In this commentary, which we have colloquially referred to as “The Octogenarian Surgeon: A View From the Jurassic Era,” we discuss “The Aging Surgeon: Evidence and Experience.”
A few years ago, I went to India (Hyderabad and Bangalore) for SmileTrain (New York, NY), a cleft charity of which I am a member of their medical advisory board. A few months ago, I received a call in the office from an Indian plastic surgeon who said that he had met me in India: could he stop by the office the next day for a visit? Of course. We had a congenial afternoon seeing some patients and going through a few PowerPoint (Microsoft Corporation, Redmond, WA) presentations on various subjects. The next day, I received an email from him, thanking me for the visit. He added, “Dr Wolfe, you are one of the true Dynosaurs [sic] of plastic surgery” (Figure 1).
The “Dynosaur” with his award from Bar and Austin, Florida International University Herbert Wertheim College of Medicine medical students.
I was delighted to pass this story on to my staff and the residents, fellows, and medical students who were on the service. Two of the medical students were even thoughtful enough to buy a present for me, a small model of a Tyrannosaurus Rex. Much has been written about the aging surgeon.1,2 This recent submission to the Aesthetic Surgery Journal provides a good review of the current thinking about the pros and cons of surgeons continuing to operate beyond the age of 65.3 No definitive cut-off date is given, but caution is advised.
Brian Sommerlad was forced at 65 to take mandatory retirement from repairing cleft palates at Great Ormond Street Hospital when he was at top of his game as the premier cleft palate surgeon in the specialty. Although his skills were no longer available to children with clefts in the United Kingdom, the beneficiaries were cleft children in Bangladesh, where he is persona grata. On the other hand, there are certainly instances, often undocumented, where a patient has been injured due to the aged surgeon forgetting some important step of a procedure.
Ed Luce, contemporary with me and who continues to operate, has written a thoughtful paper specifically on the aging plastic surgeon.4 One question raised was whether the older surgeon can adopt new techniques, or does he or she continue on with what has worked in the past. Last year I went with Chiara Botti to spend a week in Curitiba, Brazil, to visit Dr André Auersvald, a leading exponent of deep neck surgery (digastric reduction/plication, trim of submandibular glands), and see the A-net suture—a whole new approach to aesthetic surgery of the neck.5,6
Both of my teachers were operating in their 80s. Dr Paul Tessier formally retired at age 75, operating until 3 am on 15 cases on his last day of scheduled surgery, but he continued to help others with cases until he was 80. He went to Rome to perform a facial bipartition with Ernesto Caroni, who was only slightly younger, and said that it was a dreadful experience without his usual scrub nurse, Elizabeth, and his instruments, and everything transpiring in a foreign tongue. He went to Switzerland to perform a sphenoidal encephalocele and facial bipartition with Beat Hammer, which was easier on him than his Italian case. After his definitive retirement, he continued to provide advice to younger surgeons when requested, even after he broke his hip at age 90. Five days before his death, he answered a letter from Eric Arnaud, giving advice on a complex case with multiple facial clefts (he suggested visual evoked potentials). The advice given was insightful and useful due to his vast experience and sharp memory.
Dr Ralph Millard was still operating on his cleft patients in his early 80s and stopped only to care for his wife, Barbara, as she struggled, unsuccessfully, with a lymphoma. After Barbara’s death, Millard was looked after by his youngest son, Bond, but retirement was a sad time for him with neither surgery nor writing to keep him busy, and there was a gradual cognitive decline.
Sir Harold Gillies, who had taught both Tessier and Millard, died at age 78 in The London Clinic. He had just finished a facelift, and after the case he sat down in the surgeon’s lounge, where he peacefully expired. Fortunately for the patient, he finished her operation, leaving it to others to remove the sutures.
Dinosaurs are extinct, as I will be myself before too long, so I thought it would be useful to look back, and ahead, from my Jurassic vantage point, having turned 80 last July.
The frustrations associated with medical practice may be greater for the older of us, because we have known different times, when things were easier. One could write in the chart “discharge patient” rather than dealing with finding a computer, logging in, finding the current password, and dealing with a user-unfriendly Electronic Medical Record, and a needlessly complex system. Many doctors are retiring earlier to avoid these annoyances.
Physiological changes are inevitable—cardiopulmonary, genitourinary, gastrointestinal, visual, and cognitive. They can be dealt with to a certain extent, but they should be regularly assessed by a physician not serving beneath the surgeon in question. Diet, exercise, and supplements may help, but hereditary factors probably are more important. Anti-aging is a misnomer. We age one day at a time no matter what we do about it. “Anti-changes brought about by aging” would be more appropriate terminology.
Transitioning
Can I perform an operation as well at 80 as I did at 60, or 40? Yes, and possibly better, with the experience gained over a long career. I do not want to stop cold turkey; that seems too much like death. I will continue on with the “impossible” cases that I have been working on for years as well as clefts and rhinoplasties, the results of which are easy to appreciate. And, in particular, I will be available to younger colleagues if they feel they can utilize help on something that they have neither seen nor done before.
My daughter, Erin, is in her third year of medical school, interested in plastic surgery, and a literal sponge for information. I am considering writing an update to my book on plastic surgery of the facial skeleton with her and with Chad Perlyn, my associate. I am also pleased to be available as a mentor to Lauren Yarholar, who is starting as a craniofacial surgeon at Jackson Memorial, where I received my training with Millard.
My career goal remains the same: to pass on to the next generation what I have learned from Millard, who was the author of multiple books, and in particular from Tessier, who wrote none. As Millard once said to younger surgeons in a video interview I created of him in 2000, “Plastic surgery now remains in your hands.”
Disclosures
The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.
Funding
The authors received no financial support for the research, authorship, and publication of this article.
REFERENCES
