A beginning aesthetic surgeon should be led...

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He is a pupil of Professor Fahoun. He has much experience and has passed much on. He is one of the top aesthetic surgeons. We spoke to Dušan Záruba M. D., Senior Surgeon at the Institute of Aesthetic Surgery, about the training of young surgeons, risks and unsuccessful procedures.

Mr. Záruba, how did you get into aesthetic plastic surgery?

When I received the specialization in surgery I came to Professor Fahoun who taught me aesthetic surgery. He was fully devoted to this as the only surgeon in this country at that time. He passed his experience and knowledge of the field to all of us who worked with him.

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You were instructed by an experienced surgeon, what is the role of such instruction in the education of surgeons?

It is, of course, very important. A beginning surgeon should be instructed before he starts to operate on his own. Unfortunately, it is usually not like that.

If you come across a poor operation result and it is the surgeon who is to blame, do you inform him?

If we settle it directly with the patient, I don’t inform him.

Do you think it is of any importance for the original surgeon?

It might be logical; however the communication is often difficult. Mostly I deal with it only in cases if it is a colleague I know.

Do you come across patients who come with requests for re-operations from one and the same surgeon?

Yes, certainly. There are surgeons who have no problems, but also clinics where a procedure is repeated several times.

Is it possible to fix this within a system?

Nowadays, there are no legal regulations which would enable or disable certain surgeons to perform certain procedures. There is no chance to treat it unless serious health damage occurs. Satisfaction or dissatisfaction with operation results is not considered serious damage.

What is the role of the Aesthetic Surgery Society in this issue?

The Society may only give recommendations. If a surgeon gets his Certificate of Specialization in plastic surgery, it is impossible to direct him.

Is it necessary to perform a certain number of aesthetic surgeries to get the Certificate of Specialization in plastic surgery?

No, the specialization does not include aesthetic surgeries. It is fundamental because the specialization in plastic surgery is done from general plastic surgery or its subfields. Nobody teaches aesthetic surgery despite the fact that 70% of surgeons earn their living through aesthetic surgery.

Do you regard the fact that foreign clients want to leave for home as soon as possible after the operation as a risk?

It is complicated. There are clinics which have 20 foreigners delivered, operate on them within few days and send them back in two days and see them no more. It has nothing to do with medicine. It is necessary to have the chance to check on patients.

Do you think it is important to have some time between the consultation and the operation?

I regard it as important in one out of about 20 patients. When, for instance, a person has no idea what to expect from the operation, he or she needs to speak with the surgeon and then think it over. However, current advances knowledge, thanks to the Internet, is on a very high level. The patients are usually well-informed about the problems of standard operations and by the consultation they more or less just need to clear up details regarding themselves.

So it means you admit it’s a possibility: consultation one day and the operation the other?

If I communicate with a patient via e-mail for two months, I have seen photos, I admit the possibility. Another thing is when I see a person for the first time in my life and I should operate on them the following day. If it is a patient who has, for instance, saggy eyelids, there is nothing to think about. However, an operation which will change the appearance, for example rhinoplasty, is something different. In this case I would probably not operate the next day.

What may be stressful in aesthetic surgery for such an experienced surgeon as you?

Today I am not concerned if I can handle the operation or not. Professor Fahoun used to say that every surgeon brings about most of his complications himself and he was right. A surgeon learns to avoid complications with practice and experience. However, what is stressful for me are the unexpected complications which may occur in any patient and which cannot be predicted. Even in aesthetic surgery there may be complications endangering life. Then the surgeon must quickly move from aesthetic surgery to classic medicine. Not every patient realizes the risk.

Let’s mention the problems with augmentations. How long should the after care of a patient following augmentation take?

Augmentations should not be a one-shot operation. Every woman with implants should be monitored on a long-term basis and should have the opportunity to contact the clinic where the operation was done. Augmentation is a procedure in which complications may occur after half a year but also after five or ten years.

Is there a growing tendency to proceed in such a way in the clinics performing augmentations?

I think there is a growing tendency to perform the operation and not see the patient again. The package tours of foreigners who you never see again are typical. I don’t think it is right.

Updated: 2009-10-07

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