Aesth. Plast. Surg. 27:5, 2003 DOI: 10.1007/s00266-003-0001-5 Online publication: 14 April 2003

What Are We Doing and Where Are We Going? In the last hundred years aesthetic plastic surgery has progressed much, evolving from an almost casual practice, as performed by Mrs. Noel in Paris, to become an important part of the great field of plastic surgery. Everybody recognizes it to be a very glamorous activity, an image no doubt inflated by the media and by many surgeons’ egos. It is a big business. Less evidently, the expansion has occurred mostly outside the traditional medical environment—big hospitals and medical schools—probably because aesthetic plastic surgery is not reimbursed by social systems or medical insurance. For that it is regarded as one of the last bastions of the so-called private practice—the service for fee, direct business with the patient that most of us still envision as the right way to practice medicine. In this new millennium our subspeciality will face many challenges and undoubtedly will grow and transform to a degree that is impossible to foresee. At this point, however, two questions should be addressed in order to provide a clearer scope for our journal. The first question deals with the limits of aesthetic plastic surgery—how to define it. The second question is how to evaluate the outcome of aesthetic procedures in a more scientific way. Definitions of aesthetic plastic surgery are numerous, the most accepted being that of the ASPS, ‘‘Aesthetic surgery is performed to reshape normal structures of the body to improve the patient appearance and self-esteem.’’ This is in contrast with reconstructive surgery which attempts to bring deformed individuals to normalcy. This distinction seems artificial and may not be useful in the future. Apart from the fact that it is impossible to define ‘‘normal,’’ we can name many other occasions related to ‘‘reconstructive’’ or medical situations where the aesthetic outcome is clearly important: breast reconstruction, congenital craniofacial anomalies, reanimation of facial paralysis, microsurgical reconstruction of the face, facial burns, contour problems after gastroplasty-treated obesity. In both, plastic surgery is the method, but it is the

well-balanced appearance, or the aesthetic outcome, that is our focus. Evaluation of the results of aesthetic plastic surgery is another major problem that we should concern ourselves with. Both this and our aesthetic goal should be represented in this journal by an expanded variety of articles and sections. Manuscripts that present personal techniques, technical innovations, comparisons between diverse approaches, and complication rates are, of course, important, but they relate only to our surgical perspective. We need more papers that reflect what the other side feels—the patient’s perspective of the results. Outcome studies must quantify psychological improvements, gains in self-esteem, shifts in quality of life, and differences in social performance. Articles should report on result assessments done by independent observers, with long-term followups. This will bring us closer to practicing ‘‘medicine based on evidence.’’ Aesthetic procedures done on patients deformed either congenitally or by acquired physical abnormalities, will be discussed more frequently. Expansion of the horizons of aesthetic surgery will bring us back to where we belong—in medical and academic circles. There I see a great future for aesthetic surgery in which the challenges of plastic surgery will be correctly addressed and we will better employ our resources to restore deformed patients and to improve the overall appearance of human beings. Aesthetic plastic surgery should not be considered a peripheral or minor medical activity. On the contrary, it deals with human dignity and deep, personal expectations. For the benefit of the patients, the plastic surgeon will create beauty. Marcus Castro Ferreira Division of Plastic Surgery University of Sa˜o Paulo Av. Dr. Arnaldo, 455—Sala 1360 Sa˜o Paulo, Brazil Email: [email protected]