But it is an open secret that famous actresses and actors and people from the jet-set have passed through the hands of Ivo Pitanguy, in addition to thousands of anonymous names. Both of them trusted a surgeon who began more than 30 years ago and is now the symbol of the aesthetic miracle.
–Why have you become a legend and a teacher to all plastic surgeons in the world?
-I have a good foundation, some interesting principles in plastic surgery. I worked with specialists from all over the world in the 1950s, such as the American John Longrece. I graduated from the University of Rio de Janeiro and began to do an internship in one of the city’s hospitals, in the emergency room. There I understood that there are very important ailments for patients, which escape the attention of surgeons, such as scars or burns. At that time there were no structured study programs, so I had to start a double pilgrimage to different countries to meet the specialists who were working in plastic arts and learn from them. I spent two years in each country, in the United States, France, England and Germany. I returned to Brazil, with extensive training, when I was still very young. Even then I liked teaching, because I firmly believe that knowledge cannot be kept to oneself, and I set out to pass on everything I had learned, as a mission. So I immediately became a professor at the Catholic University, then I became a full professor and in a short time I started a postgraduate course.
–Was it then that you set up your private clinic in the Botafogo neighborhood, in Rio?
-I created the clinic not only to receive patients from all over the world, but from the beginning I considered the facilities as an extension of the university for the training of plastic surgeons from around the world. We made an agreement so that the clinic was well equipped for teaching. In about 30 years we have trained more than 400 plastic surgeons, who have later spread throughout the world. A very active alumni society was even created, which tries to maintain general ethical criteria and a philosophy of art.
–What are those criteria?
-One of the principles I teach is not to separate plastic surgery from aesthetics. You have to support aesthetics. There was a time when they were put aside because many people considered that the two specialties should be separated, but today we understand just the opposite. Collaboration is necessary, so that they complement each other. Each specialty has its own limitations, and unity is strength. For example, if we talk about the skin, to give a good service you have to have a dermatology department and a cosmetic department, like I have in the clinic. The surgeon cannot do everything.
To study with Pitanguy, more than one hundred candidates are presented each year for about ten places, and approximately half are for doctors from outside Brazil. The students, who are already certified surgeons, work on a rotating basis in burn, oncology, microsurgery, maxillofacial and hand surgery units.
Manuel Antonio Sánchez Recasens is one of the Spanish disciples who have followed the teachings of this teacher. Together with Pitanguy and many other professionals, he recently commented on the latest techniques of both specialties in Sitges (Barcelona) during the Mediterranean Conference on Aesthetic Medicine and Surgery, organized by the Europa Medical Center in Barcelona.
They talked about the newest techniques, such as laser as a complement to lifting surgery, or stretching, and endoscopic surgery applied to aesthetics, one of the techniques that is having the most success, although it cannot be practiced in all the interventions. Endoscopy can also be used on silicone breast implants through the navel.
–Have you created innovative techniques, such as replacing the classic cut under the breast with one in the center of the nipples, which reduces the impact of scars. What other techniques have you contributed?
-In breast surgery, the technique that I described as “rhomboid angular” is used all over the world, which consists of a vertical incision from the areola. If we are talking about breast hypertrophy, in which the purpose is a reduction of the breasts, my classic intervention consists of making an inverted “T” shaped scar. And a vertical “L” shaped incision is also possible. It depends on each patient.
Pitanguy has also invented a polyurethane cover for silicone implants, which creates fewer encapsulation problems. One of the forms of rejection of these implants is what is known as capsular contracture. The body makes a fibrous sheath that surrounds the implant and isolates it from the rest of the body by forming a collagen capsule. That is why not only the filling is important, but the cover. It has been seen that it cannot be completely smooth and that the rough ones have a lower rate of contractures.
–Another specialty of his clinic is lipofiling. What does it consist of?
-In using the fatty tissue extracted from any part of the body by liposuction to fill furrows in the face or, especially, in the hands. I am known for the techniques that I have developed, and perhaps some specialties, such as that of the hand, that I have worked in depth, have become so important that they have been widely publicized. In the case of hand, there is a department in my clinic dedicated exclusively to this specialty.
–What changes and progress – and not only in the techniques, but also in the demands of your patients – have you observed in plastic and aesthetic surgery since it began until now?
-Today there are well-trained plastic surgeons all over the world. That is true progress. And also the fact that through plastic and cosmetic surgery we have come to understand the individual. These medical specialties have benefited the population. And not only on the physical side, but also on the emotional side, because we work to increase people’s self-esteem, a very important social concept. If someone is unhappy because of their appearance, we must help them to feel good. There are those who have defects but it is in harmony with their state of mind, and therefore intervention is always inadvisable. Therefore, it is necessary to make a physical diagnosis of the patient, but also psychic, to understand their motivations. That he knows what he is going to achieve and what not with the surgery techniques that we are going to apply. If you see a mutilated or burned person, it is understood that it is necessary to restore, but sometimes things are less serious: a defect in the nose may or may not be a problem, it depends on how it is perceived. Sometimes, there are patients who ask for something that is not in the hands of the surgeon, but of a psychologist or a psychiatrist, to teach them to accept the truth that they do not want to assume. There are perfectly normal people who look ugly.
–You arouse admiration in everyone who has passed through your clinic, both patients and students. What is your secret?
-I grew up in a city perched on a mountain, Belo Horizonte, in the state of Mina Geraes. There, people, when they reach a mountain, think about the new peak they have yet to reach. That desire to always go further has moved my life. Another thing is that I always have an individual relationship with my patients, whether they are famous or rich or the opposite. I attend two plastic surgery services: one in the Carlos Chagas chair, at the postgraduate school of the Pontificia Universidad Católica, in Rio; and the other chair is at the Hospital de la Santa Casa de la Misericordia, in Rio de Janeiro. There we serve people without resources for free, because plastic surgery is not the whim of the rich, but the problem of many people who need to benefit from the possibilities of current medicine: injured, burned, mutilated, people with congenital defects. For this reason, hospitals have repair departments in all countries and, on the other hand, aesthetics cannot be everyone’s right, because there are more important health issues that have not yet been resolved.
–In Brazil, the concept of the cult of beauty is deeply rooted and the population is very concerned about physical appearance. What do you think it is due to?
-The weather. In Brazil, the warm temperatures mean that people are always dressed lightly, and the body becomes more evident, more public. For this reason, the image is more important than in cold countries, where people are covered and the body is only shown in privacy. It is a difference that influences character and concern for the external. The weather affects psychology.
Pitanguy, cultured and refined, slightly vain, speaks several languages and considers himself a lover of art and literature. In addition, he practices karate “because it generates a philosophy that helps concentration.”
Cristina Ribas
This interview was published in July 1997, in number 194 of VERY Interesting
