the long oars in perfect harmony, both to balance the boat and to maximize the power generated pulling through the water. While a shell can move fast when the rowers are slightly out of sync, the wasted energy is palpable. There are times, however, when the boat feels of one mind. No energy is wasted. The blades hit the water at the exact same moment, pull through with ease, and exit with the shell in perfect balance. Even our coxswain – the individual who sits at the back of the boat, steers, and coaches the team – described feeling when the boat experienced flow. It felt like we were moving faster and with more intention but with less effort. 'Flow' in Surgery Engages All Senses and Cognition The concept of flow applies in the operating room as well. Flow describes not a mindlessness but an all-encompassing focus that optimizes the careful execution of each step in the procedure. For example, I ask my patients what background music they would like to listen to in the operating room before surgery. A common reply is "whatever you would like." I then explain that when I am in the operating room, I hear no background music playing. I am "in the zone." All attention is focused on their care. All senses are engaged with them, from what I see to what I hear, including their vital signs on the patient monitor. My surgical team – consisting of an anesthesiology physician, nurses, and scrub technologists – facilitates this flow state. Like rowing, achieving a flow state makes the procedure feel like I am working with more intention but less effort, though the opposite is true. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us

A surgeon mentor once told me many years ago: "Jeff, we are like plumbers." I initially perceived this negatively. However, the positive reality of this comment became clear to me over time, particularly after reading Shop Class as Soulcraft: An Inquiry into the Value of Work by Matthew B. Crawford, who advances the argument for "work that is meaningful because it is genuinely useful." The book not only transformed my perspective on the value of the craft trades (e.g., electricians, masons, plumbers) but also my perception of my chosen specialty, facial plastic surgery. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. "Any discipline that deals with an authoritative, independent reality requires honesty and humility." – Matthew B. Crawford (author) Matthew B. Crawford, a professor in philosophy and motorcycle mechanic from the Bay Area, became an electrician as a teenager, learned the mechanics trade in his 20s, earned his PhD in philosophy and dipped his toes in the Washington D.C. think tank world as well as consulting prior to leaving it all to start a motorcycle repair shop in a grungy building in Richmond, Virginia. He now works as a professor at the University of Virginia from his home in Silicon Valley. His central argument in Shop Class as Soul Craft calls to mind the story the author Robert Pirsig tells in his book Zen and the Art of Motorcycle Maintenance: An Inquiry into Values in that both argue that "real knowledge arises through confrontations with real things." In the case of Mr. Crawford and Mr. Pirsig, that is motorcycle mechanics. Matthew B. Crawford praises work that is technical, requires manual dexterity, is embedded in the community, and cannot be outsourced. He includes medicine in his list of jobs as well as the building trades and mechanics. This contrasts with more traditionally white color jobs, including his work as a consultant and in a think tank, which he feels have become so systematized as to demand little independent judgement and skill. He argues that independence means having the agency to harness your own knowledge, experience, and skill to work towards an end that flows from something that physically exists. That is because there is universal validity in the end-product of the work or craft, such as a motorcycle that runs properly or a well-lifted face and neck that imparts a more naturally youthful appearance. Like a table or chair, these end-products are a long-lasting, physical example of the execution of good judgement. He provides multiple examples of problems he has encountered with motorcycles for which there are multiple possible explanations. He walks through the process by which a skilled mechanic utilizes the evidence and their understanding of the possible causes to determine a specific course of action to evaluate and treat the problem. The effort made is like an artist drawing what they see, which appears easy because of our ability to picture an image in our mind's eye but is quite difficult to translate to a piece of paper. Like an artist, mechanic, or tradesman, surgery requires a combination of technical skill and judgement derived from study, training, and experience that allow a surgeon to see things in a way others do not. "The surgeon's judgement is simultaneously technical and deliberative, and that mix is the source of its power." – Mike Rose (author) Matthew B. Crawford states "craftsmanship means dwelling on a task for a long time and going deeply into it, because you want to get it right." That is an apt description of medical school, residency, and fellowship that, in my case, took a decade to complete. I completed one of the most rigorous aesthetic fellowship programs in the world through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with Andrew Jacono MD, FACS. Not only was I trained in the most advanced facial plastic surgery procedures available by a master surgeon who developed, among other procedures, the extended deep plane facelift, but I also gained the experience of learning how to approach the complex variation that exists in the anatomy between individuals. While we share the same basic anatomy – and this is why specific surgical procedures can be taught – there are many minor, albeit significant, variations in this anatomy that is relevant to surgery. Anatomic variation can be learned by reading, because there are normal anatomic variations that exist naturally whose chances of an encounter intraoperatively are measurable. However, there is much more to understanding anatomic variability than this, and it comes down to feeling. The feel of tissue is relevant to executing the fine steps of surgery. It is not something that can always be visualized, and it is sometimes difficult to explain. However, it factors into our clinical judgement as another data point. Haptic feedback allows our trained hands to respond reflexively to the tissue, pushing in some areas and limiting ourselves in others. We are simultaneously factoring in visual data as well as our knowledge of medical literature and experience when making judgements intraoperatively. As the author Mike Rose writes: "that mix is the source of its [surgical] power." "The ability to yield, to bend, to give way, to accommodate, he said, was sometimes a source of strength in men as well as in wood, so long as it was helmed by inner resolve and by principle." – Daniel James Brown (author) of George Yeoman Pocock (Rowing Coach and Boat Builder) I have long had a love for wooden crew boats. One of my favorite books, The Boys in the Boat: Nine Americans and Their Epic Quest for Gold at the 1936 Olympics by Daniel James Brown, tells the story of the University of Washington crew's unlikely win over the Nazi German team in the 1936 Olympics while rowing in one of these wooden boats. My favorite part of the book is the story of George Pocock, the English boat builder and coach who was the brains and soul behind the University of Washington team, despite not being the head coach. He started a boat building company that got its financial start building planes for the United States during World War I. Pocock Racing Shells is now an internationally renowned boat-building company that still exists in the Seattle area. The author describes the great skill and effort George Pocock exhibited when building wooden crew boats, which are composed of multiple types of wood placed in areas that maximize the natural features of the wood to optimize the performance of the boats. More detail about George Pocock's life can be found in the book Ready All! George Yeoman Pocock and Crew Racing by Gordon Newell and Dick Erickson. His story and my love for rowing has inspired me to build my own wooden single-person crew boat. A close friend of mine's father is a carpenter – he designed and built the frame on which my photo background hangs in the office – who built his own boat years ago. We have long discussed building a boat together. It is a dream of mine which I hope to fulfill sooner rather than later. I will make sure you all remain up to date on the process of designing and building the shell when we start. George Pocock was an inspiration to his team and to boat builders around the world. He recognized many of the same qualities that make a master boat builder in his rowers. Matthew B. Crawford recognized the same qualities in masters of the trades, including medicine. These qualities include honesty, humility, resolve and focus. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching "plastic surgery near me." Get in touch with us to learn more. Contact Us