The role of plastic surgeons to family doctors is a critical one as they work together to provide comprehensive care to their patients.

There are several first to this article.

1. Endeavours of Kauvery hospital, a new age hospital, to involve and provide an opportunity for plastic surgical team to share their views on the relationship they have with the family doctors. A very vital aspect and opportunity to further excel in the delivery of quality plastic surgical services in a collaborative manner.

2. Plastic surgical team share the knowledge in the form of case studies and also will make the varied and complex services of plastic surgeons easy to understand for every doctor.

3. This is also the first attempt to collaborate with Chat GPT. This has given me a new paradigm in preparing a document. I just need to have the creative mind and the background work is delivered by Chat GPT. This is again a collaborative work.

Here are some of the ways in which the plastic surgeons and the family doctors collaborate:

1. Referral network:

A GP is the first point of contact who is responsible for providing preoperative care.

2. Post-operative care:

After a surgical procedure the GP provides the crucial role in the continuity of care in following the instructions and taking necessary medications.

3. Ongoing management

Chronic conditions: Collaborative work in the management of chronic conditions after cancer reconstructions, diabetic foot problems, hand injury rehabilitation and aesthetic conditions.

4. Patient education:

GP has the key role in educating about the general information and specific outcomes.

The timing of referrals has a significant impact on the patient’s outcome.

Face, hands and the foot in addition to other areas of the body form an important domain of the plastic surgeon. I am going to summarise some of the common, the uncommon and some of the unique cases presenting to a plastic surgeon. Emphasis will be on the structural deformities of the blood vessels, nerves and the scarring which causes some of the bizarre deformities.

Face: and scar:

Face forms an important domain of the plastic surgeons. In fact plastic surgeons are well know for the excellent Rhinoplasty, Face lift and other daring and challenging cases done on the face. Face gives the first impression and a plastic surgeon can strive to provide for the patient present his best first impression. This is something that not only people in the media, cinema and front office, but every teenager and even the common man and women seem to be seeking after.

Some examples.

Early referral in a young man following an RTA, fall from a motorbike without wearing a helmet. Accidents and facial injuries can cause disfiguring injuries. Ideal recovery is possible. Early and prompt reconstruction has produced a very pleasing effect. Face is important organ of communication. Facial expressions form an important part of non verbal communication.

Both function and aesthetics are preserved

Delayed primary referral.

Surgery done at inappropriate time and without respect to the basic principles can have disastrous results This is called suturing and not reconstruction. Plastic surgical reconstruction involves attention to detail which included meticulous debridement, restoration of form thus preserving function. Scarring impacts the aesthetics. Functional deformity can be the result of scarring impacting eye, eyebrow

Both function and aesthetics are Restored.

Delayed referral:

Face can speak a thousand words. Face can launch or destroy a career. Remember the adage” Fist impression”. This poor fellow has a bad first impression. The tiny scar unfortunately evokes an impression of having been in a fight or a brawl. His employers did not  go beyond forming such an impression. Plastic surgery helped his confidence, job, and finally life.

Both Aesthetics and Life Restored

A GP’s Unique referral.

This lady was being treated for headache. Numerous tests, referrals, consultations did not give her any relief. Psychiatric evaluation angered and depressed her. One of the GP knows I deal nerve related problems. That prompted this unique referral. The scar in the forehead was entrapping and causing severe pain in the scalp. The pain was constant but with some periods of relief. Touching the forehead almost made her throw a fit. A diagnosis of scar pain and entrapment was made. The scar was marked out and the point causing the lightning pain was marked. Neuroma was excised, thus giving her the much needed relief of her life.

Both pain relief and sanity restored.

A case of Facial deformity with scarring and blood vessel abnormality.

Venous malformation

This young lady is bothered with bleeding of the nose and mouth. She also has disfigured face and has had multiple surgeries for the correction with residual scarring. Surgeries inside the palate and floor of the nose by an ENT surgeon. Surgery on the gums by faciomaxillary surgeons and also plastic surgeons with surgery on the face. A through plan with the need to perform one surgery is important. Again keeping the principles of restorative reconstructive surgery in mind and the need for supreme aesthetics have to be taken into consideration. This is a perfect example of supreme challenge. A young pretty girl, left with scarring and bleeding.

Both Reconstruction – perfection and Beauty Acheived

Face and the facial nerve:

As said earlier, appropriate timely referral, evaluation of the complex nature of the problem, sensitive to the cost of the procedure, an eye for detail and aesthetics, are some the qualities which makes a plastic surgeon provide solutions for different conditions. However you might have noticed that, it is a mismatch between the structural components of the face and also the physiological needs it provides which results in patients seeking a solution.

We looked at the conditions. due to obvious structural damage involving the skeleton, muscles, bone ,nerve and the blood vessel. Facial palsy causes unparalleled misery to the patients. Surgical option for this can give good results.

For continuity of care, home care under the supervision of the physiotherapist with physiotherapy is impotant. In the above picture, this person developed facial palsy. Every smile was painful, bringing down his confidence and severely affecting his demeanour. Life was miserable

Comprehensive treatment included facelift ,facial reanimation, neural retraining and rehabilitation. He went back to meaningful life and lived life happily ever after.

In short a plastic surgeon in collaboration with family doctors can conduct a surgical orchestra orchestrating the various abnormal components leading to the deformity and bring out the best master piece. , He can be master chef to bring out the best recipe to cherish.

The bottom line in plastic surgery is – in evaluating the components of deformity- real or imagined (as in the case of cosmetic surgery), whether in the face, hands, foot or any part of the body for that matter, and reconstructing, restoring it with an aesthetic touch and presenting it in a near normal or superanormal condition.

Prof. V. B. Narayana Murthy
Sushrutha Professorship Plastic Surgery
Senior Consultant Plastic Surgery