EDITORIAL

Plastic Surgery in Times of the Pandemic

Go Back to the Roots!
Sunil Choudhary, MS, FRCSEd EBOPRAS, Soumya Khanna, MS, MCh, DNB,
Raghav Mantri, MS, MCh, and Prateek Arora, MS, MCh

lthough wars caused bodily disfigurements through history, a new surgical specialty called “plastic surgery” was
A constantly figuring itself out. In its early avatar, it was devoted mainly to the art of “reconstructive surgery.” His-
tory kept repeating itself, the new-age wars seeing advanced weaponry and even more horrifying injuries. The chal-
lenges in reconstruction furthered new innovations, notably microsurgery, newer flaps, esthetic surgery, tissue
transplantations, and advanced wound management.1 The ongoing COVID-19 pandemic is not unlike a war; this time,
however, we fight an invisible enemy, the beginning of the end being nowhere in sight, even as we write this. With end-
less lockdowns, fatalities, and economic struggles, it has forced the human being to reinvent their way of life and their
livelihood. Surely, today's plastic surgeons must also reinvent themselves to be relevant.
During the lockdown, there has been the advent of new business strategies for survival, with the need for simul-
taneous management of “work from home” and “working for home.” People are now doing things that had not secured
a place in their previous routines. The stress of a tight online working schedule, coupled with the management of chil-
dren and household chores, are creating jittery hands and jittery minds. This has led to a new breed of injuries. We have
noticed that since the introduction of lockdowns and associated restrictions, our usual emergency caseload of road traf-
fic accident injuries, workplace injuries and assaults has been replaced by this new class of “lockdown injuries.” People
working from home have their minds on the video call instead of the job at hand, and hands often get caught in the
mixer grinders as the lids fly off unattended. Tries at complex DIYs using heavy duty power tools have resulted in quite
a few partial hand amputations. Children trying outdoor games at home have suffered injuries pertaining to falls off
glass tabletops or from banging into glass doors while playing hide-and-seek. We also beheld the curious case of a lady
keeping up with her fitness regime by running up and down 10 flights of stairs in her apartment building, who ended up
with an avulsed finger on account of its getting caught in the iron railing as she lost her balance and tumbled down! The
list is endless. In a short span of 3 months, we have seen 1 to 3 of such injuries on an average per day. The COVID-19
pandemic has also unleashed a mental pandemic resulting in an increase in abuse and self-inflicted injuries. Reports
from other countries too have described an increase in the injuries occurring at home alongside a decrease in road traffic
accidents and leisure injuries during the pandemic.2
Most nonessential surgeries like esthetic surgeries and treatments were halted during the lockdown as per the
guidelines to conserve hospital resources and prevent the spread of the novel coronavirus.3,4 However, a subset of
non-COVID conditions, like cancer surgeries, neurosurgeries, serious wound and trauma treatments were allowed as
essential treatment—their potential to cause damage being greater than that of the pandemic. This is where, as an in-
stitutional plastic surgery practice, we found our utility and our calling, because unlike physicians and intensivists,
we were not considered suitable for any of the COVID duties!
Vaccine development is still not near completion, and a second wave is predicted to be just around the corner.
Globally, there is a worrying economic slowdown and financial setback. This may have put a huge break on the cos-
metic procedures due to lack of the so-called extra cash. In such adverse times, looking good may have lost priority
because of virtual contact, online meetings, staying indoors, and the need to wear a mask. This has further reduced
the need for invasive and noninvasive esthetic procedures.
Not only do we need to cater to essential surgeries like oncological reconstruction, wounds and trauma, we also
need to ensure the sustainability of our specialty and the safety of our teams. Individual practitioners can collaborate
with other colleagues to pool common resources and reduce running costs.5 This will not only cushion the finances
but also provide continuity in the care of our patients in case one gets infected and has to be isolated.
Our social responsibility also lies toward the staff and the resources available to the facility and the community. It
is our duty to never let our guard down when it comes to protecting ourselves and the supporting staff from this pan-
demic.6 At times like these, it is this very sensibility that will take us forward. In many countries, plastic surgeons have
offered their office equipment—ventilators, oxygen cylinders and monitors—to COVID hospitals to help overcome

Received July 9, 2020, and accepted for publication, after revision July 12, 2020.
From the Max Institute of Reconstructive Aesthetic Cleft and Craniofacial Surgery (MIRACLES) Max Super Specialty Hospital Saket, New Delhi, India.
Conflicts of interest and sources of funding: none declared.
Reprints: Sunil Choudhary, MS, FRCSEd EBOPRAS, Max Institute of Reconstructive Aesthetic Cleft and Craniofacial Surgery (MIRACLES) Max Super Specialty
Hospital Saket, New Delhi, India plasticsurgerymax@gmail.com.
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0148-7043/20/8505–0459
DOI: 10.1097/SAP.0000000000002546

Annals of Plastic Surgery • Volume 85, Number 5, November 2020 www.annalsplasticsurgery.com 459

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Editorial
shortages as the infection overwhelms cities and nations.7 Simulta-
neously, we have a duty to our loyal esthetic and other patients, and the
use of telemedicine can help in follow-ups and psychological support.8
All in all, we believe that in these desperate times, plastic sur-
geons will have to go back to their roots and show their reconstructive
prowess, not just to stay relevant to society but also to be able to stay fi-
nancially afloat and emerge unscathed when this tragedy subsides. This
is also a moment of reckoning for all young plastic surgeons who in-
creasingly abandon “reconstructive work” to favor the more lucrative
“cosmetic work.” It has been rightly said—“It is the roots, and not the
branches, wherein a tree's greatest strength lies.”
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Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Annals of Plastic Surgery • Volume 85, Number 5, November 2020
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© 2020 Wolters Kluwer Health, Inc. All rights reserved.