The Initial Period: 1969-1970
The idea to join those Plastic Surgeons with a priority interest in Aesthetic Surgery in a new international scientific body was in the mind of several Plastic Surgeons in various parts of the world (2).
Despite the fact that already in 1934 a "Societé Européenne de Chirurgie Structive" was founded by Esser (Monaco) with Sanvenero Roselli (Italy) and Leon Cardenal (Spain) as Vice-Presidents, -the latter was the teacher of my preceptor in Pediatric Surgery, Prof. Gutierrez Guijarro-, this Society interrupted its activities due to World War II. The "International Society of Plastic Surgeons" was not created until 1956 in Stockholm. Undoubtedly the development in the techniques of repair of war injuries, of congenital malformations and acquired deformities demanded a special knowledge and justified the separation of Plastic Surgery from General Surgery as a Specialty by its own. As compared to the obvious morphological and functional benefits of Reconstructive Surgery, initially the primarily psychological motivations and benefits of aesthetic operations were considered less justified. Not included in socialized Medicine, "many Senior Plastic Surgeons performed aesthetic operations in private settings with a certain feeling of shame, not appreciating the psychological need fully. This attitude was turned to profit by the independent "Cosmetic Surgeons", when advertising their exclusive dedication to "Aesthetic Surgery"(10), as I stated in the introduction to the Round Table on "Present Status, Training and further Development of Aesthetic Plastic Surgery" in the First Congress in Rio de Janeiro, February 1972.
In a report about the Education Council, the late Julien Reich writes in 1991: "The creation of ISAPS was an exciting move at the time when Aesthetic Surgery was the ugly stepchild of Plastic Surgery, which was hidden in a cupboard whenever visitors came"(11). Nevertheless, already in the first meeting of the IPS in Sweden(12), several papers dealt with Aesthetic Surgery subjects and this increased from congress to congress. Parallel to the improvement of the functional and anatomical repair in Reconstructive Surgery, the aesthetic aspect of reconstruction became more and more important. Mainly in wealthy Societies, people became more conscious of the importance of appearance, while, of course, Reconstructive Surgery was and will still be more important in developing countries. Many Plastic Surgeons who focused their attention and gave priority in their practice to Aesthetic Surgery felt that, within the IPS and thereafter IPRS congresses, not enough time was dedicated to Aesthetic Surgery, despite the fact that the auditorium in which aesthetic papers were read was always overcrowded as compared to those dealing with Reconstructive Surgery(10).
This proved not only the interest in this branch, but also the need for an adequate training, at that time only made through personal preceptorships or conferences and seminars, such as Gonzalez Ulloa's "Dalinde" Seminar.
Due to the insufficient representation and defense of Aesthetic Surgery by our Plastic Surgery bodies, Specialists other than those in Plastic and Reconstructive Surgery started to perform "regional cosmetic operations" trying to displace the Plastic Surgeon. Even general practitioners or dermatologists without any surgical background invaded the field. It was felt that to best protect the public and the Specialty itself, it was necessary that Aesthetic Surgery should be performed by those professionals who not only played the most outstanding role in developing this surgery, but who also were trained to offer the best results: Plastic Surgeons with a wide background in General Surgery and a special interest in aesthetic procedures. In order to always prove excellence there was a definite need for an increase of training and teaching in these fields. This premise has not changed today if we wish that Aesthetic Surgery rests identified with the Plastic Surgeon, who is able to achieve better results than other Specialists.
To found the adequate International Body, it was felt necessary to join an initial group of Plastic Surgeons with special interest to further this branch of Plastic Surgery, to teach and train, identified in their philosophy and with high deontological aims.
Discussions concerning the convenience of creation of an International Association were held in various countries, but did not crystalize until David Serson Neto from Sao Paulo (Brazil) proposed the foundation of an International Society of Aesthetic Surgery(13).
David Serson, who deserves full credit for the initiative, visited with Salvador Castañares at the end of 1968, asking for support, knowing that he was one of the Founding Members of the "American Society for Aesthetic Plastic Surgery" (ASAPS). This foundation was not free of troubles and Serson anticipated similar obstacles(14). Salvador Castañares and David Serson "discussed the organization and the wisdom of having two Founding Members from each of the three countries having the greatest membership in their own National Societies (they could be Brazil, Argentina and the U.S.). A single member could represent each of the smaller, but important Societies of other countries". They felt that a total of 12 Founding Members would be adequate. Before committing himself, Salvador Castañares wanted to know who had been, or wanted to be, approached and if David Serson was sure of their acceptance.
On March 29, 1969, David Serson met with Jose Viñas and Hector Marino in Sao Paulo also for discussion of the possibility of a Foundation(15). Thereafter he proceeds to invite several Plastic Surgeons from other countries(16).
David Serson then submitted to Salvador Castañares the following list of surgeons who had accepted his invitation. Castañares stated: "From Argentina, Hector Marino and Jose Viñas; from Brazil, besides David Serson, Perseu Lemos. The single members were: Ulrich Hinderer from Spain; Mario Gonzalez-Ulloa from Mexico; Rodolphe Meyer from Switzerland; John C. Mustarde from Scotland; Guillermo Nieto Cano from Colombia, making a total of 9 Founding Members, besides the two that would represent the US. Being certain of the prominence of the above surgeons, I contacted John Lewis, whose acceptance, added to my own, made a total of 11 Founding Members"(14).
David Serson called for a constitutional meeting in Sao Paulo, October 1-4, 1969(16). Hector Marino was invited, as well as Mario Gonzalez-Ulloa, but they did not attend. John Lewis and Salvador Castañares arrived first and started to prepare the Constitution and Bylaws to substitute a draft presented by Dr. Serson. After the arrival of Ulrich Hinderer the next day, on October 1, the Constitution and Bylaws were concluded and thereafter corrected and the structure and ideals of the Society defined(17). It was agreed to call the Society "Aesthetic Plastic Surgery" to demonstrate that Aesthetic Surgery is a branch of Plastic Surgery. Perseu Lemos also attended as Luiz Carlos Martins, collaborator of David Serson.
A second meeting was held in Bogota (Colombia) also on October 1969, on occasion of the Latinamerican Congress. "During this meeting Dr. Viñas arrived with Dr. Ernesto Malbec, stating that he wanted Dr. Malbec to be one of the Founding Members. Taking into account the distinguished career of Dr. Malbec, we agreed to his acceptance, even though the previous plan of having two members from Argentina would now be increased to three from Argentina and thus making a total of 12 Founding members"(14).
In Bogota several meetings took place. It was decided to form a first "Steering Foundation" with David Serson acting as Secretary. A few modifications of the Constitution and Bylaws were proposed and Dr. Castañares was assigned to correct and rewrite the final Constitution and Bylaws to be sent to David Serson for distribution.
"Foreseeing that ISAPS would become worldwide, and probably the largest Plastic Surgery Society of all", in the new Constitution and Bylaws Salvador Castañares included the idea "to have 3 Vice-Presidents and several Secretaries to represent the various parts of the world, the last under the leadership of a General Secretary"(17).
John Lewis proposed to meet in Atlanta on the occasion of the first meeting of the American Society for Aesthetic Plastic Surgery, to prepare the foundation of the Society. Jose Viñas suggested to give official birth of the Society in New York at the Headquarters of the United Nations.
Immediately following the meeting in Bogotá, Mario Gonzalez-Ulloa visited Mr. William Manchester, then General Secretary of the International Confederation for Plastic and Reconstructive Surgery, in New Zealand for information, and to discuss the possibility of creating the Society as a Chapter of Aesthetic Surgery within the Confederation(2).
David Serson, as Secretary of the "Steering Foundation" called for a meeting of the proposed Founding Members on February, 1970 in Atlanta, during the first Congress of the American Society for Aesthetic Plastic Surgery.v
In Atlanta the following 12 Plastic Surgeons agreed to be Founding Members: Salvador Castañares, Mario Gonzalez-Ulloa, Ulrich T. Hinderer, Perseu Lemos, John R. Lewis Jr., Ernesto F. Malbec, Hector Marino, Rodolphe Meyer, John C. Mustardé, Guillermo Nieto Cano, David Serson Neto and Jose Viñas.
As proposed by Jose Viñas in Bogotá, on February 12, 1970, a room was requested at the Headquarters of the UN for the purpose of Foundation of the Society. Various Diplomatic Representatives were invited. The "Act of Organization" of ISAPS was signed on behalf of the 12 Founding Members by the 5 members present in New York (Fig. 2) : Drs. Salvador Castañares, Mario Gonzalez-Ulloa, Ulrich Hinderer, David Serson Neto and Jose Viñas. Witnesses at this act were: Mr. Mark Gough, Ambassador from Argentina; Mr. Medeiros, from the Brazilian Embassy; Dr. John Eller, President of the Panamerican Medical Association; Mr. Pedro M. de Aristegui from the Spanish Embassy, as well as representatives from the Permanent Mission of the Mexican Embassy.
The aims of the Society were specified by the 5 Founding Members signing the following "Act of Organization" (18)":
- To organize, promulgate and disseminate, by teaching and scientific programmes, an interchange of knowledge and ideas for the benefit of younger surgeons and trainees, as well as for surgeons already engaged in the practice of this Specialty.
- To attract, as members, qualified Aesthetic Plastic Surgeons in a Society whose principal aims shall be the preservation and protection of Aesthetic Plastic Surgery, placing it before the scientific body of World Medicine so that it may assume its proper place within the field of Surgery.
- To propose and promote proper legislation in order that only qualified Plastic Surgeons may be allowed to practice this branch of Plastic Surgery."