8/9/2019 Pitanguy Master Class Article-Vasco Senna-Fernandes & Lee Seng Khoo

1/220 PlasticSurgeryPractice.com February 2015

INDEPTH

By Lee Seng Khoo, MB, CHB, MRCS Ed, and Vasco Senna-Fernandes, MD, PhD

Ivo Pitanguy, MD, was born in 1926 inMinais Gerais, Brazil. The son of a gen-eral surgeon, Pitanguy followed in hisfathers footsteps. He studied under J.J.

Longacre, MD, of Cincinnati; Marc Iselin,MD, of Paris; and Sir Archibald McIndoeand his cousin, Sir Harold Gillies, in theUnited Kingdom.

Upon his return to Brazil, Pitanguy setup the first hand surgery service in Latin

America at the 19th Infirmary at the SantaCasa General Hospital in Rio de Janeiro,Brazil. He also became the head of theDepartment of Burns and Plastic Surgery

at Souza Aguiar Hospitalin Rio de Janeiro, Brazil.

In 1960, Pitanguyopened the 38th InfirmaryDepartment of Plastic andReconstructive Surgery inRio de Janeiro, where itcontinues to serve someof the countrys most dis-advantaged citizens. The38th Infirmary, in con-

junction with the ClinicaIvo Pitanguy, are Centersof Excellence for the train-

ing of international plasticsurgeons.

At 88, the Michelangelo of the scalpeloversees a staff of 70 at the Clinica IvoPitanguy. Here, he shares much of what hehas learned during his lengthy and legend-ary career.

Why did you choose plastic surgery?After qualifying as a general surgeon,

I worked in an emergency hospital inRio de Janeiro for 3 years. I noticed thatalthough emphasis was given to life-savingprocedures, little importance was given torestoring a normal appearance. For exam-ple, a mans face could have been slashedby a knife, but the subsequent stigma of

I set up the Ivo Pitanguy Clinic in Riode Janeiro because I realized I needed astructure to be able to teach and transmitthe knowledge. I set up a library and audi-torium with a secretary. I also started adepartment at a teaching hospital in SantaCasa General Hospital in Rio de Janeiro totreat patients with various deformities andaesthetic concerns.

A formal residency program in plas-tic surgery was offered. I trained manyresidents who, in turn, became professorsand instructors in my department. Ourtraining program continues to this day.

Of course, we dont gain anything by thisexcept the opportunity to teach.

In my opinion, aesthetic and recon-structive surgery are one. We cannot sepa-rate one from another. What gives megreat joy is when those who have beentrained by me become teachers themselvesnot only in Brazil, but also in many othercountries.

Tell us what you learned from theluminaries you studied with.

J.J. Longacre, MD:

In general surgery, one often rushes tocomplete a surgery very quickly. But inplastic surgery, one has to be very meticu-lous and patient.

Sir Harold Gillies:When I first met him, he said, Ive

never seen a Brazilian, and he looked atme from head to toe like a novelty. Hewas a great man. He taught me the joy ofteaching. He was the one who gave me thatpleasure. To teach is one thing, but to liketo teach is another. For Sir Harold Gillies,teaching was pleasurable and somethinghe enjoyed.

Sir Archibald McIndoe:He taught me to understand the struc-

ture before even touching it. For example,

Plastic surgery foundingfather Ivo Pitanguy, MD,on life, learning, and legends

MasterClass

the scarring was not considered impor-tant. To fight to have a normal appearancewas not considered necessary in that era.

And it was at that time that I realized Iwanted to improve my knowledge to beable to perform surgery to restore not

just form and function, but also a normalappearance.

At that time, there were no formalresidency programs in plastic surgery. Wehad to learn by going to different places. Iwent to learn under Dr John Longacre, adistinguished plastic surgeon in Cincinnatiwho also worked with Sir Harold Gillies in

London. This was in the 1950s. I realizedI liked the detail and creativity that couldallow the surgeon to restore an appearancecloser to normality. This is what plasticsurgery is all about.

I returned to Brazil and worked inmany hospitals and services trying to applythe various flaps and techniques that Ilearned. However, I felt I needed to learnmore. I went to France to learn under MarcIselin, a hand surgeon, and others in Paris.

After my stint in France, I won a scholar-ship from the British Council and went toEngland to learn under Sir Harold Gillies.

It was here that I met David Ralph Millard,Jr, MD, a visiting surgeon in England. Ialso studied under Sir Archibald McIndoe,who instilled the importance of aestheticsurgery in me. At that time, aesthetic sur-gery was not taught in public hospitals

just private practices, where Dr McIndoeand many others were kind enough toinvite and teach me.

When I returned to Brazil, I felt that Ihad a responsibility to share the knowl-edge that I gained from the masters. Ibelieved that aesthetic surgery should notonly be available to the elite, but toeveryone. A deformity should not just be

judged by its appearance. The psychologi-cal impact also matters.

Ivo Pitanguy, MD

8/9/2019 Pitanguy Master Class Article-Vasco Senna-Fernandes & Lee Seng Khoo

2/2February 2015 PlasticSurgeryPractice.com 21

understanding the nose inside and out,interpreting what needs to be done, andrespecting what can or cannot be donewithin the nasal form and anatomy isessential. That had a great impact on me.

Marc Iselin, MD:He taught me about the French cul-

tures way to treat a patient: approachingthem not just as a doctor, but also as ahuman being, giving life and hope.

In life, I am always learning; we arealways learning. We should always beopen to knowledge.

Why is broad-based training inplastic surgery so important?

When you are going to do plastic sur-gery, you need to have a broad vision ofthe specialty. The challenge we face todayis the services or departments of plasticsurgery are becoming very subspecialized.

Just the other day, a patient presentedwith a secondary hare lip deformity. Andmy assistant surgeon, who was verywell-trained, requested that I per-form the case as she had little expo-sure to hare lip repair.

In my residency program, myresidents rotate through other ser-vices or subspecialties of plasticsurgery. Back in my day, a singleplastic surgeon would operate ona very broad spectrum of plasticsurgery, from trauma and hand toburns to pediatric cases. I had thepleasure of operating on a widevariety of reconstructive casesduring my career. In a way, thereconstructive aspects gave me the

tools necessary to perform aestheticsurgery.

I believe a plastic surgeon needs a broadformation to have a deeper understandingof reconstructive surgerylike microsur-gery, for example. The aesthetic conceptsare applied to reconstructive cases, andthe reconstructive concepts are applied toaesthetic cases.

How has plastic surgery evolved overthe years?

There has been great improvementin reconstructive surgery. Many moderntools and biologic materials have beendeveloped. In aesthetic surgery, if youtry to do too much, the results may notbe desirable. There has to be limitations.For example, in the face, if you overdoit, the end result would not be natural.It is a dangerous thing, progress withoutdigestion.

What is the Ivo Pitanguy philosophyof plastic surgery?

In many cases of breast, abdomen,and other types of surgery, you dont justlearn the technique but also need to learnthe philosophy. You need to know howto approach the surgery, what to do, andmaster the technique. Each time you go to

a plastic surgery meeting, you will try toadopt a new technique. But if you have abasic knowledge and technique that comesfrom a solid experience, the procedures wecreate or adopt will have the best resultsin our hands. We pass the knowledge toothers. After you graduate, you can dowhatever you want to do, but you shouldcome out with a solid knowledge of basicprinciples and apply them.

For example, when I started doing

abdominoplasty in the early days, I alwaysmade it a point to tighten the muscles.This was one of the main points of mytechnique. If you follow the basic prin-ciples, they give you the possibility ofdeveloping other techniques.

What is the secret of your successtalent or hard work?

No talent is needed at all. All you needis a good interpretation of what needs tobe done and what you need to do. Even if

you have a hand like this [he contorts hisright hand in a malformed position] andyou interpret the case and operation cor-rectly, you can do it better than someonewith well-formed hands. It is a matter ofknowing what you are going to do.

If you are not very gifted, do it slowly.And in this way, you can always do itwellif not betterthan anyone whodoes not pay importance to interpretation.Of course, manual dexterity is also impor-tant, but even more important is the ability

to interpret. Dexterity comes with practice.

Are you concerned about aging andretirement?

Aging and retirement are never my con-cern. They are the concern of others. If youare not concerned, you should keep goingprofessionally. There is always a reason ofwhy we are here; everything has a mean-ing. Everything is moving, and we shouldkeep moving forward.

Can you define beauty?Beauty is very difficult to define. Beauty

can be looked upon and approached inmany different ways, even in a religiousway. If you listen to Santo Tomas Aquino,

who quotes, Beauty is a gift from God,it carries the meaning that if you are notbeautiful, you are not gifted from God.True beauty comes from within. Onlytruth is beautiful.

As the poet John Keats says, A thingof beauty is a joy forever: its lovelinessincreases; it will never pass into nothing-ness. But one can also say, beauty lies inthe eyes of the beholder.

The concept of beauty differs based on

culture. Voltaire, the French philosopher,quoted, Ask a toad what beauty isgreatbeauty. He will tell you that it is his toadwife with two large, round eyes stickingout of her little, flat face, a yellow belly,and a brown back.

I feel today there is a notion of impos-ing one cultures concept of beautyonto anothers. Beauty has been manipu-lated by marketing. Think about the beau-tiful model that you see in the shampooads with very long legs. If we put an

amputee in place of her, the peoplewill go crazy.

In my opinion, one can be shortand one can be tall, but harmoniousin many different ways. Everyonehas a different biotype. You donthave to change your biotype to bebeautiful. You can aim for a har-monious look with your biotype. Awoman can be slightly plump, butbeautiful with aesthetic harmony.Ultimately, beauty is a sense ofwell-being.

As plastic surgeons, we donthave the ink of the painter, thestone of the sculptor; we dont have

the vocabulary of the poet. We havethe creativity and the interaction

with others, and with that we learn whatwe can do, what we can improve, butalways acknowledge our limitations.

What matters most?The most important thing in life is your

family. One needs a family regardless ofsocial class. My wife, my daughter, and mytwo sons and close friends are my family.

When one cultivates a good close family,one can develop a very good comprehen-sion of life. We are part of the world. Our

limbic system is intertwined. So if we loveour family, we should love the world aswell. They are our extended family.

Any advice for aspiring surgeons?If you like and love what you are doing,

you should do so with pleasure and love.Do so responsibly on your chosen path,however long it may be, and you willalways be happy.

Lee Seng Khoo, MB, CHB, MRCS Ed, is asenior resident in plastic surgery, and VascoSenna-Fernandes, MD, PhD, is a professorof plastic and hand surgery, both at the IvoPitanguy Institute. They can be reached viaPSPeditor@allied360.com.