A doctor's comforting hand

Both the eminent Beverly Hills board-certified plastic surgeon Stuart Linder, M.D. (Dr. Body) and and the equally eminent Beverly Hills board-certified facial plastic surgeon Robert Kotler, M.D. (who blogs as Dr. Face) rely heavily on the sense of touch to produce rejuvenations that delight patients.

Often mentioned are the many extra years of training – four to seven years after medical school — required to become a board-certified cosmetic plastic surgeon.

Part of that education comes through hands-on experience that teaches a surgeon’s fingers and hands to walk their way around the human body, guided by the sense of touch.

Jointly, Doctors Face and Body belong to the following medical organizations, including:The American Academy of Facial Plastic Surgery and Reconstructive Surgery; the American Board of Plastic Surgery and The American Medical Association.

______________________________________________________________________________________________________________

Dr. Body (Dr. Linder:) I was thinking about the sense of touch yesterday while doing some liposuction. In liposuction, a plastic surgeon uses a long suction tool, known as a cannula, inserted through a very small incision in fatty areas. And the only way I know exactly how deep I am in the body is by the way the cannula feels in my hand. I can’t actually see inside the body. And there are three levels, or planes, within two inches under the skin where I remove fat.

Dr. Face (Dr. Kotler:) Can you tell if you are no longer thrusting the tool through fat?

Dr. Body:  Absolutely! It’s the sense of touch that lets me know I have left a fatty area and am approaching muscles with the tool. In fact, one of the dangers of liposuction in untrained hands is puncturing an internal organ with that long tool.

Dr. Face: So if you read that a physician trained in, say, radiology, is offering liposuction to the public after learning the technique in a weekend course, how do you react?

Dr. Body: My hair stands on end! The basic thought in my mind is “Yikes!”

Dr. Face:  With expert plastic surgery professors as your guide, how long did it take to learn it and then feel confident offering to your patients?

Dr. Body: A good six months to learn the technique and a couple more years to offer the procedure with confidence – and also to know when NOT to do it.

Dr. Face: In my area of plastic surgery – facial surgery – surgeons must often lift the skin from the underlying facial and neck muscles. That’s done over the cheekbone, jaw and neck regions. It must be done very diligently and carefully because vital nerves and blood vessels are just underneath.

Dr. Body: Is there an instrument that tells you when enough is enough?

Dr. Face:  Not exactly. After years of watching masters and doing basic general surgery, a facial plastic surgeon uses his or her thumb and forefinger to feel the skin’s thickness to gauge the level of dissection.

Dr. Body: What about the nose? You can’t lift all of that skin, can you?

Dr. Face: Again, the sense of touch tells you. The skin must be lifted from bone and cartilage, the skeleton, to modify the basic shape of the nose. In some nasal procedures, the bones of the bridge of the nose must be realigned while cartilage may need to be trimmed.

Dr. Body: Do you mean broken?

Dr. Face: Yes. And that is also done with thumb and forefinger which first feel the precise location. The other critical part is being able to visualize all the tiny and intricate structures of the nose in your mind. Again, that comes after years of training and experience.

Dr. Body: Breast augmentations and breast revisions are somewhat like that, too. No patient wants a large scar on her breast so we make the incision only as long as necessary and then rely on the sense of touch to know how much we can stretch the incision without tearing it. Then, we use our fingers to work the breast implant into the pocket and feel when it is positioned properly.

Of course, that incision must be a little larger for a silicone breast implant. We use a surgical tool to help with that but just the right amount of force must be applied. Just a tad too much and you may have an unhappy patient.

Dr. Face: Right! The last person we want to have a “Yikes!” moment is a patient!