Aesthetic surgery from the specialist’s point of view

We are talking about an area that works on the entire human body and that is truly diverse in its action, never separating aesthetics from function. “If, when correcting an aesthetic defect, we do not take the functional aspect into account, the result will always be bad. This allows me to derive another fundamental aspect, which is the way the specialty is taught to us and how it should be…”. With this, Dr. António Conde means that the specialist in Plastic, Reconstructive and Aesthetic Surgery must have a very strong foundation in Reconstructive Surgery. This experience is acquired in the daily practice of a hospital service where cases of major accidents, amputations, etc. are directed. and where it is necessary to correct all these deformities, some of which are congenital. “It is this experience that allows us to move towards Aesthetic Surgery”.

“The “School” transmits knowledge about the practice of Plastic and Reconstructive Surgery, with the aesthetic aspect being a branch of this large area, however we must also teach Aesthetic Surgery in hospitals where interns practice the specialty. There is no doubt that a functional defect requires much more attention than an aesthetic defect – in this sense, hospitals are much more dedicated to this type of correction – however, once the specialty is finished, many surgeons embark on Aesthetic Surgery and need to have the knowledge to carry out these surgical procedures. I therefore believe that this matter should be reviewed.”

During the internship period, it is the responsibility of the Service where the doctor is located to provide him with all the tools for his development within the specialty, but, says Dr. António Conde, “it is also up to the intern to fight for his training”. It was with this ambition that in the 90s, many of the doctors who were part of the Plastic and Reconstructive Surgery Service at Hospital de São João went abroad in search of new techniques. In this position, our interviewee interned for eight months in Bordeaux, France, in a center that was, at the time, highly developed in terms of microsurgery and hand surgery. As a result of this research work and continuous training, Dr. António Conde was a pioneer in the introduction of some techniques in Portugal: “In terms of Reconstructive Surgery, I introduced the island sural flap for reconstruction of the lower limb in Portugal. I described and published, together with Joseph Bakhach, the inverted flow island auricular flap for nasal wing reconstructions. And also the dorsal digito-metacarpal flap for digital plasties, a flap of major importance in reconstructive hand surgery”.

Despite advances and changing mentalities, we still live under the stigma that aesthetics is an area of ​​surgery that deals with “small whims”, the dream of achieving the ideal body. As a specialist who deals with these cases on a daily basis, our interlocutor opens a window to another reality where the correction of small aesthetic defects brings unimaginable repercussions to the individual’s life, such as greater self-esteem, greater social integration and even adaptation to the job market. where, in certain professions, image assumes high importance. Furthermore, in a universe commonly associated with the feminine image, more and more men are resorting to surgery to correct some aesthetic problems, namely baldness.

In light of the State of the Art, in which the best professionals have reached a level of excellence in their area of ​​specialization – through a lot of research, training and work –, the presence in the market of people not qualified to perform Aesthetic Surgery techniques becomes unsustainable.

We know that the Medical Association allows an individual with a degree in Medicine and a specialty to carry out surgical interventions, freely entering, for example, the field of Aesthetic Surgery. If this can be acceptable in border areas, although they are better achieved if carried out by plastic surgeons – “for example, an otorhinolaryngologist who works on the nose from a functional point of view can, if he sees the need, perform an aesthetic procedure” – , “it also opens the way for ‘curious people’ who, without training, using materials of dubious quality and in spaces without minimum conditions, present themselves as experts, competing with duly accredited professionals with years of training”, warns Dr. António Conde. This intrusion is highly dangerous resulting in many cases of bad practices that become public, often resulting in deaths.

With more than 20 thousand surgical interventions performed, and a large volume of reconstructive surgeries, Dr. António Conde ensures that his success in aesthetic surgery is due to the strong case series he has in Plastic and Reconstructive Surgery. “Aesthetic Surgery, being a delicate surgery, often becomes invasive and can be subject to complications. These complications must, of course, be avoided, but in the event of an occurrence, the specialist must have the ability to treat it, something that is acquired through training, particularly in Reconstructive Surgery”. Experience allows you to face all situations with the awareness of the real ability to solve problems that, although not at all recurring, can happen.

Throughout his career, valuing seriousness in contact with users, Dr. António Conde offers his patients safe conditions to practice his activity. Operating in a hospital that has medical and nursing assistance 24 hours a day, he does not remember having been in any critical situation, but he cannot do without “doing the trapeze with a net”. situations with awareness of the real capacity to solve problems that, although not at all recurring, can happen.

In terms of aesthetics, the specialist performs a considerable volume of breast augmentation and reduction surgeries, mastopexies, and breast reconstruction in the field of Plastic and Reconstructive Surgery. Regarding facial surgery, face lifting, facial aging surgery, blepharoplasty, rhinoplasty, abdomnoplasty, liposuction, baldness surgery (an act he pioneered in Porto) stand out. In all these surgical procedures, our interviewee highlights that common sense must prevail: “We have to establish the patient’s expectations well, explain what is expected and achievable, so that the final result is as harmonious as possible”.

Reinforcing the issue of the quality of the materials used, in a common intervention such as the placement of breast implants, for example, for a layman in the field, the products are all identical, but the differences are overwhelming in the eyes of professionals. “The prostheses we use have associated insurance that is offered to the patient in the event of any complication – contractures, poor positioning, rejections, etc. – that may occur over time. There are (large) details like this that patients are unaware of and that can be crucial when choosing the professional or entity that will carry out their intervention”. In this field, Dr. António Conde will start using software that allows the user to see the results in advance. By scanning the woman’s torso, it is possible to select different volumes and formats with the woman’s participation.