In recent years, aesthetic medicine has developed at an impressive pace. However, there is a feeling that rapid growth mainly concerns cosmetology, plastic surgery is more conservative. This is true?
Plastic surgery, as a separate specialty, appeared in Russia only about 10 years ago. In the Soviet Union, medicine in principle had other tasks that were far from aesthetic requirements. Therefore, the pace of development of aesthetic medicine in Russia is staggering, and there is something to be proud of. But this applies to all its areas - both plastic surgery and cosmetology. There are simply more cosmetologists than plastic surgeons, and they have more patients, so their development is more noticeable.Since last year, mass inspections of plastic surgery clinics have been conducted in Russia. Clinic control is tightened all the time. How justified are these measures?
Over the past few years, we have seen in plastic surgery a number of egregious cases of death of patients, and not from some complications that could not be avoided, but from problems that could and should have been prevented. Of course, the authorities could not help but intervene. Therefore, the very fact that the Ministry of Health is responding to this problem is justified and explainable. Another thing is that as usual all this happens very awkwardly. After all, why do patients die?
From the fact that inexperienced doctors are engaged in them, or from lack of any drugs, from the fact that the clinic does not have a debugged quality control system for providing medical care. Officials need to check all this. In fact, the nuts are tightened too much, and often the bona fide clinic owners are given the conditions under which they simply can no longer work.Can you give an example?
I was surprised by the requirement of regulatory authorities to provide patients with a walking area after surgery. Over the 20 years of my medical activity, I have never seen a patient who, after an aesthetic operation, wants to walk around the clinic. After plastic surgery, as soon as the patient can go out, he prefers to immediately go home.
An equally absurd requirement is the presence of resuscitation in the clinic of aesthetic surgery. Just because resuscitation cannot work once or twice a year, no surgeon will put his patient there. I saw one example when this requirement was met, and executed perfectly. A tremendous amount of money has been invested, a separate intensive care unit with monitors, a rest room of the on-duty anesthetist-resuscitator, and the on-duty nurse-anesthetist has been built. This led to the fact that a non-working unit appeared in the clinic. Resuscitation should work, only then will patients with really serious complications be put there. There should be a combat brigade that deals with saving lives every day. And of course, when there was a complication requiring resuscitation efforts, the patient was not put in this intensive care unit at the clinic, but the Sklifosovsky Institute in Moscow was taken.
The fact is that in the clinic of aesthetic surgery, a situation where resuscitation is really needed arises once every two to three years. So this room, in which millions of rubles have been invested, serves simply as a hostel for nurses. I consider such requirements to be excessive.There is a stereotype about the difference between schools of plastic surgery. So, the American school is often blamed for excessiveness, the European school is considered more moderate. Are there any distinctive features in the Russian school?
There really is a difference between schools, and it is associated with the most popular procedures for patients. Although this certainly does not mean that in Russia there is no demand for any moderate and natural results after plastic surgery, or in Europe there is no demand for large breasts and buttocks. In general, people are more or less the same everywhere, but the trends are certainly different. The Russian situation is very similar to the American one. We also have very demanding patients, and the development path and trends in plastic surgery are more like American ones. European plastic surgery is very conservative. We quickly learn new techniques, many of our surgeons operate quite radically, aggressively, with pronounced results.You have worked in a thermal lesion clinic for a long time. Do you prefer the work of an aesthetic or reconstructive surgeon?
Of course, aesthetic surgery! For the past 17 years, I’ve only been doing it.
But reconstructive surgery - it is still more interesting. Each patient is a non-trivial task that must be solved creatively. For example, an electric burn of the nape, when an electric current struck all tissues up to the brain. The task is to somehow close this defect. And my teacher and I go to the morgue, and on the cadaveric material draw up an operation plan: we form a flap on the back, we try to drag it to the back of the head. We practice this technique and inspired go to the operating room. It is hard to imagine that I was doing something like this now. Aesthetic surgery in this sense is a more routine thing.
But in the burn center I worked at the military medical academy. And the star of military medicine, which was hypertrophied in the USSR, has been rolling for the past 20 years. Work in a quietly dying structure, let’s say, acts depressingly on any person.What technique do you find most promising now?
I don't have a universal answer to the question what technique is promising now. There are new methods, but they, in my opinion, have exhausted their potential. For example, lipofilling (transplant of own fat).
This method, like a rocket, took off at the beginning of the zero years, then the complications and problems associated with it were described. But enthusiasts, primarily Americans, continued to persistently try, look for approaches. As a result, now it’s a great tool that accompanies almost any operation of mine, I use lipofilling almost always - with face rejuvenation, with eyelid surgery, with breast enlargement, when you need to close the implant. The approach to remote fat has changed, I'm just sorry to throw it away. And when there is fat from liposuction, I always look for where to put it back, for example, in the ass, because it is an excellent plastic material.
Only 15 years ago there was no such attitude, we mercilessly got rid of fat and were gladly glad that the patient became slimmer and more beautiful. But it is difficult to call lipofilling a promising method, its potential has been developed. He took his rightful place among other methods, and so far I do not see new technological breakthroughs.What do you think of cell technology?
I have been observing some steps on the part of cell technology over the long term. Back in the late 90s, when I worked in a burn clinic in St. Petersburg, and we had enthusiasts who transplanted artificially grown cell cultures to burn wounds. But this did not give a practical result. Over the past 20 years, biotechnology has remained in the category of classical basic science. It is explainable. In classical science, 90% of the development will go to the basket, but the remaining 10% may give some kind of technological breakthrough.
There is no practical application of stem cell culture, for example, artificially grown fibroblasts. Surely this will work somewhere, someday. For example, there were interesting reports in neurosurgery. But for now, no.
At one time, we were engaged in isolating stem cells from fat during liposuction, propagating them in an artificial environment and injecting them back into patients, but I honestly did not see any real result from this. While classical methods are an order of magnitude more efficient.The latest techniques for correcting appearance make plastic surgeons and cosmetologists constantly intervene in each other's areas. In your opinion, where is the line that cosmetologists better not to cross?
In the scope of the operation that is being performed. I do not see any fundamental difference if the cosmetologist does a little lipofilling of the lacrimal groove, or if he injects gel into the same area. Both requirements are the same: sterility, a small amount of surgery, the use of a local anesthetic.
The cosmetologist should stop where the potential danger of complications exceeds the capabilities of his cosmetology office. Can a beautician perform blepharoplasty? Technically, yes. But the likelihood of bleeding, or anaphylactic shock during plastic surgery is higher simply because the volume of intervention is greater and we use more drugs.
Surgeons need to reassure and anesthetize the patient, apply an antibiotic. With a large number of medicines, the risk of complications increases. The duration of the intervention is longer. The surgeon uses other methods: dissection of tissues, mobilization - releasing them from old ties, moving to a new place and fixing. The cosmetologist does not apply these methods, even when he pulls up the tissue, he does not dissect, does not exfoliate them from the place of attachment. Nevertheless, cosmetologists go into the area of surgeons and vice versa, because these are related specialties and there is no crime in this. There is a human mind to distinguish between what can and cannot be done.You teach a lot - at the faculty of advanced training of medical workers at RUDN University, conduct anatomical courses for cosmetologists in Prague on the basis of Charles University. Do you like to teach?
I really like it when there are the results of thinking about what you did. And then there is a need to share it. But basically I'm still a practitioner: 95% of my work is surgery.Cosmetic methods are becoming more invasive. Perhaps a completely different approach to the training of cosmetologists is now needed?
The requirements for training are getting higher, and objectively there are prerequisites for this. Now, only a dermatologist who has received appropriate training can become a cosmetologist. It used to be different. After passing the course for several months, the nurse became a beautician. And the bases of educational institutions have become more serious. That is, the situation is getting better, serious efforts are being made in this direction.Why then should doctors, in particular, cosmetologists, attend additional anatomical courses?
In Prague, I worked with the French surgeon Yves Saban, who said that he first organized an anatomical course for doctors 30 years ago, which turned out to be very popular. And this is in the West, where there has always been high training. That is, the point is not in poor primary education, but in the fact that even a doctor cannot be learned as a narrow specialist in all matters.
As for the development of skills on anatomical material, this is not enough for doctors of other specialties, not only cosmetologists. Each doctor has a personal learning curve, we learn all our life. And when we begin to perform more and more aggressive manipulations, we need some additional support. A look at the anatomy of a doctor who, for example, begins to use thread lifting methods in his work, is changing. The doctor begins to need additional knowledge in anatomy. And in this sense, the anatomical course in Prague devoted to thread implantology helps a lot. It makes it possible not only to see everything with your own eyes, but also to try it with your own hands, and a truly experienced teacher is always there and available for any questions.Alexander Fadin
- plastic, aesthetic, reconstructive surgeon of the Plastica.one project, anatomist, candidate of medical sciences. He has been operating for more than 20 years, teaching at the Peoples' Friendship University of Russia (PFUR) and at anatomical courses for cosmetologists in Prague. Full member of the Society of Reconstructive and Plastic Surgeons of Russia, author and co-author of 30 scientific papers, reports and presentations.Medical Esthetic
is a Czech company, a distributor and manufacturer of medical devices, equipment and preparations, as well as an organizer of anatomical courses for cosmetologists and research based at Charles University in Prague and Comenius University in Bratislava.