Volume 135, Number 3 • Viewpoints Learning from the Masters: The Pilgrimage of a Plastic Surgeon Sir:

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uring residency training, trainees learn basic principles and skills from their program director and supervisors. However, not every institution can afford a sufficient education in every field of plastic surgery because each institution has its pros and cons. Therefore, we learn from textbooks, journal articles, and books. Although we are familiar with famous books themselves, knowledge about the philosophy or motto of the author might be rather superficial. Recently, I attended a valuable lecture entitled “Learning from the Masters” at the Twentieth Anniversary Symposium of the Department of Plastic Surgery at Ajou University, Suwon, Republic of Korea. The speaker, Henry Kawamoto, introduced us to the mottos and principles of the masters of plastic surgery that he had met and learned from. At the end of his lecture, I recalled a Buddhist scripture I read several years ago, Flower Ornament Scripture (Avatamsaka Su ¯ tra, 華嚴經).1 It describes a cosmos of infinite realms upon realms, mutually containing one another. It consists of 10 stages, and the last chapter of it is known as the “Gaṇḍavyūha Sutra” (入法界品, “Entering the Dharma Realm”). This section details the pilgrimage of the youth Sudhana to various lands at the behest of the bodhisattva Mañjuśrī (文殊菩薩). In his quest for enlightenment, Sudhana would converse with a diverse array of 52 wise advisors. The final master that Sudhana visits is bodhisattva Samantabhadra (普賢菩薩), who teaches him that wisdom only exists for the sake of putting it into practice; that it is only good insofar as it benefits all living beings.2 As Sudhana’s pilgrimage for enlightenment started from bodhisattva Mañjuśrī, Kawamoto’s lecture began with Varaztad Kazanjian (1879 to 1974), who pioneered techniques for plastic surgery and is considered to be the founder of the modern practice of plastic surgery.3 At the beginning of his book Surgical Treatment of Facial Fractures, Kazanjian’s pupil John Converse wrote that it is “imaginative and resourceful, he taught to improve new methods rather than follow the conventional. ‘Do it just right’ he would say, meaning in his laconic way that each patient’s problem required an individual solution.” He never denigrated a colleague’s work.4 Kawamoto’s boss was John Converse (1909 to 1981). He was a man of curiosity and energy, was full of ideas, and had a great sense of humor. He kept an open mind and never swore. He preferred autogenous materials in reconstruction. He appreciated history and photographic documentation and team competition. After completion of his plastic surgery residency, he met many great plastic surgeons and learned a lot from them: Gillies, Harrison, Robinson, Mulkey, Obwegeser, Ortiz-Monasterio, del Capmo, and Ricketts. Ralph Millard (1919 to 2011) said to him, “If you don’t

know how to assist, you will never be a good surgeon.” In the operating room, he himself set the position of assistant and the direction of light. To reduce glare, he preferred black instruments. He emphasized purposeful economic movement and precision. The final master that Kawamoto visited was Paul Tessier (1917 to 2008). He never examined a radiograph before seeing a patient. Kawamoto had a special relationship with his best mentor, Tessier, who passed away on June 6, 2008, and Kawamoto participated in Tessier’s funeral in Héric, France. At the end of the lecture, I asked Kawamoto who he thought was the greatest contributor. The answer was of course Tessier. As Sudhana was enlightened when Samantabhadra concludes with a prayer of aspiration to Buddhahood, I am sure that Kawamoto became a real master when he lowered the rope holding Tessier’s coffin at his funeral. Finally, I have to say something about the invaluable lesson at the International Confederation of Plastic, Reconstructive, and Aesthetic Surgery meeting that was held in Yokohama, Japan, in 1995. At the opening ceremony, Joseph Murray (1919 to 2012), who wrote the preface of Deranian’s book about Kazanjian, had the keynote lecture.5 The elder retired plastic surgeon emphasized that scientists should remember three important words: curiosity, imagination, and persistence.6 After listening to his lecture, those three tips have been the source of much research. DOI: 10.1097/PRS.0000000000001110

Kun Hwang, M.D., Ph.D. Department of Plastic Surgery Inha University School of Medicine 27 Inhang-ro, Jung-gu Inchon 400-711, Republic of Korea [email protected]

disclosure The author has no financial interest to declare in relation to the content of this article. references 1. Cleary T. Entry into the realm of reality. In: The Flower Ornament Scripture. Thomas Cleary, transl. Boulder: Shambhala; 1987:369–404. 2. Hua H. Entering the Dharma realm. In: Flower Adornment Sutra. Ukiah, Calif: Dharma Realm Buddhist Association; 1980:1–245. 3. Wolfe A. A Man from Héric: The Life and Work of Paul Tessier, MD, Father of Craniofacial Surgery: Volumes I and II. Raleigh, NC: Lulu Enterprises; 2012. 4. Converse JM. Kazanjian & Converse’s Surgical Treatment of Facial Fracture. 3rd ed. Baltimore: Williams & Wilkins; 1974. 5. Deranian HM. Miracle Man of the Western Front: Dr. Varaztad H. Kazanjian: Pioneer Plastic Surgeon. Worcester, Mass: Chandler House Press; 2007. 6. Hwang K. How to write a scientific paper: Three tips to remember. Arch Plast Surg. 2012;39:77.

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Learning from the masters: the pilgrimage of a plastic surgeon.

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