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Buoying Up the Spirit

Gaspare Tagliacozzi is known as the “father of plastic surgery” for his work in 16th century Italy on reconstructing noses. Apparently there was no shortage of noses requiring “a little work,” back then. While in India certain criminals were tagged in what could be referred to as “offender confirmation surgery,” by cutting off their noses; in Italy it was the common practice of significance-seeking and testosterone-flaunting men to dual with a long narrow sword known as a rapier. Many a nose was cut, or amputated in the process. Whether in India or Italy, no nose was “no bueno,” serving as a “permanent reminder of a temporary (misguided) feeling.” (My apologies to Jimmy Buffet). Jordon Peterson, psychology professor at the University of Toronto, has described the “Matthew- effect” or the Pareto principle where one negative experience can result in a cascade of bad effects resulting in a downward spiral of consequences. In the New Testament, Matthew 25:29 states “For whoever has, will be given more and they will have an abundance,. Whoever does not have, even what they have will be taken from them.” Just for a brief moment try to imagine the consequences of not only being soundly defeated in a test of masculinity and honor, but also having your nose removed in the process. The deformity of the nose, the central feature of the face, has radically changed your overall facial appearance by creating a skeletonized look , like Harry Potter’s adversary Voldemort, as both airways are exposed. It’s not hard to imagine that a series of negative consequences may follow. Your wife or girlfriend may decide she can’t stand to look at you. Your occupation or employment could be lost or diminished. The lost income may result in the loss of your home and less food to eat. Poor nutrition may result in declining health and higher likelihood of illness. Sun Tzu, Chinese general and philosopher who is credited as authoring The Art of War stated that “Victory comes from finding opportunities in problems.” Tagliacozzi, was willing to take a bold step and accept criticism and failure in order to help turn around this spiral of humiliation, depression, and desolation. In a world of sandy necked ostriches, I applaud those who take calculated risks to help others. Those courageous individuals, in turn, are risking a first class seat on the spiral down the Pareto House of Horrors ride. And while I am sure Taglicozzi’s operative schedule was full; I am also sure he dealt with more criticism and ridicule than he deserved for trying to help those in need. Infection, flap loss, separation were not uncommon for his procedure that took the thin skin of the inside of the arm and temporarily attached it to the open wound of the nose: conjoining these two areas for several weeks. In the magic of wound healing, the blood supply to this flap of skin from the arm, would eventually be supplemented and then taken over by the skin around the nose. Over time, the blood supply from the arm could be completely divided and the tissue would survive by blood supplied from the face. The process is much like parents’ financial support of children. At first children are like flaps, completely supported by their parents. Gradually they are able to pay more of their expenses so that parental support becomes less important and eventually children become financially independent. What a beautiful thing this is. But wait, it wasn’t the “beauty” that motivated Taglicozzi, it was the positive psychological effect that motivated him. Just as there is a negative Matthew effect, there can also be a cascade of positive effects that result from a certain event. The verse in Matthew begins by stating that “whoever has, will be given more and they will have an abundance.” With this favorable effect in mind Taglicozzi stated, “We restore, rebuild, and make whole those parts which nature hath given, but which (mis)fortune has taken away. Not so much that it may delight the eye, but that it might buoy up the spirit, and help the mind of the afflicted.”

It is this positive psychological energy that motivated Taglicozzi then and continues to motivate plastic surgeons now.

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      Bruce K. Smith, M.D.

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      (713) 659-2700

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