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This could be explained by the fact that married respondents tended to be older and wealthier. Although age and wealth did not show individual links with a preference for surgical modalities, marriage essentially brought both factors to bear on this question. It would seem logical that older patients would more strongly consider procedures to the face and wealthier patients would select the more expensive option. This study has other limitations. First, the sample size is small and therefore prone to sampling error. Second, this cohort is not a faithful representation of the general public, as it is geographically confined to Southern California, where, as the survey indicates, the average annual household income ($91 298) is well above that of the national median ($60 088 in 2010).14 However, it should also be noted that in 2010, the income group with the largest number of members in the US census data was the $100 000 to $149 999 group (14.9%). It could also be argued that the population most interested in cosmetic surgery belongs to a higher income bracket than what would be represented by the national median income. Nonetheless, the geographic and income limitations of this study could be addressed with a larger sample size, which would capture a more diverse and therefore more representative survey population. As the demand for cosmetic surgery continues to rise, additional investigation into this unique patient population is warranted. Defining the demographics of this group as well as those factors patients use in selecting their providers will help plastic surgeons optimize the use of their resources. Downloaded from https://academic.oup.com/asj/article/33/4/585/204723 by guest on 20 May 2021 590 Aesthetic Surgery Journal 33(4) Conclusions Understanding public interest in aesthetic surgery, as well as the factors that govern patient selection of a surgeon and practice, are essential to the success of the practicing aesthetic surgeon. In our sample general population, nearly 90% of respondents would consider plastic surgery in the future. Surgeon reputation and board certification status were the 2 most important factors for surgeon selection, and the majority of patients preferred a surgicenter setting. Subjects cited fear of a poor result, cost, and fear of the recovery process as the principal reasons for refusing plastic surgery. In a patient-driven field such as aesthetic surgery, insight into the mind-set of potential patients is an invaluable tool to maximize success in the surgeon’s practice. Continued study is warranted. Editor’s Note Please see the Editorial in this month's issue of the Journal for an extended discussion of the differences between definitions of “plastic” surgery and “cosmetic” surgery in our specialty. practice a. Average cost of b. Understand the relevance and components of clinical pathways and how to deal with deviation. § Practice cost-effective healthcare and resource allocation that does not compromise quality of care § Know how to partner with healthcare managers (Plastic Surgery coordinator, Social Work, Case Management, PT/OT and Rehabilitation Medicine, etc.) and other healthcare providers (PMD, specialty providers in and out of the hospital) to assess, coordinate and improve healthcare for the individual patient and cohorts of patients This book was an exciting undertaking and represents the hard work and collaboration of the Young Plastic Surgeons Steering Committee, along with plastic surgery residents and fellows throughout the country. In this updated version of Essentials, there are new chapters focusing on current popular topics in plastic surgery, including lymphedema, gender affirmation surgery and composite tissue allotransplantation. Previous chapters were modernized and now include color photographs. The book was written primarily for medical students and other students of plastic surgery to obtain a brief introduction into the specialty and provide references for further reading. It is not designed to be a comprehensive text, but rather an outline that can be read in the limited time available in a burgeoning curriculum. It is designed to be read from beginning to end. Plastic surgery had its beginning nearly 3000 years ago, when Sushruta, an Indian surgeon, reconstructed the nose by transferring a flap of cheek and then forehead skin. It is a modern field, stimulated by the challenging reconstructive problems of the unfortunate victims of the World Wars. The advent of the operating microscope has thrust the plastic surgeon of today into the forefront of advances in small vessel and nerve repair, culminating in the successful replantation of amputated parts as small as distal fingers and bypassing of lymphatic vessels, only a few millimeters in diameter. Furthermore, these techniques have been utilized to perform the first composite tissue transplantations of both hands and partial faces. The field is broad and varied and this book covers the many areas of involvement and training of today’s plastic surgeons. The American Society of Plastic Surgeons is proud to provide complimentary online copies of the Plastic Surgery Essentials for Students handbook to all medical students in the United States and Canada. Continually updated information about various procedures in plastic surgery and other medical information of use to medical students and other physicians can be found at the ASPS/PSF website at www.plasticsurgery.org and the Plastic Surgery Education Network at www.psenetwork.org. The information in this book has also been converted to an app in the Android Market and the Apple App store under the name Plastic Surgery Essentials for Students. 5 CHAPTER 2 CAREERS IN PLASTIC SURGERY Chad M. Teven, MD and Ash Patel, MBChB, FACS Plastic and reconstructive surgery is one of the most diverse specialties within the field of medicine. Unlike many other fields, it is not confined to a single organ system, region of the body, or patient population. The Greek term “plastikos” means to mold or to shape, and this is where our specialty derives its name and underlying principles. By reshaping, remolding, and manipulating both soft and hard tissues, plastic and reconstructive surgeons help patients with a myriad of issues. The goal of our specialty is to restore form and function, and to do so in an aesthetic fashion. The first known plastic surgery procedures on living patients date back to 600 BCE, when the Indian surgeon Sushruta offered reconstruction to people who had had their noses surgically removed as a form of punishment. As early as 100 BCE, the Romans began performing procedures to improve self-image and cosmetic appearance. Since, plastic surgery has come a long way and now is integral to the treatment of patients with disfigurement due to trauma, burns, scarring, cancer, infection, and more. As opposed to treating specific conditions with a limited set of procedures, plastic surgeons use skills and principles based on anatomy, physiology, and tissue transfer when managing patients. The challenge of plastic surgery is the combination of the surgeon’s judgment and problem-solving abilities with surgical technique at any given moment. Because of this approach, the plastic surgeon often acts as a “last resort” surgical consultant to surgeons and physicians in the treatment of many wound problems and is often called “the surgeon’s surgeon.” While plastic surgeons offer life-saving procedures in many situations, an additional important theme in our specialty is the improvement in quality of life for patients. Plastic surgery not only restores body function, but helps to renew or improve a patient’s body image and sense of self-esteem. Along with psychiatrists, plastic surgeons are especially equipped to handle the patient’s problem of body image and to help the patient deal with either real or perceived problems. Consistent with these far-reaching goals, the scope of the operations performed by plastic surgeons is broad. As outlined by The American Board of Plastic Surgery,” the specialty of plastic surgery deals with the repair, replacement, and reconstruction of physical defects of
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