Cliche I know, but time really flies. I started my Plastic Surgery Practice in Boise 15 years ago this month, fresh out of Fellowship training. Then, 10 years ago also this month, we moved into our current location in Meridian with a larger space and our own Accredited Surgery Center. What has changed over the years? I do less general reconstruction and more cosmetic surgery, but maintain a significant volume of breast cancer reconstruction. Surgical skills really do not change much, but time and experience lets one use them in a more effective manner with less risk. I try to only do procedures which have a high likelihood of patient satisfaction paired with a low chance of problems. In a word, a good operation is a reliable operation.
As far as breast surgery materials, round silicone breast implants became available and now we have shaped form stable implants which are great for reconstruction and sometimes right for particular cosmetic patients. Patients rarely want a saline implant. I also now see at least as many beast augmentation revision patient now as first time implant patients. We use materials like human cadaver dermis and silk mesh to support soft tissue and breast implants as needed. Fat grafting, both for breasts and faces, has gone from cutting edge to mainstream to downright popular.
For body surgery, the basics are the same, but treating excess skin problems from all over the body secondary to large weight loss surgery was just introduced when I started and now is very common. Faces have not changed much either. There have been efforts at minimalist surgery and filler and Botox use has exploded, but if you really want to look better, you still need a well executed full facelift / browlift/ rhinoplasty, etc. This is supported in the literature. For example, if you do not do surgery to improve the neck (in effect a mini-lift), then you do indeed have a worse neck as you age.
While lasers and injectables have been helpful, no one has created a magic machine just yet and surgery by well trained practitioners remains the best option for real improvement. So, 15 years down, and hopefully another 15 plus to go.
Mark D. Wigod, MD, FACS, providing Cosmetic and Reconstructive Plastic Surgery to Boise, Meridian, Treasure Valley and Southeastern Idaho.
