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November 19, 2013

Thoughts from the American Society of Plastic Surgeons annual meeting

I attended the American Society of Plastic Surgeons annual meeting this October and had a very interesting time discussing clefts with other plastic and reconstructive surgeons dedicated to cleft care. During this meeting, several thoughts popped into my head:

It is a small group nationally, but one that is passionate about and dedicated to cleft care.
Evolution of cleft care and art has progressed toward focusing on “perfection.”
The evolution of cleft care and techniques continue to change.
What do I mean?

It is a small group nationally, but one that is passionate about and dedicated to cleft care.

Since plastic surgery covers both cosmetic and reconstructive surgery, there is a lot of ground to cover at these national meetings. With about 4,500 participants, there is plenty of good energy and sharing of ideas. There are sessions where acknowledged national experts will give talks and panels, and the sessions are organized as being either aesthetic or reconstructive. Because there is so much information, the two sessions will run at the same time. Naturally, the session dedicated to cosmetic surgery (such as face lifts, eyelid tucks, breast augmentations, belly tucks and liposuction) is usually standing room only, whereas the reconstructive sessions tend to attract a smaller crowd. While talking about cleft care in the reconstructive session, I looked around the room and saw a lot of familiar faces, all of whom have dedicated themselves to clefts and pediatric plastic surgery. I couldn’t help but think that this is truly a small and dedicated group that easily could walk next door and focus on the more lucrative practice of aesthetic surgery. Yet we remain in the quarter-filled room to share ideas and discuss where we are taking cleft care in the future. It is this continual drive for perfecting cleft craft that keeps us coming back year after year.

Evolution of cleft care and art has progressed toward focusing on “perfection.”

It used to be that closing a cleft was what was expected and nothing else. Then we began to focus more on the aesthetics and the function. Now, we have evolved to the point of understanding and have enough experience gathered up in our specialty that the lip repair is actually the easier part of the operation. We also focus on making the nose perfect and trying to make repeat surgeries a less frequent occurrence. The goal is to make it look like there was never a cleft to begin with. And although trying to predict how a child’s lip and palate repair will grow over time is difficult, we have come to a point where we can get a pretty good idea. Besides focusing on altering our procedures to give a beautiful natural repair of the lip and nose, we also focus on minimizing future surgical procedures if possible.

The evolution of cleft care and techniques continue to change.

I keep in touch with several other cleft surgeons, as well as my mentors. All of them have at least 20 years of experience fixing cleft lips and palates. We often share pictures of our patients to discuss cases and see where things went well or discuss areas that could be done differently. These are wonderful exchanges since they allow a good flow of constructive discussion and criticism of what works and what doesn’t. It’s this continual discussion that keeps us striving for perfection in each case. It’s humbling when the older cleft surgeons still are open to change and new ideas about operations and techniques they have been doing for the past 20 years.

It is the same during national meetings since we see results from other cleft surgeons and have lively discussions about what works and what doesn’t. It probably comes as no surprise, but cleft surgeons are their own toughest critics. We are self-described perfectionists, and this is perfect for improvement! Because of this attitude of “We can always do better,” cleft techniques continue to change. I think this is great since the ones who benefit the most are the kids.

These national meetings recharge my professional batteries. Rubbing elbows with the “experts” and seeing that your own results are on par with theirs is reassuring. Dr. Ralph Millard is the modern father figure of North American cleft surgery and he labeled it Cleft Craft. This is the perfect description since although medicine prides itself on the science, cleft care it is still an art and craft. Its practice requires constant dedication, constant study, and above all, constant care of each individual patient.

- James Liau, MD

James Liau, MD

Posted by James Liau, MD

Dr. Liau practices the complete spectrum of plastic and reconstructive surgery. He also specializes in pediatric plastic and reconstructive surgery and craniofacial surgery, focusing on comprehensive treatment of children with cleft lips and palates, congenital craniofacial deformities, as well as other more unique congenital problems requiring pediatric plastic surgery.

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