Facial reconstruction and transplantation: treating the patient and not the x-ray
The Norman Rowe Lecture
11 July 2024 (Last updated: 11 Jul 2024 18:46)
The final keynote (The Norman Rowe Lecture) at the 2024 BAOMS Annual Scientific Meeting was delivered by Daniel Borsuk, associate professor at the University of Montreal and Chief Plastic Surgeon at Sainte Justine University Hospital Centre, Canada.
It was a fitting end to a conference with a patient focus, as his presentation underlined that at the heart of every surgery is a patient’s story. Daniel spoke about how his facial reconstructive work can restore people to their true selves by bringing back their identity, confidence and appearance.
After his training in plastic and reconstructive surgery, Daniel specialised in advanced craniofacial, microsurgical and aesthetic surgery. He has performed facial transplantation operations on several patients and outlined the tools surgeons have, and how techniques have improved over time with more emphasis on the aesthetic.
This is important, he says, because his patients' lives are so affected by their facial appearance. One told him that every time he comes to Daniel’s office means leaving the house, and every time he has to leave the house is the worst day of his life. Restoration of his face changed this, giving him the freedom to live without constant attention, questions and focus from others because of his facial injuries.
As his technique has evolved, so too has his focus on the communication between patient and surgeon. He says: “Listening to a patient’s individual needs is the most important thing we can do. Their aesthetic and functional demands and expectations are unique and the only way to understand that is through an open and transparent discussion before any form of rhinoplasty. To me this is the richest part of medicine, and I tell residents, you can do a lot more good with your voice and words than you can with your scalpel.”
Through his talk, Daniel tells the stories of patients whose confidence has been rehabilitated by surgery and who have gone back to their everyday lives. He shows a photo of one young woman, on whom he operated several times from the age of ten. One postoperative photo shows her looking so miserable that he asked her what was wrong. She revealed that she had never been concerned about her facial appearance but had undergone surgery because her mum and Daniel had advised it, and her lack of confidence was around the appearance of her breasts. After a simple 45 minute augmentation a newer photo shows her beaming. She has since had her own family and lives a happy life.
Daniel says: “When I realised we hadn’t listened to her, the patient, I felt sick. Sir William Osler who was a graduate of my alma mater, McGill University and went on to be Chief of Medicine at Oxford University used to say: ‘treat the patient not the x-ray’. Over a hundred years later I had failed at that. I had treated the x-ray.”
Since then, Daniel has focused on the patient’s voice, working harder than ever to agree on what is important before any surgery. He showed photos of happy patients living their best lives, and relayed their stories, how each one is special and how he worked with them to achieve the best result for their circumstances.
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