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Journal of Plastic, Reconstructive & Aesthetic Surgery (2010) 63, 2211e2212
LETTER FROM AMERICA
The war of the ‘Noses’
Figure 1 is a cartoon by Hugo Keunen, who practiced plasticsurgery in Washington D.C. for many years and publishedseveral cartoons on plastic surgery themes.1e4 This previ-ously unpublished cartoon contains caricatures of severalplayers in 20th century American plastic surgery drama. In1983, I purchased the cartoon and its accompanying hand-written caption by Keunen that reads:
“At the Uffizi Gallery great Nose men are gathered todiscuss the problem of the Duke of Urbino.JackS. [Sheen] is sure that he has covered it somewhere in“the Book”, but Tom R. [Rees] wonders about it andwonders that a conservative approach might be enough.George P. [Peck] maintains that pushing in the suctiontip will show you the top of the dome. Don Mario[Gonzalez-Ulloa] sees it as a clear indication for “per-filo-plastia” while Gusti [Aufricht] wonders how he willcheck the other side with his mirror, (would he besurprised to see what’s hidden!) Tagliacozzi, excom-municated and hiding from the purple Robes, dares topeek from behind the curtain, which prompts RalphM. [Millard], who definitely has something to say aboutthis nose to find out how Gaspare fixed his lips. AndSusruta, back from several centuries, cannot believewhere rhinoplasty has gone. But signore Nasogrande,the dutiful watchman being definitely interested in thisdebate must tell this stranger that nobody is allowed inon bare feet. Professor Joseph, high on his pedestal (ofcourse) does not see much of a problem here (after allthere were big noses also in his days) But at his feet, theold controversy rages to a nose bashing pitch: to saw orto osteotome.”
Although Keunen inaccurately repeated the historicalmistake about Tagliacozzi having been excommunicated,his commentary on plastic surgeons, their egos andeccentricities is spot-on.5 Keunen’s concept that plasticsurgeons barely listen to one another and have debatesthat degenerate into physical fights still rings true.
1748-6815/$-seefrontmatterª2010BritishAssociationofPlastic,Reconstrucdoi:10.1016/j.bjps.2010.07.023
Questions without answers
Keunen‘s cartoon raises a number of questions about our alltoo human foibles for which I have no answers:
1. Why do we waste much time and psychic energydisagreeing?
2. Why are we so concerned about whose procedure is‘best’?
Mere opinion is no substitute for scientific proof. Theconcept of high quality randomized controlled trials todetermine what is ‘best’ remains alien to aesthetic surgery.
3. Why engage in turf wars that we can rarely win?
We are but a small specialty compared to our ‘proce-dural competitors’. Though we may excel in quality, welack in quantity. We will always be outvoted by our‘procedural competitors’ at any forum in organizedmedicine.
4. Why do we fight intrinsic battles within our specialtywhen more powerful political, economic and legalextrinsic forces gather to threaten our existence?
Our capacity for creativity is coupled with our propensityfor argument. The War of the Roses between the Houses ofYork and Lancaster lasted for 30 years.6 Our ‘War of theNoses’ and other turf wars have lasted decades longer. Thesooner we cease internecine warfare, the better.
Hopes for the holiday season
Consider this cartoon a gift for the holiday season. When youlook at it, heed this quote by a 20th century Americanpolitical cartoonist, Walt Kelly, whose character, Pogo said:
‘We have met the enemy and he is us.’7
Hopefully, for plastic surgeons it finally is time for‘peace on earth and goodwill to men’.8
tiveandAestheticSurgeons.PublishedbyElsevierLtd.All rightsreserved.
Figure 1 “The Great Nose Debate” cartoon by Hugo Keunen (Author’s collection).
2212 Letter from America
References
1. Keunen HF. Rounds with Sir Harold at Rooksdown House. AnnPlast Surg 1980;5:338e9.
2. Keunen HF. Madame le Docteur Noel, dans sa clinique privee.Ann Plast Surg 1981;6:330e1.
3. Keunen HF. Professor Jacques Joseph perfecting his rhinomiosis.Ann Plast Surg 1981;7:506e7.
4. Keunen HF. Skinning with Archie at East Grinstead. Ann PlastSurg 1984;13:539.
5. Freshwater MF. Corrections to the birth of plastic surgery. PlastReconstr Surg 2008;121:1071.
6. http://en.wikipedia.org/wiki/Wars_of_the_Roses [Accessibilityverified July 6, 2010].
7. www.igopogo.com/final_authority.htm [Accessibility verifiedJuly 6, 2010].
8. http://www.potw.org/archive/potw118.html [Accessibilityverified July 6, 2010].
M. Felix Freshwater,Voluntary Professor of Surgery,
University of Miami School of Medicine,9100 S Dadeland Blvd., Suite 502, Miami FL 33156-7815,
United StatesE-mail address: [email protected]
