Facial Cosmetic Surgery : The Philosophy of a Team Approach

Dr. Vinod B Nair, Consultant ENT Surgeon, PVS Hospital, Cochin
Dr. Sajish Kuriakose, Consultant Maxillo-Facial Surgeon, Hospital, Cochin


Right from the evolution of modern medicine there has been surgical and medical practice. Eventually the surgical specialties got themselves divided into different subspecialties based on anatomical and physiological considerations.

Each of these specialties has developed into water­tight compartments and they evolved exhausti­vely into separate entities all by themselves. It has become difficult even for a consultant in one particular area to become a master of everything in his/her own specialty.


The anatomy of head and neck region is very complicated and many medical and surgical specialties independently play crucial roles in management of diseases in this area. But at least in certain situations things can be different for e.g., cancers, polytrauma and cosmetic deformities do not respect the divisions and specialties created by man. In such situations specialist trained in different specialties could work together giving maximum benefit to the patient from a functional as well as cosmetic point of view.

In cases of facial cosmetic surgeries the expectations of the patient and the bystanders are usually very high. Most of the time they appear to be demanding, aggressive, unrealistic and difficult. Such patients can be very deceptive in their demands. They appear not to be bothered about functional aspects initially. But once they get what they want from a cosmetic point of view they show signs of dissatisfaction and may start pestering on functional aspects.


Patients should realize that cosmetic surgeries will only improve their confidence and their outlook towards life. This will never change the attitude of others towards them. If they expect that life will be different because of the surgery then you will end up with a disappointed patient. Hence a thorough psychological evaluation is necessary prior to such surgeries. We should be very careful about patients who thinks that the root cause of failure in their life is due to any cosmetic problem they may be having.

Face is one area where the senses of vision, smell, hearing, taste and very important aspects of touch are concentrated. More over basic functions like breathing, chewing, speaking, swallowing are very much associated with this region. Achieving a cosmetic result with a compromise on any of these can have a disastrous effect on the total personality of the patient.

But if the cosmetic & functional aspect can be taken care of comprehensively in a single step, we have a much happier patient at the end. Such a concept is particularly important in facial cosmetic surgeries like orthognathic surgeries of the maxilla and mandible, rhinoplasty and management of cleft lip & palate and polytrauma. Here lies the relevance of a comprehensive team approach from the beginning to the end.