Millard and Gillies’ 2nd Commandment of Plastic Surgery: “Thou Shalt Have Style”

by Or Friedman, MD (@Friedman_MD)
Tel Aviv Medical Center, Israel 
PRS Global Open Resident Ambassador

Millard reported on his mentor Sir Harold Gillies’ “ten commandments of plastic surgery” in 1950,1 codifying a set of principles encompassing practical, technical, and ethical axioms to guide the reconstructive efforts of plastic surgeons (Table 1).

Table 1

Rohrich et al., revisited those commandments and described their practical application during our daily practice.2 We would like to highlight each principle with a resource from PRS Global Open that demonstrates its use.

“Only great minds can afford a simple style.” -Marie-Henri Beyle

1. Thou shalt have style-

Jean Cocteau said “style is a simple way of saying complicated things”. A surgeons style is the interpretation of knowledge and skill by his attitude and personality. During consultation it effects how the patients goals and concerns are extracted and put into practical surgical steps; then reflected back to the patient. Building upon this critical interaction, and in line with the surgeons character, it effects the markings, surgical mile stones, pace of surgery, effective communication with the surgical team, and reproducibility of the results. An informed patient is more likely to adhere to the post surgical protocol, optimising the outcome.

Trim Labiaplasty” by Dr Heather Furnas demonstrates how personal style can emanate from the text and video supplement.3

trim labiaplasty

From “Trim Labiaplasty.” Originally published in PRS Global Open. Full video available here.

Basic and complicated plastic concepts such as the anatomy and its surgical correlation are delivered in a concise stream like manner following “plastic” logic which is reflected in the markings, excision, homeostasis and closure. The videos echos the text, and the key points presented address the major and minor pitfalls of the surgery.

Granted, style is something we adapt over time and is influenced by many different things and experiences. Some times we may even adept a certain manoeuvre or shtick. But understanding how it effects our actions and interactions may help us consciously develop our own style.

PRS Global Open case reports are a great source for challenging plastic surgery cases and breaking them down to the “ten commandments” may help consolidate our “plastic” approach and reasoning.

  1. Millard DR Jr. Plastic peregrinations. Plast Reconstr Surg (1946) 1950;5:26–53.
  2. Rohrich RJ, Timberlake AT, Afrooz PN. Revisiting the Fundamental Operative Principles of Plastic Surgery. Plast Reconstr Surg. 2017 Dec;140(6):1315-1318.
  3. Furnas, Heather J. Trim Labiaplasty. Plast Reconstr Surg Glob Open. 2017 May; 5(5):e1349.

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