Retrospective analysis of history of ISAPS and considerations about the future of Aesthetic Plastic Surgery (personal observations)
To go over the quite complete files of documents and letters concerning the ISAPS, not only refreshed the memory of a personal intensive 25 year dedication to the ISAPS but also allowed to question as to whether the aims included in our Constitution were the correct ones and whether we always tried to have them in mind in all of our actions.
Looking over what has been accomplished in these 25 years, the balance is absolutely positive. Surprisingly, only a few mostly involuntary birthpains and pitfalls occurred, by not following the rules or maybe due to human weakness. Thus, the Local Arrangement Committee of the first Congress was insufficiently controlled by the Executive Committee; the cause of the technically illegally convened meeting in Los Angeles was an excess of zeal to speed up the consolidation of the Society; irregularities in the nomination process 1979 and 1989 prove an insufficient supervision of the Bylaws by the Parliamentarian. However, they were all corrected. Rectification is a sign of good health and, such as "Watergate", actually means victory over human weaknesses.
Although the relationship ISAPS-IPRS is absolutely clear since 1975, and even more since the IPRS has added in 1992 "Aesthetic" into its name and logo "IPRAS", and "Aesthetic" also has been included in the EC in the denomination of the Specialty "Plastic, Reconstructive and Aesthetic Surgery", the future of Aesthetic Surgery is still not so clear. Fortunately, "Aesthetic" Surgery is in the opinion of both the medical profession and the lay public, still synonymous with "Plastic" Surgery.
I believe that the initial decision taken about the denomination "Aesthetic-Plastic" was correct, as well as that of not to separate from the Confederation. To found a "Society of Aesthetic Surgery", independent from the IPRS or only affiliated to the Confederation would have resulted in the creation of the category of "Associate Member" for surgeons of other specialties performing regional Aesthetic Surgery. It is possible that the Plastic Surgeon, at the end, would have lost the control over Aesthetic Surgery. It would also not have prevented the proliferation of "self-made" and "self-named" Aesthetic or "Cosmetic" Surgeons nor the appearance of National and International "Aesthetic" or "Cosmetic" Societies. Frequently these substitute the insufficient training in basic and/or Plastic Surgery by publicity.
We must achieve that also in the future we, Plastic Surgeons, have the control over Aesthetic Surgery. With this in mind, as General Secretary of the IPRAS, I have proposed to form a Chapter on "Relationship with other Societies performing Aesthetic Surgery" within the new International Plastic, Reconstructive and Aesthetic Foundation "IPRAF", the educational and humanitarian arm of the IPRAS. "It might be of interest for ISAPS and our Confederation to come to some sort of agreement about the minimal requirements concerning training, ethical behavior, etc... to be requested to those who perform Aesthetic Surgery within these Specialties" -with the purpose of improving the overall standards in Aesthetic Surgery and to protect the public"(111). This IPRAF Committee will be headed by ISAPS and has to study the problem very carefully.
We have to harmonize the first duty we have towards the public, -of improvement of the quality of Aesthetic Surgery-, with the corporative obligations towards our young and future Plastic Surgeons, -to preserve Aesthetic Surgery for the Plastic Surgeon. In principle "we can defend ourselves only by aiming for excellence" (Trudy Vogt).
Personally I believe that we should not split Aesthetic from Plastic Surgery. However, we may come to an agreement with those Specialists having a comparable surgical training, who perform "Regional" Aesthetic Surgery. It is utopic to believe that we can prevent them from performing Aesthetic Surgery. However, together we can act against unqualified "Cosmetic Surgeons" with insufficient surgical background and ethics, with some possibility to succeed, thus fulfilling our first obligation, which is to protect the public.
Acknowledgement: Our Founding Member and outstanding Plastic Surgeon, Salvador Castañares, who always was there when help was needed, my utmost gratitude for carefully reviewing the History and discussing details of the early period, when I visited him for this purpose on September 18, 1993 (Fig. 18).