When I asked our surgeon “What makes a good facelift surgeon?” the other day he replied “training, experience and above all the ability to select the right procedure for the right patient”. Actually, as an anaesthetist who has watched hundreds of surgeons of all shapes and sizes operate , I think that the real answer is a bit more involved than that. So for what it is worth, here is my take on it.
The principal quality needed is training and experience, and lots of it. If you don’t agree with that statement, think how you would react if you asked your surgeon just before your surgery “How many of these operations have you actually done?” and he replied “Well, you’re the first, actually.” I suspect you would probably not simply smile and say “Well, we have all got to start somewhere!” The plain truth is, you are not paying for thirty minutes of a surgeon’s time, you are paying for thirty years of his experience. You may be familiar with a concept popularized by Malcolm Gladwell that it takes a minimum of 10,000 hours to truly master a skill. My generation of surgeons (typified by Phil Guest) trained in a ‘sink or swim’ environment where 100 hour working weeks were commonplace and as a result young surgeons very quickly became extraordinarily experienced. Pretty much like battlefield surgical training, in fact. For better or for worse, that is not the case for surgical trainees today. There is widespread unease amongst senior surgeons today that the amount of first-hand experience trainees currently receive is insufficient.
Allied to experience already under the belt is a keen desire to constantly learn and improve. We have a particular consultant surgeon who travels regularly from Germany several times a year to learn technique from Phil Guest and this willingness to put oneself out to learn and refine skills is another hallmark of a good facelift surgeon.
In addition to the amount of training and experience, you should also consider the breadth of surgical training. With increasingly short and specialized training pathways, many surgical trainees nowadays bypass general surgical training completely. It becomes correspondingly more difficult for them to develop intuition, which is the next most important hallmark of a good surgeon. Most very experienced clinicians give a lot of weight to intuition and rightly so, because basically you only develop intuition by getting things wrong and thereby learning how to avoid (or deal with) difficult situations in the future. Our entire team has developed a strong ‘gut feel’ about things and we use this resource to avoid problems all the time.
On the technical side, it is my view that a high kinaesthetic intelligence (one of the forms of emotional intelligence described by Daniel Goleman) is the hallmark of a good facelift surgeon. At one end of the spectrum, we joke about surgeons who need to wear slip on shoes, because they can’t tie up their shoelaces. At the other end of the spectrum, there are surgeons who have an extraordinary dexterity, economy of movement and grace that is extremely rare. I have only witnessed two such surgeons at work in my entire career. One is Phil Guest and the other is Ilana Langdon, a hand surgeon in Bath. I am convinced by talking to Phil Guest that his brain is actually wired differently – if you ever get the chance, ask him about how he learnt anatomy (and if there is enough time, about the mislabelled anatomy specimen presented to him in an exam).
Of course, there is a human dimension to this question. Integrity, a genuine desire to do the right thing and simply being ‘a nice person’ are essential qualities for pretty much everyone in the practice of medicine. However, you don’t need me to tell you that.
In my next post, I plan to deconstruct some of the myths that currently surround cosmetic surgery. Specifically
- the myth of the ‘top’ surgeon
- the myth of the facelift surgeon as ‘sculptor’ (or artist)
- the myth of the ‘top Harley Street’ specialist
- the ‘publications and learned society’ myth