I just got back from an intensive five day conference in San Francisco entitled The Art of Rhinoplasty.  This course has been in existence for 47 years, all under the watch of Dr. Leslie Bernstein.  Dr. Bernstein is in his eighties and his enthusiasm for teaching his accumulated knowledge involving the nose to his pupils is electric.  I feel as though I was lucky to meet someone whose found his life’s passion.  Dr. Bernstein had our conference begin everyday between 6 and 6:30 am, and jammed the day full of lectures by his proteges.  We quickly advanced to discussing the most complicated cosmetic rhinoplasties possible.

As the name of the course implies much emphasis was placed on the artistic nature of cosmetic surgery.  I’ve long thought about this subject and felt that after the years it takes to accumulate the knowledge and techniques necessary to perform cosmetic surgery there’s another dimension to embark on.  I feel that this is where artistry comes in.  A Plastic Surgeon that I trained under used to say,”Plastic Surgery isn’t Art, it’s a craft.  One needs to have predictable outcomes which fall into the range of the ideal human figure, such as a master craftsman builds furniture or weaves a fine fabric to certain standards.”  That statement never felt right to me.  I believe that Surgeon was correct in describing the middle stage of a cosmetic surgeon’s career, after the technical skills are achieved, but I think that in some ways that’s just the beginning.  Most people would agree that fine art such as the Mona Lisa wasn’t done by a craftsman, Leonardo breathed life into those paint strokes.  By seeking perfection Leonardo became known for his work because it stood out from the other painters.  This is exactly the same pursuit for the cosmetic surgeon.  However it’s a little more difficult because the science of healing, aging, and patient selection all comes into play.

One of the week’s highlights for me was to perform nose dissections on human cadavers at the UCSF Medical School.  For a Surgeon the cadaver lab is a sacred place.  It’s where another human being has died and given you permission to take a look inside to educate yourself to help the living.  It’s a powerful experience that always has mixed feelings of humility and excitement for me.  In the lab I was reminded of Irving Stone’s description of the young Michelangelo dissecting corpses in the catacombs to a single candle’s light in The Agony and the Ecstasy. That’s where the famous Artist learned his anatomy in the middle of the night.  During Medical School we had 24 hour access to our lab and I would often go late in the evening to try to emulate the artist.  Needless to say I found the experience at UCSF immensely helpful in furthering my understanding of the human body.

Dr Bernstein repeatedly urged those in the audience to follow his example and take adult education courses in drawing and sculpture.  He told us that in his earlier career he did this and it made a huge impact on his cosmetic results.  One of our many talented lecturers was a former student of Dr Bernstein’s who took his teacher’s advice and found that he was gifted in sculpture.  His name is Dr. Steven Neal from Oregon.  Dr Neal is the most accomplished Surgeon/Artist that I’ve met.  Dr Neal’s talks revolved around bridging that gap between Art and Science, he backed up his talks with examples of his patients as well as photos of monumental bronze sculptures that he was commissioned to create by his home city.  Dr Neal brought 50 clay human faces to the conference.  He asked us to sculpt noses where he had left a void.  I found it interesting that so many rhinoplasty surgeons in the room couldn’t do it.  It’s not as though they didn’t try but the proportions were off or the anatomic structures that we had been discussing at the conference were all ignored.  I found this exercise really gratifying, I quickly made a well proportioned nose with some subtle details that I was happy with.  More importantly while I was sculpting I quickly entered a zone where I wasn’t thinking about the 10 hours we had already spent listening that day.  The Japanese have a word for the mind and body becoming one during an activity, Satori.  This is where time stands still and you become engrossed in an activity such a tea ceremony, flower arranging, calligraphy or in this case sculpture.  I find the act of surgery to be exactly the same way.  A surgeon needs to have his/her judgement and skills perfectly in tune so that the differences in patients anatomy can be seen and thereby a surgery can work with the patient, not against them.  I’m more aware of these relationships now than I was 10 years ago and I try to incorporate them into my OR cases.

As I was sculpting that night I keep thinking that this could encourage areas of my brain to grow in ways that could benefit my patient’s results.   I’ve decided to take Dr. Bernstein’s advice, so I’ve enrolled in a continuing education sculpting class starting in January.

I’ll let you know how it goes.