And Speaking of Plastic Surgery

I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights.   The show stars Clive Owen as the charismatic cocaine addicted Chief of Surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop.  The tagline is, as they say, priceless– “Modern medicine had to start somewhere.”  On the third episode, last Friday night, Dr. Thackery performs a pedicle skin graft from the upper arm to cover a gaping hole in a woman’s face where her nose used to be, before she got syphilis.   Back in those days, this was a marvelous feat.  Real progress in what we now know as reconstructive surgery didn’t come until the end of World War I, when Sir Harold Gillies, a New Zealand otolaryngologist later known as the “father of plastic surgery,” established the first hospital ward for the facially wounded in Queen Mary’s Hospital in Kent.

For over fifty years, I have been a bystander to the evolution of plastic surgery.  As a teenager I remember the heady early days of microvascular surgery—my father, Dr. Melvin Spira reattaching the scalp of a man whose hair got caught in machinery, then the tales of sewing back severed fingers and ultimately entire limbs with gradually improving functional results.  In the 1970’s the great French surgeon Dr. Paul Tessier, pioneer in techniques for cranio-facial surgery to correct birth defects came to the United States to teach, and I remember a Saturday morning clinic at my father’s office, where mothers whose children’s facial deformities were so severe that these kids had, literally, never seen the light of day waited in line to be seen by the great surgeon who could give them back a normal appearance, and thus a life.

Plastic surgery, like my own specialty of Radiation Oncology, has become one of the “lifestyle” specialties to which medical students aspire, particularly those with an artistic bent and good hands, and for good reason.  Cosmetic procedures are highly reimbursed, and are done during “regular” working hours. Walking around here in San Diego and Los Angeles, surely two of the plastic surgery capitals of the world, it’s easy to spot who has had “a little work” done.  Having one face lift might be a good thing (I wouldn’t know because, as I’ve covered in previous blog pieces, my imagination runs wild with the possibilities of complications and I am far too chicken for elective surgery), but have three and you become one of “Our Ladies of Perpetual Surprise”, eyebrows at the hairline.  Same goes for breasts—it is not normal for the “girls” to be rigidly immobile as their owner pounds away at the Stairmaster.

Last year I mentored a medical student who had started his medical education thinking that he wanted to become a plastic surgeon.  After a beloved aunt developed breast cancer and needed radiation, he started to think that perhaps he would rather become a radiation oncologist because he enjoyed dealing with cancer patients.  He was an outstanding student, and I was quite sure that he would be accepted, and do well in either specialty.  I assured him that with his gifts, and his compassion, he could combine his interest in helping cancer patients with his interest in reconstructive and restorative surgery. Residency interviewers for plastic surgery residencies have a difficult job these days: all of the applicants SAY they want to do reconstructive surgery, but most end up doing cosmetic work.  Apparently my student was convincing when he said he wanted to do plastic surgery to help cancer patients.  He started his plastic surgery residency at Stanford last month.  Dr. John Thackery of “The Knick” may be fictional, but I hope that my student leads the way in new innovations in reconstructive surgery.  My cancer patients may depend on it.


  1. During my first year of college in 1961, my father was diagnosed with squamous cell carcinoma situated on the bridge of his nose. The initial surgery ended up with a totally unexpected result: the removal of his entire nose. The result was not unlike the way you cut out a triangle on a jack-o-lantern for a nose. After several free grafts failed–my father had had radiation treatment for cystic acne as an adolescent–the surgeon finally succeeded via a pedicle graft, the second phase of which had the end of the pedicle on his raised arm attached to his face. This was held in in place by a cast for six weeks.

    My father was forever grateful for this surgeon’s efforts, though the results were far from perfect. Over the next fifteen years he underwent many revisions, some cosmetic and some because of additional breakdown of the irradiated skin.

    Reconstructive patients just want to ‘fit in’ again, to be able to walk down the street as an average person. I hope your student is able to use his skills to facilitate that simple goal for many people with facial differences and other reconstructive needs.

  2. It is truly amazing to see what a talented reconstructive surgeon can do. I didn’t always see the final result as a recovery room nurse. Many patients who had major surgery by ENT doctors for oral/throat cancers – including what is called a radical neck dissection would ask for a mirror. Suture lines from ear, down side of face, sometimes bilaterally, left some wondering about any resultant scarring. As is said, a picture is worth a thousand words. I was fortunate not to have had cancer but did have almost duplicate bilateral suture lines and showing my almost invisible healed “scars” seemed to alleviate patient concern. I always felt good to see my patients smile in relief :>)
    I do remember asking my jaw surgeon about his training and as noted above he also learned as a military surgeon practicing during the Vietnam era. Ironic that war can be the source of so much evil and good.

  3. My sister who just recently passed away from breast cancer, had a t-shirt that sums up the reconstructive process and getting new breasts for her. “Hell yes their fake, my real ones tried to kill me.” She needed the surgery, wanted to feel feminine again and it helped to make her whole. As you say plastic surgery is so much more than a nip, tuck.

    1. Heather, thanks for writing. My Dad would love to see yours–he’s down here in San Diego at La Costa Glen. We should get together. M

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