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GOOD HEALTH MAGAZINE : Medicine : THE FIX IS IN : Plastic surgery is no longer the prerogative of aspiring actresses or aging dowagers. In 1989, there were at least 2 million such operations in the United States. This year, about one in 100 Americans will undergo treatment. Today's typical patient is, according to the California Society of Plastic Surgeons, a product of "Mainstream U.S.A."

October 07, 1990|ANNE C. ROARK | Roark is a Times staff writer who reports on science and medicine.

The question of who needs help the most, who is most deserving of treatment--those are distinctions that Shaw, as a surgeon, is unwilling to make. To be sure, he says, there are cases at the ends of the spectrum: A child with a congenital cranial deformity that makes him look positively monstrous is surely more in need of a plastic surgery than a perfectly gorgeous actress who wears a size C bra but would prefer a size D. But what of the child with a severe birthmark versus a woman with abnormally small breasts or a man with abnormally large ones? Is one more worthy of a surgeon's attention than another? Does one have more severe psychological problems than the other? How is a doctor to choose?

The role of a plastic surgeon is to be an architect and artist as well as a physician and surgeon, Shaw says. He is as pleased to help a patient enjoy the finer things in life as he is to help another regain some semblance of normality.

Shaw's job, as he sees it, is not to save lives but to improve the quality of life. That means reconstructing body parts both so they function better and look more appealing.

"What has happened to plastic surgery over the past century and in particular during the past 20 years is the story of what is happening to all medicine," Shaw says. "Where doctors once worked solely on major epidemics and other matters of life and death and pain, they can now focus on how to improve lives. Some of the life-and-death questions, of course, remain. But the focus in medicine has clearly shifted.

"More and more, the emphasis is on improving form and function, which is what plastic surgery has always done. It is simply a field (that has been) ahead of its time." Time was when cancer victims had to live with having their bodies mutilated by surgery. Survivors of accidents often had no choice but to have one or more limbs amputated. Thanks to plastic surgery, working in tandem with orthopedics, neurology and other specialties, that is no longer the case.

For years, before coming to UCLA, Shaw had been director of microsurgery at New York University and chief of plastic and reconstructive surgery at Manhattan's Bellevue Hospital, an inner-city medical center renowned for salvaging traumatized limbs.

Even in a field that has long been considered progressive, Shaw was viewed as something of a maverick because of the lengths to which he went to perfect both the art and science of his work. The result in New York was an impressive track record and a spectacular list of "miracle" surgeries.

In an eight-hour-long operation in 1979, Shaw and a team of five doctors and as many nurses made headlines for successfully reattaching the leg of a New Jersey policeman who had been crushed between two cars. In another multi-hour operation that year, also involving a large operating team and sophisticated reconstruction techniques, Shaw reconnected the severed hand of an aspiring young musician who had been pushed in front of a subway train. In 1985, in an operation involving eight doctors, all of whom were simultaneously working on two other trauma victims, Shaw and his colleagues again made headlines, this time for reconstructing the legs of a Manhattan woman who had been pinned for six hours beneath a fallen construction crane.

Within months after coming to Los Angeles, as chief of UCLA's plastic and reconstructive surgery department, Shaw had overseen equally difficult and extraordinary cases. In 1989, for example, UCLA surgeons reattached the scalp of a young Los Angeles factory worker whose entire head of hair, from the top of his forehead to the nape of his neck, had become entangled in a machine and had been ripped off his head.

This fall, members of the UCLA plastic surgery team operated on another male, a psychiatric patient who had amputated his own penis with a knife.

The policeman whose leg was severed is now retired from the force but has a working leg. The woman whose legs were crushed spends her summers walking five miles a day on the beach. The musician whose hand was severed--though not able to play the flute at the concert level--is an occupational therapist, helping others recover from similar traumas. The factory worker is back at work with a full head of hair.

Only the fate of the young mental-health patient is in question. Even he has made tremendous progress. Already he is urinating normally and his doctors have reason to hope that one day he may even have normal sexual function.

"Twenty years, even 10 years ago, these operations would have been unthinkable," says Dr. Jay Orringer, who directed the surgery. "Today they have become almost routine."

The routine, however, is far from simple. Although many cosmetic procedures are done in outpatient clinics or in private physicians' offices and take anywhere from two to six hours, complex reconstructions are invariably done in sophisticated medical centers and can take the better part of a day or night.

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