Budmano, as I said, it's a complex issue.
Originally, I was very against the cosmetic aspects of plastic surgery. But, I've seen enough cases where people are mentally suffering (yes, that word is strong, but it applies) because of what they perceive to be a single, significant physical defect. Whether it's a large bump on their nose or breasts that have seriously "deflated" after breast-feeding, it's something that stands out to them, becomes a focus point, and does actually cause them distress. They may be perfectly happy with the rest of their bodies, but these patients desperately want one particular thing corrected. In those cases, I have no problem doing the surgery, if (and only if):
- the patient has realistic expectations
- the patient's health is not at risk
- I'm sure that there's not a non-surgical option
There are certain cases in which I won't operate:
- patients under the age of 18, unless they are post-bariatric surgery
- patients whose mental health is fragile (eg not sure what they want, in the middle of a divorce, etc.)
- patients for whom the risk outweighs the benefit
- patients who expectations are not in alignment with what I know I can do
I formed these opinions over a few months observing and working with plastic surgeons whose technical skills and ethics I respect. These
are not Dr. Rey types who will inflate every breast in a 10 mile radius if they have the opportunity. They have years of experience in the field and are very talented at handling the mental aspects of plastic surgery as well - indeed, as one of my psychiatry attendings joked with me, part of the reason I'm going into plastics is because I'll be practicing fake psychiatry.
I like that psychological aspect, being empathic, managing patient expectations and so on. But part of my training as a surgeon, believe it or not, will be a strong grounding in when
not to operate, since any medical or surgical procedure has an inherent risk (heck, you could get MRSA from acupuncture
).
Of course, I also like the artistic aspect - you need a good sense of proportion and what will look best on a particular patient, finesse, and a desire not to stop until you are satisfied with how your work looks.
Now keep in mind, I still don't intend to make cosmetics the bulk of my practice. I hope to keep it below 50% of what I do, simply because to me, reconstruction is more interesting. There's a lot more thought that goes into correcting a unique structural defect that you may never have seen before - and still making it look good.
Now, that's not to say that I don't have respect for God's creation or an inflated idea of my own abilities. I still say bismillah every time I step into the OR.
Bud, I know that's long, but I hope it's clearer than mud.