CHAPTER I HISTORY OF PLASTIC SURGERY "The surgeon should try to understand the s oul in the same proportion in which

the psychoanalyst seeks to understand the bo dy." Ivo Pitanguy in Veja, July 23, 1986, pg.64. Abbreviations: CP - Plastic Sur gery CPR - Reconstructive Plastic Surgery CPE - Characteristics of Aesthetic Pla stic Surgery Plastic Surgery The Surgery, taken in its general sense, is a branch of medicine that studies the pa tient and his illness, contributing to a correct diagnosis and aimed at its trea tment by surgery that acts directly on the affected organ or who is deemed worth y of the event. The term "plastic surgery" (CP) was first used in 1838 by Edward Zeis, giving you the sense of unified technical and art in the somato-psychic f unctioning and consequent relief. (Davis, 1941). The division between restorativ e and esthetic is considered only for didactic purposes, for the vast majority o f residents in CP, as in pragmatic terms, as much a fan as an ear nose "ugly" br ing psychosocial problems (PITANGUY, 1960). In the first example, the CP is reco mmended because most patients are benefited by the surgery that makes them "norm al." The Plastic Surgery restorative main objective is the integration or reinte gration of the patient in their social group. In the second, CP involves at leas t two criteria: 1) the person's own (personal domain) without symptoms or other apparent deformity, but wants to withdraw as "ugly", "rough" or "rough "or to ad d items of symmetry, smoothness, lightness and harmony, or 2) indication for sur gery: beyond the personal criteria of aesthetic surgeon, is now considered the t echnical feasibility of surgery. Also false is the belief that the CPE is a nobl e activity or elitist, while the CPR is a 2nd line (AMARO, 1985; Paillet & Gate, 1980 and PITANGUY, 1984 and 1990). Reconstructive Plastic Surgery is the first branch of general surgery that takes care of problems associated with skin graft s, and grafts of organic and inorganic inclusions seeking to restore or establis h forms. The CPR also includes the restoration of function and have their own co ncepts, along with particular methods appropriate. (ASSUMPÇÃO, 1990). To form th e plastic surgeon, in addition to medical school, residency is required in Gener al Surgery. Upon completion of this residence is made to specialize in CP and CP Aesthetic Restorative, with specific examinations of qualification. (Ruzzante, 1986). It is required of its practitioners, as well as interpersonal skills and a spontaneous inclination and especially for the task itself, an artistic vocati on for aspects related to proportion, symmetry and shape (FARINA, 1946). Accordi ng SCHOR & FREITAS (1992) there are several similarities between the office of p lastic surgeon and psychologist, hence the need to ease the surgeon has to liste n, understand and guide the patient: "The physician must listen to the patient t o thoroughly understand your expectations before the plastic breasts, and this i s a true dogma for us. The view of the patient is also crucial, because it binds not only the position or objective opinions, but also the feelings and desires that are attached to their costumes and something extremely difficult to be disc ussed with anyone else: what she wants make your own body. "(SCHOR & FREITAS, 19 92, p. 113). The aesthetic sense is inherent to human beings, but the concept th at each group had about the notion of beauty was preserved within the different ethnic groups or tribes, when they were not placed in confrontation, in which th e idea of comparison could arise. So, before the great voyages, the concepts of beauty and identity were kept because the groups live apart or isolated from eac h other. (Pitanguy, 1992). With the development of exploration, the man started to expand the concept page 15 Earth's geographic and increased exchanges of people between continents. With th e improvement of communications and, most recently with the tremendous advanceme nt of computer technology, it is increasingly easy transportation of images and

information around the world. The concept of beauty and individual perception of what is standard within the social group will be changed by the strong impositi on of the standard esbeltoretilíneo conveyed by the media, which will generate t he consequent increase in the number of plastic surgeries worldwide, as a way of achieving the desired body shape or tax. (Wolf, 1992). Currently, CP is still s urrounded by many myths, favorable or not. To name a few, many people feel that plastic surgery leaves no scars,€which contradicts a law of nature of the skin: if a cut or wound will scar to close it. What happens is that CP can hide it wel l or fairly well. Another myth is the frequent confusion between facial rejuvena tion and elixir of youth: those who expect an increase vitality by removing wrin kles tend to be disappointed after CABG. (SCHOR & FREITAS, 1992). Another myth s urrounding the CP is to find her ability to turn any part of the body as desired by the patient, believing that the surgeon has the same creative freedom as a p ainter, sculptor or poet: ".. . The surgeon, being a slave to form and anatomy, often feels frustrated, because dealing with the human being, add and remove are more subject to the laws of their own body than its creative force ...". (PITAN GUY in MELLO-FILHO, 1992, p.264). Men phases that have an aesthetically classic always had an aversion to ugliness, deformity or asymmetry. Unsightly aspects, w hether of objects or people have always caused bewilderment. The very appearance is crucial in establishing the first printing and the various interpersonal rel ationships. The aversion unsightly represented the starting point in the history of Plastic Surgery (FARINA, 1946), as people tried to correct the deformity or leaving passive attitude of resignation and, together with the need for symmetry , perfection and beauty, made the CP to develop and establish itself as a medica l specialty and controversy, especially in the twentieth century. CP to reach th e level of acceptance, demand, development and currently has that status, its jo urney was very long and complex. There were moments of technical stagnation, for getfulness and serious attacks by the Church (FARINA, 1946). When the anthropoid (our ancestor) could have the thumb separately, via the evolutionary process, d eparted from the pure concern for the delicacy of the gesture (fine motor), and hence for the refinement of its objects. This technical improvement has led the man to get objects produce more precise and effective, thereby increasing the po ssibility of symbolic expression that reflects the aesthetic experience (DUARTE, JR, 1986). The PC is very old and practiced since 3800 BC Its development is di rectly linked to the history of Surgery. The instinctive act of plugging the ble eding with his hands is the reflex of thinking that led the man, acting in a rat ional to prefer a direct means for the cure of diseases, acting in their own reg ion considered ill and developing knowledge and tools for this (DAVIDSON , 1986) . This is the beginnings of any surgery: open the site, perform the operation an d close. Only from 3500 BC, however, is that their existence can be proven throu gh manuscripts, objects, etc. entries. (FARINA, 1946) are reported, according SC HOR & FREITAS (1992), sharp stones that were used to lance the pus accumulated i n a cavity formed in the middle of body tissues, or even a body cavity, as a res ult of inflammatory process, or do bloodletting, aiming not only a relief to the patient, but also better-looking wound. ADLER (1961) showed that the cult of ph ysical perfection was always observed in the history of mankind and that the Gre eks practiced infanticide in those who were born deformed, throwing them into th e river or abandoning them in places known to be devoured. The harsh laws of Spa rta ruled that newborns (children of legitimate Spartans) with abnormal formatio n or defective, congenital or hereditary, and should be immediately euthanized f or reasons of military at first and aesthetics secondarily, because they would b e beings with adjustment difficulties and have problems of deformity, which woul d prevent a good performance in the war (PITANGUY, 1992). Among the Jews there w as the explicit prohibition of the ugly, or with any apparent deformity occupy c ertain positions in society. One example refers to the priests, whose office was exercised only by persons of good looks (BARBOSA, 1984). This disposal practice through infanticide was being abandoned as the page

16 He began to realize that the ugliness or deformity could be corrected or even el iminated in some cases by surgery in person "carrier". Another contributing fact or for infanticide came into extinction was the notion of social justice that pl aced the new spiritual values as important, so that only the Greek and Roman cit izens were equal before the law since birth (Davis, 1941). Moreover,€ancient Gre ece left a legacy of classics that aesthetic standards, the harmony, cohesion an d coherence, crossed the centuries and are still influential factors of various forms of artistic creation. An example of this aesthetic symbolization can be se en in the statues representing the ideal of man or of Greek citizens (Pitanguy, 1992). FARINA (1946) divided the history of CP in five phases, using techniques remarkable discoveries as a criterion for Division 1. Briefly, one can say that: - The first period (3500 BC to 53 BC) is characterized by the use of primitive methods, coarse and empirical, attempting to transform the skin and nasal recons truction. Susruta, considered the father of Hindu surgery, as did CP in the nose (rhinoplasty) in hilly or maimed people. In his works he described 121 Medical instruments and recommended medical colleagues of all times that a good doctor s hould "wear clean clothes, wedge sandals, be gentle and have a look benevolent" (SCHOR & FREITAS, 1992). - The second period from 53 BC until the mid-fifteenth century, is marked by the works of Cornelius Celsus who introduced the technique of rotation flaps, aimed at repairing noses, lips and ears. Celsus was who disc overed that flaps taken from the vicinity of the deformed body's own had greater chances of success (no danger of tissue necrosis). Therefore, C is considered t he father of CP, since his works were written in 30 AD and represent a milestone , for there were very detailed descriptions of repair surgeries. (ASSUMPÇÃO, 199 0) In this second period, Hippocrates (5 BC), father of medicine, was already co ncerned with the problems considered in the context of CP, prescribing creams an d ointments with purely cosmetic purposes, addressing the imbalances of the lowe r limbs such as higher gravity compared to the upper limbs and recommending that the bandages were made in an elegant way to be more pleasing to the eye and pro vide a better healing (FARINA, 1946). At that time, had already propagated the i dea of treating or correcting the deformity, but the CP was considered a satanic activity, as contrary to divine will, to the extent that changed the fate of pe ople. In the thirteenth century, Pope Innocent III forbade the practice, causing the CP to stay stagnant for several centuries. (ADLER, 1961). Within this same period, Tagliacozzi Gasparo (1546 - 1599) rose Susruta surgery, the classic Indi an retail to repair nasal: a fragment of the forehead skin is transferred to the place of the nose. But according to the Inquisition, which saw a CP form of dem onic intervention, ended up being punished with the opening of his tomb and crem ation of his remains. (ADLER, 1961; DAVIS, 1941, and FARINA, 1946). KHOO (1982) wrote that the SP has been left out for other surgical procedures, because it is considered unnecessary (cosmetic) and non-emergency (could always be delayed). In England, in 1605, the CPE was seen as a reprehensible practice in the light o f other priorities, such as avoiding death, control pain, relieve burns etc.. Th is author summarized the concepts of beauty and aesthetics throughout the histor y of humanity and showed that punitive practices, especially in the nose, preven ted the restorative CP (CPR), because the goal was to "mark" the punished foreve r in your face . Indicated that some doctors have observed the psychological ben efits to restore some facial defect or withdraw some detail "ugly" of the patien t, without specifying what these benefits. - The third period (fifteenth century until 1869) begins with the Renaissance, the Anthropocentrism time when the nee d arises to record and systematize all knowledge acquired by man. This feature w ill reappear in the CP, with the return of interest in the specialty. Thus, know ledge about rhinoplasty, acquired by the wording of Susruta Tagliacozzi and beca me interested again to scholars. Ollier in 1860 performed the first transplantat ion of skin that has news, but Jacques Joseph in 1871, gave the real start to th e CPE, performing plastic surgery on the nose of a woman who "felt ugly because of the nose be great ", with results that pleased both. (GIILLIES & MILLARD, 195 7). At this stage, there was great progress in general surgery because of four f

actors together: 1st Farina phases overlap, because their main concern was the period in which the te chniques predominated. Thus, the dates and historical periods presented in this chapter are only references to duration of the techniques described, which, in t urn,€exist simultaneously until another revolutionary technique more effective o r causes of the above come into disuse or are abandoned. page 17 1) gradual loss of strength and power of influence of the theologians of the Rom an Church, they stopped attacking the CP, 2) due to greater freedom (previous it em), the actual ZIP code will be developed, improving their techniques, refining its procedures and disseminating their findings (directly linked to the develop ment of medicine), 3) discovery of chemical agents in 1856, which gave greater f reedom to the patient before surgery, and 4) the increase in aseptic precautions and the use of antiseptic substances (disinfection) during surgery. The CP then began to gain credibility and acceptance with the authorities, since their risk became smaller. The pain that was inherent in any surgical event was fought, wh ich led to a lessening of fear among the population. (Thorwald, 1976). In the Re naissance the surgery was developed with the rhythm of anatomical discoveries an d CP has been called to intervene in cases of accidents due to the use of gunpow der and the spread of firearms. On the battlefield, the main target of the enemy was the face and especially the nose. The highlight was Reverdin in 1869, which brought a new method of skin transplantation, which detailed the region, area a nd depth of the skin should be withdrawn so that the surgery was successful. - T he penultimate sentence of between Reverdin in 1869 and the First World War (191 4-1918). During this period there were more experiments with grafts and rotation flaps, and the job description of Indian retail. The German doctor Dieffenbach recommended to all specialists in the area that had a deep respect for the patie nts. The surgeons should take into account the needs and values them, and the ar ea to be operated. From the late nineteenth century with the rise of scientism, began to disappear on doctors isolated, lonely hero who defied the mysteries of nature or the incomprehension of society, giving rise to the emergence of work t eams or groups of physicians. The vast majority of new contributions of science to humanity came to be the result of research and work collectives. Another impo rtant factor is that the results or the small theoretical advances / technicians have been considered worthy of publication. (MOSCOVICI, 1985; MINAYO, 1992). Finally, the fifth and final period begins with the First World War in the twent ieth century, when the CP wins confirmation and its real value, developing new t echniques, strategies and tools in an attempt to provide the human being a highe r standard of living, through their facial and body image. In World War I, the s pecialty was obliged to give a major step toward the development, the need to pr ovide real help to thousands of injured, burned or maimed. Another factor explai ning the large impulse received toward the improvement was to change the lifesty le of man. The technical development of machinery and means of production, the d eep historical and social transformations will determine an acceleration of surg ical techniques to precisely monitor these developments. (ADLER, 1961; SCHOR & F reitas, 1992; PITANGUY, 1984; POLANYI, 1980). Great strides since the First Worl d War the CP is undergoing significant technological advances and has several su b-specialties, such as: a) Cranio-maxillofacial, 2) Microsurgery, 3) and Burns 4 ) Congenital (or cleft lip and palate formation defective). Adopting the criteri on of surgical techniques notable discoveries FARINA (1946), we can demonstrate the great technical development of CP through some advances: 1) OP ee ling chemi cal in 1960, with which to combat the increases in skin derived from acne scars or fine wrinkles is more effective. It is also used by dermatologists. The evolu tion of the peeling did appear to dermabrasion and microdermabrasion, surgical t

echniques that are designed aluminum crystals in the area to be repaired or work ed on with the goal of thinning or smoothing the skin surface. The principle use d in these techniques is a dermatological sanding that will stimulate the regene rative capacity of cells and promote the appearance of a smoother and more youth ful. (STRAP & ZANI, 1977), 2) Liposuction in 1976, which represents a milestone in the history of CP. According AVELAR (1986) there are two moments in the evolu tion of CP: before and after liposuction. Designed by Yves Gerard Illouz, this t echnique allows the removal of fat deposits through special tubes connected to a vacuum apparatus.€These tubes are increasingly thin (4-6 mm), causing very litt le trauma to the area suctioned. They are introduced (only one at a time), after anesthesia of the area, a small hole in the skin and the risk of unsightly scar ring is minimal. page 18 (Ruzzante, 1986). It is a procedure in which the surgeon does not see the inner area to be suctioned, you can not keep a good control of blood loss (hemostasis) and requires significant skill, expertise of the surgeon, if not a work of othe r professionals (team ). There are risks of rupture of vessels, perforation of n eighboring organs, nerve lesion, aspiration of excess fat and blood, unwanted ae sthetic effects (ripples in the skin) without counting the anesthesia itself. (S CHOR & FREITAS, 1992). According to the creator himself: "This is a simple techn ique, but in compensation is intended to resolve many complex psychological prob lems." (Folha de Sao Paulo, 27/nov/1983, pg. 11). Currently, CP has more specifi c criteria for surgical indication and selection of patients for the use of lipo suction. Depending on the volume of fat to be suctioned, the patient should, bef ore surgery, make a deposit of blood for autotransfusion. The beginning of lipos uction was marked by several fatal accidents or errors of indication or applicat ion, because it was mistaken for a more slimming technique rápido2 "Liposuction has proven to be excellent for face layers of fat located in pockets that is not dissolved with diet, dietary treatments, gymnastics, massages. But that does no t mean in any way, that liposuction replace all these procedures. You can not ev er put, for example, the idea of an option: banting or liposuction. "(SCHOR & FR EITAS, 1992, p. 101, bold added). There was improvement of technique: tubes with sharp edges to facilitate cutting and shedding fat, vacuum cleaner with adjusta ble intensity of aspiration, physical mapping of areas suitable for CABG, sortin g and filtering the types of fats. (AVELAR, 1993). In 1985, liposuction has evol ved to liposculpture, by Pierre Fournier. The principle is to take fat from pati ents' own, because there is no risk of rejection. The fat from areas "noble" aft er filtering is reinjected (autotransfusion) in areas of body depression, flabby skin, skin irregularities or other sequelae of liposuction. (AVELAR & Illouz, 1 986; Cottin, 1994; Veja Magazine, December 18, 1985, pg. 46-47), 3) CP in fetuse s. Corrective surgery of cleft lip in children who are still in the womb can be performed successfully and without risk of visible scars (visible to the naked e ye). This technique, developed in 1990 by Brazilian Fernando Ortiz Monasterio, w as presented at the 10th International Symposium of Craniofacial Surgery. (State of São Paulo, 20/02/1990, pg. 19); 4) Retinoic acid (vitamin A acid in skin pro perties) or glycolic acid derivatives. Tested in Brazil since 1989 in the form o f creams, their efficiency in combating rugas3, streaks and patches of skin have been proven also in injectable form. This is not an operation in the strict sen se, but more a way of complementing or postponement of surgery in April. (This I s It "from 08.05.1992), 5) Computer graphics applied to the CP. By magnetic reso nance imaging coupled to a computer with imaging software or a video camera, thi s technique allows plastic surgeons to show their patients the final outcome of surgery on the video screen and remove many doubts after surgery. The images are transferred to the computer so three dimensional and allow several amendments b y the surgeon (Folha de Sao Paulo "on 29/6/1991, book 4). Openly or requiring co nfidentiality, is increasing the number of men seeking liposuction of the breast

s (gynecomastia) or the abdomen, removal of the "chicken-feet" around the eyes 2Apesar not a form of weight loss, liposuction can function as a technique to support th e treatment of obesity. 3O lifiting CP is a predominantly aesthetic that removes the signs of aging (wrinkles and / or depressive points) of the face or neck by stretching (traction) or non-smooth skin. His scars are hidden in the scalp and behind the ear. If this is mild traction, it will have to refresh the face. (FR ANCO & REBELLO, 1977). 4O appearance of Cosmetic Medicine can also be considered as an evolution of the specialty, it aims to complement the benefits of a CP or delay the trip to the operating table.€Other clear examples are the use of hydr oquinone as a bleaching of the skin, permanent makeup, the softlaser as revitali zing the skin, collagen and hair implantation. ("Look, 23-07-86, p. 65). page 19 (Blepharoplasty) plastic surgery baldness or reduction of adiposity of the neck. The fact that the male patient to seek specialty is considered an asset to some surgeons, because one of the myths surrounding the CP is that it is superfluous or "women's". Some plastic surgeons are usually sensitive to that fact aside di fferent times for male patients. The objective of this conduct is to avoid embar rassment in the presence of women in the waiting room, which hypothetically woul d arouse curiosity about the reason for the patient to be there. (STRAP & ZANI, 1977; GALVÃO, 1978; Magazine "Look" of 18-12-85, pg. 46-47 and 1/4/1992, pg. 5455, Ruzzante, 1986 and SCHOR & FREITAS, 1992 ). Plastic Surgery in Brazil Accord ing LOEB (1993), the Brazilian CP can be divided into three very different perio ds: before 1842; from 1842 until 1940, and after 1940. The criterion used is bas ed on the number of publications of Surgeons. There are no documents that could prove the existence or practice of CP before 1842, only guesses that it was comm itted. Januário Joaquim Carneiro published in 1842 in Rio de Janeiro, the first documented work in the area. It did considerations harelip. At that time, it was customary to call "Theses" such publications. From that time until 1928, won on ly 59 spaces specialty publications, many dealing with burns and rhinoplasty. (L OEB, 1993). The post-1940 LOEB ( 1993) called it "contemporary" because it is th e time when surgeons Antonio Prudente Meirelles de Moraes and Joseph Rebello Net to founded schools attracted students from CP that the rest of the South America n continent. The PC has become very productive in Regarding the number of articl es published and began to gain prominence worldwide. The productivity was due to two major milestones: 1) creation of the Latin American CP in 1941, and 2) crea tion of the Brazilian Society of CP in 1949. According LOEB (1993) this is a tim e honored "to Brazil fell the honor of being the country where he founded the La tin American Society of Plastic Surgery, as well as having held the First Congre ss of the Society." (LOEB, 1993, p . 03). The professor and plastic surgeon Ivo Pitanguy (1925 -) came to prominence with his work of burned in CPR in 1949, wit hin the contemporary period. It was on that date who founded the first clinic in hand surgery and CP in Brazil. In 1952 he created the Santa Casa's eighth ward, which performs CP until today. Currently, the professor Dr. Ivo Pitanguy is par t of the group of plastic surgeons the most famous and competent in the world, i ncluding being cited in international films . As a consequence is one of the mos t sought after experts for various training and research, recognized for its exp ertise in the area. Still develops work to the Holy House of Mercy, which serves free of charge poor patients worldwide. Perform both reconstructive surgery as aesthetics. His recognized expertise lets see if in many published works (video SPECIAL Ivo Pitanguy, 1993). The popularization of surgeries by Brazilian media is encouraged particularly by the pharmaceutical and cosmetics as well as the me dical group who aim to profit on this market share (teaching video of SMS & CEFO R). According to the video itself, there is a large and clear interest in the be auty industry and the medical group for that plastic surgery is not practiced by

the public because it would fall in profit with the increase in CP "free" as we ll as weakening of the private sector that funds the surgeries. There legal and environmental explanations for the great development of CP in Brazil. In terms o f legislation, the Brazilian legal structure does not possess the agility requir ed to follow the evolution and surgical technique, the resulting gap with the pe rmission of the practice or not. The little ethical control, coupled with the ch eapness of plastic surgery in Brazil and to the fact that Brazil is predominantl y tropical (which encourages the use of scantily clad, leaving revealed more of the body and increasing the need to be aesthetically perfect) make it the world center of the EPC. A growing number of patients seeking plastic surgeons in Braz il and is of interest to the surgical specialists who reach an increasing number people. (STRAP & ZANI, 1977; DAVIDSON, 1986; GALVÃO, 1978; Ruzzante, 1986).€Sev eral surgical techniques are developed here by the fact that Brazilian legislati on is not as rigorous as that of other countries, for example, England or the U. S., and also by the great worldwide demand for plastic surgeons in Brazil. There are international tour packages, among other activities, offer the potential of the tourist spend in consultation with a Brazilian plastic surgeon and, if agre ed to surgery, still make it on tour. (This Is It "from 08.05.1992). The result of the great freedom of research, along with little monitoring of medical ethics , coupled with the widespread diffusion of its results and achievements allowed the Brazilian to become CP page 20 fruitful and that experts stay enthusiastic: "The Plastic Surgery with much of i ts representatives, really deserves all the merits attributed to it, and be hone st work, perfectionist and ideological progress that will determine the ever-inc reasing specialization, firming further, the pride of us Brazilians in one of th e best, if not the best plastic surgery in the world. " (Ruzzante, 1986, pg. 26) . The Brazilian Society of Aesthetic and Reconstructive CP adds more than 1,800 affiliated surgeons in the country (heading 1994), also taking care specialty in its ethical aspect, and promoting scientific exchanges with experts worldwide. To enter this society, is necessary, long beyond the training of medical school and residency, conducting scientific studies and other examinations of qualifica tion. Unfortunately, not all plastic surgeons have gone through this long traini ng, so not all belong to the BSPS Aesthetic and Reconstructive, even though they are the specialty. (ASSUMPÇÃO, 1990; Ruzzante, 1986). The Future of Plastic Sur gery History of CP shows us a growing trend and is closely related to medicine i n its overall aspect. Thus, any technical development in medicine will reflect p ositively on the specialty. For example: a breakthrough in genetic engineering c ould bring the possibility of using plastic, because the development of grafts w ithout risk of rejection or creating one that has the same skin tone and texture that the receiving area will be advances in the CP, a new form of Clinical diag nosis will allow a further refinement of patient selection, since it will allow acceleration of the process without the need to draw the surgical plan. Historic ally, the initial techniques were concentrated on the face, being the body part most expressive of our personality. However, universal standards of beauty and f ashion were posed by the advent of communications and a greater exchange of men, and CP was forced to develop techniques for the entire body. With tissue expand ers, inner plastic surgery, gender reassignment, laser liposuction, CP baldness, development of database of skin or cartilage (major advance for the fight again st the apparent scars or keloid type 5), opened a new and distinct phase in the history of CP and medicine in general appearance: CP in order to restore or impr ove the quality of life of those who seek or Qualitative CP. The trend is the co ntinued increase of male patients seeking specialty. The refinement of these tec hniques and the development of new, according to a specific body part, because t he human communications are ever more rapidly, may also be noticed. The so-calle d non-traditional or innovative techniques, such as implantation of gold wires o

n the face to bring rejuvenation, appear to address the need for faster procedur es. The collagen injections that aim to soften facial wrinkles or ridges, silico ne implants in body areas that have not been scientifically tested or even a new kind of peeling applications requiring three masks, over 10 days, do not always provide the desired results, but cherish hopes of many people. An ever-present danger today is the false advertising of miracles in the CP or the inability of certain surgeons before surgery with virtually no risk. Thus, one can expect not only an increase of the selection criteria of patients or plastic surgeons to e nter the specialty, but a strict control of the media in disseminating news of t he CP as well as an internalization of ethical principles narrower. It is not th e technology or the discovery remarkable in itself that should be the focus of f urther discussions that may be necessary, if only because such elements are the result of growing demand and social evolution. The future of CP is, perhaps, off er the modern man ever faster procedures,€painless and low cost operation. Appli cants determined to undergo a facelift thorough battery of medical and psycholog ical tests, so that the specialty is an effective human achievement. The fear th at many candidates have anesthesia or the operation will decrease substantially and make a plastic will be considered a procedure similar to dental treatment. T he dreaded type keloid scars or the famous cellulitis (both considered aversive in the western world) will be tackled successfully, or perhaps eliminated when t he 5Quelóide is an irregular scar formation. Without a genuine tumor, it resembles a "twisted cord" linking the two parts of the skin that suffered the cut. Their origin usu ally is linked to the unsightly scar the skin, often followed by surgical interv entions and tend to recur when excised. page 21 incision. It is very likely that the development of new chemicals causes some su rgical events come into disuse or become restricted to only certain cases, as we ll as with the surgical peeling that was replaced in some cases, the dermatologi st. Such development can be explained because it is much easier to eat or spend any medication than undergo anesthesia, hospitalization or surgical risks. Regar dless of the technical criteria developed or improved, will always be a human be ing with his body and his interpretation that will be the focus of discussions. The full range of positions psychological, legal, moral and ethical issues shoul d be restructured, upgraded or reaffirmed. The cost and the elements that are ar ound a plastic surgery should be viewed in its aspect of implications beyond the individual and the actual product. The ultimate goal should be to maintain the binomial plastic surgeon and patient so that it is within the limits that charac terize the Hippocratic medicine now is the welfare bio-psycho-social. (KORNPROBS T, 1972). page 22