Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 15  |  Issue : 1  |  Page : 14-19

Building capacity for aesthetic surgery in Nigeria: perspectives from the cosmetic surgery fellowship at the Ivo Pitanguy Institute Rio de Janeiro, Brazil


Department of Surgery, College of Medicine, University of Ibadan; Department of Plastic, Reconstructive and Aesthetic Surgery, University College Hospital, Ibadan, Nigeria

Date of Web Publication26-Aug-2019

Correspondence Address:
Dr. Olayinka A Olawoye
Department of Plastic Surgery, Reconstructive and Aesthetic Surgery, University College Hospital, PMB 5116, Ibadan
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njps.njps_1_19

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  Abstract 


Very little of cosmetic surgery procedures were done hitherto in most of the plastic surgery training institutions in Nigeria. The reasons for this are many. The practice and training is tilted significantly in favor of reconstructive surgery compared to aesthetic surgery with a ratio as high as 9:1 in the major teaching and training institutions in the country. As a result, experience is limited in cosmetic surgery and the trainees rarely participate in significant number of cosmetic procedures throughout their training. With the progressive increase in demand for cosmetic surgery locally, concerted efforts must be made to build the capacity of plastic surgeons to meet this growing demand. This article documents the experience of the author during a cosmetic surgery fellowship at the Ivo Pitanguy Institute, Rio de Janeiro, Brazil, and drew perspectives from the experience for the building of capacity for cosmetic surgery in Nigeria.

Keywords: Aesthetic surgery fellowship, building surgical capacity, cosmetic surgery fellowship


How to cite this article:
Olawoye OA. Building capacity for aesthetic surgery in Nigeria: perspectives from the cosmetic surgery fellowship at the Ivo Pitanguy Institute Rio de Janeiro, Brazil. Nigerian J Plast Surg 2019;15:14-9

How to cite this URL:
Olawoye OA. Building capacity for aesthetic surgery in Nigeria: perspectives from the cosmetic surgery fellowship at the Ivo Pitanguy Institute Rio de Janeiro, Brazil. Nigerian J Plast Surg [serial online] 2019 [cited 2019 Nov 19];15:14-9. Available from: http://www.njps.org/text.asp?2019/15/1/14/265402




  Introduction Top


Capacity building is the process by which individuals and organizations obtain, improve, and retain the skills, knowledge, tools, equipment, and other resources needed to do their jobs competently or to a greater capacity.[1] Capacity building and capacity development are often used interchangeably. It refers to strengthening the skills, competencies, and abilities of individuals, organizations, and communities to be more efficient and productive.

The United Nations Development Program defines capacity building as a long-term continual process of development that involves all stakeholders, including ministries, local authorities, nongovernmental organizations, professionals, community members, academics, and more. Capacity building uses a country’s human, scientific, technological, organizational, and institutional resource capabilities.[2]

The capacity building approach, though introduced and popularized by international development partners for strengthening the capacities of the developing nations, can be used at many levels such as individual, institutional, local, regional, national, and international levels to build and strengthen professional and institutional competencies in the health sector especially in the surgical specialties like plastic, reconstructive, and aesthetic surgery.

It was this quest that motivated the author to undergo a fellowship in cosmetic surgery at the renowned Ivo Pitanguy Institute in Rio de Janeiro Brazil. The aim of this article was to present my experience during the fellowship and make a case for enhanced and concerted capacity development efforts for this growing subspecialty of plastic surgery in Nigeria.


  Methods Top


A 3-month fellowship in cosmetic surgery was undertaken at the Ivo Pitanguy Institute, Rio de Janeiro, from March 1 to May 31, 2018. Additional experience in both surgical and medical cosmetic procedures was garnered with five plastic surgeons in their clinics and private practice. These were Dr. Barbara Machado (Sao Jose Hospital), Dr. Mario Bonfatti (Clinica Sao Vicente), Dr. Paulo Muller (Copa Star Hospital), Dr. George Soares (Barra Life Medical Center), and Dr. Angela Fausto (Quinta D’or Hospital).

The various aspects of the residency training program at the institute were noted. The types and number of the cosmetic procedures done in each of the institutions were documented. Formal and informal interactions were held with industry representatives for implants and other cosmetic surgery instruments and consumables. Take-home lessons from all these experiences and interactions were documented.


  Results Top


The Ivo Pitanguy Institute is one of the biggest plastic surgery training institutions in South America with an average plastic surgery residents population of about 42 at any given time. An average of about 900 cosmetic surgeries are performed at the institute every year. The Gamboa Hospital is the main hospital at the institute where most of the cosmetic surgeries were done in a simple but highly efficient facility. The theater complex has five adjoining operation rooms and three to four cosmetic surgeries are performed simultaneously in the operation rooms on a typical surgery day. There is usually at least one attending surgeon who supervises the surgeries on a particular operation day. All the patients who will be operated in a particular week would have been discussed at the weekly preoperative review meeting in which the attending surgeon would review the patients along with their expectations, the surgical options, and the techniques with the residents. The final-year residents usually perform most the operations with the assistance of two or three other residents. The attending surgeons however scrubs in for the more technically challenging cases.

Residency training in plastic surgery spans for a period of 3 years. Trainees must have completed a 2 to 3-year residency in general surgery before commencing the plastic surgery training at the institute. Resident doctors at the institute do not earn salaries, rather they pay the institution the equivalent of between $1,000 and $1,300 monthly as training fee.

Cosmetic surgery forms a critical part of the residents training beginning from the first year through the third year. Because of the volume of cosmetic surgeries performed yearly in the institute, the residents have significant hands-on experience and are exposed to virtually all types of cosmetic surgery procedures before the end of their training.

I attended 72 cosmetic surgical procedures at the Institute [Figure 1] and 56 cosmetic operations at the remaining five hospitals [Table 1]. In addition, I was exposed to various office procedures such as laser therapy, botox injections, and injection of different types of body fillers.
Figure 1 Types and number of cosmetic procedures attended at the Ivo Pitanguy Institute

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Table 1 Cosmetic surgery procedures attended at other hospitals

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  Discussion Top


There has been a global increase in the demand for cosmetic surgery. An increasing demand has also been witnessed in Nigeria in the recent years. There are currently no national figures for the number of cosmetic operations done annually in Nigeria but anecdotal reports from presentations at recent Nigerian Association of Plastic, Reconstructive and Aesthetic Surgeons’ (NAPRAS) scientific conferences suggest increasing demand for cosmetic surgery all across the nation especially in the major cosmopolitan cities. There has been an increase in the cosmetic surgery procedures done all across the world. A recent publication of the American Society of Plastic Surgeons reports a 132% increase in cosmetic procedures between 2000 and 2016.[3]

This global increase in demand for cosmetic surgery operations makes it an important and timely discourse for plastic surgeons locally, one that should have relevance not only for the current practice but also set a template for the holistic evaluation and development of local capacity to meet the challenges of training and practice, on one hand, and those of medical tourism and quackery, on the other.

The abysmal deficiencies in surgical capacities in several countries in sub-Saharan Africa have been reported.[4],[5],[6],[7] Plastic surgery has also been described to be relevant to the unmet need for surgery in sub-Saharan Africa[8] considering the fact that congenital anomalies, burns, traumatic injuries, infections, and malignancy have been estimated to make up about half of the world’s burden of surgical diseases.[9],[10]

While discussions are ongoing about these and efforts are being made to correct these deficiencies by the regional and national postgraduate surgical colleges, capacity development in all the surgical subspecialties and aesthetic surgery should be complementary and all inclusive. Development of aesthetic surgery should not be left behind in the guise of esoteric philosophical debates. The danger in doing this lies in the fact that if capacities of all the surgical subspecialties are not developed holistically, a service gap in aesthetic surgery may be created as the society becomes more affluent and enlightened with increasing number of clients seeking cosmetic surgery.

The practice of plastic surgery appears to have taken firm root in the medical clime of Nigeria with increasing number of teaching and specialist hospitals with plastic surgery units. There are currently about 140 practicing plastic surgeons in Nigeria with over 40 resident doctors at various stages of training. Although an improvement from previous years, this is still a far cry in terms of proportion to the current population of Nigeria that is estimated by the United Nations to be about 196 million.[11]

Despite this wide gap, the increasing presence of plastic surgeons in many tertiary health institutions in the country is a welcome development as more specialized and focused care of reconstructive cases can be provided by these specialists rather than by surgeons of related specialties.

Recent advances in information technology and the proliferation of several social media platforms with improved access of the citizenry have widened exposure and created a more informed and increasingly sophisticated population who are more open and willing to have cosmetic procedures. The web has become one of the most important sources of information for consumers considering cosmetic surgery.[12] Similarly, the long-held cultural, religious, and traditional beliefs in Nigeria and other developing nations that have hitherto seen cosmetic surgery as vanity surgery and hence discouraged the enhancement of different parts of the body appear to be crumbling and paving way for greater acceptance and more liberal consideration for cosmetic surgery. The improvement in the economic indices of the country has also given more people the financial power to pursue not just their health needs but also their social wants.

The globalization of cosmetic surgery is making significant in-roads into Nigeria with resultant progressive interest and demand for varying types of cosmetic surgery procedures especially in the major cities of the country. All these factors put together are bound to cause a significant increase in the acceptance and uptake of cosmetic surgery in Nigeria in the years to come and the plastic surgeons must be prepared and ready for it.

This calls for timely planning, strategic consultations, and focused preparation by the plastic surgeons not just as the providers of the procedures but as trainers, administrators, and developers of the training curriculum to build the needed capacity and be on top of the game as the demand for cosmetic procedures increases. This will help to prevent or limit incursions and rivalry by other related surgical and medical specialties, on one hand, and by quacks, on the other hand. Intense advocacy and diplomacy will also be necessary with the relevant government ministries and agencies for the necessary funding and infrastructural development of the training institutions for cosmetic surgery.

Brazil was chosen for my fellowship training in cosmetic surgery for various reasons; it ranks as the country with the second highest number of cosmetic procedures in the world, second only to the United States of America [Table 2].[13] The Ivo Pitanguy Institute was founded by the world renowned plastic surgeon Prof. Ivo Pitanguy several decades ago. Ivo Pitanguy was a legend, not only in Brazil but also worldwide. His techniques in burns, hand, and cosmetic surgery continued to be used in all aspects of plastic surgery.[14]
Table 2 2017 ranking of the countries for cosmetic procedures

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The Ivo Pitanguy Institute is the biggest plastic surgery training institution in Brazil. The large volume of cosmetic surgery procedures done in the institution gives good opportunity for exposure to a wide variety of cosmetic procedures within a short period of time. The institute is one of the most sought after institutions for plastic surgery residency and for fellowships in cosmetic surgery by trainees and plastic surgeons and from all around the world.

The scope and content of the plastic surgery training program in Brazil is heavily tilted toward cosmetic surgery. The Ivo Pitanguy Institute has the reputation for the highest volume of cosmetic surgery cases in the country. This was made possible because of the expertise and visionary leadership on the founder of the institute that has attracted many clients and patients from within and outside Brazil to the institute.

Some of the other strategies that made the institute attractive to clients include the good quality of care, the lower costs for surgery compared to other similar institutions, and the flexible payment options by the clients, both for the operation and consumables such as implants.

In addition, most of the operations on the trunks including breast reduction and breast augmentation were usually done under regional instead of general anesthesia thus reducing the operation cost. This makes the procedures more affordable and accessible with resultant increased uptake.

Strategies for building local capacities should be multipronged. In the first instance, trainers should seek opportunities for fellowships in cosmetic surgery in countries with well-established cosmetic surgery practice; but where there is a challenge of time and funding, shorter exposures in specific aesthetic procedures may be undertaken sequentially. Relevant equipment may be purchased by individuals in piece meal fashion pending the time that the institutions are sufficiently motivated to invest in the more expensive equipment. The operation fee for cosmetic surgeries need not be significantly higher than those for reconstructive surgeries in the first instance so as to make it more accessible and affordable. Cosmetic surgery is also highly industry dependent, so we will need to partner with relevant industry for easy accessibility to implants, fillers, injectables, and other consumables.

Group practice by colleagues could be an easier and faster way of accessing funds for larger dedicated cosmetic practice. Our scientific conferences should feature sessions on aesthetic surgery regularly where accomplished cosmetic surgeons can be invited from different parts of the world for presentations and hands-on workshops. As we build a critical mass of experienced cosmetic surgeons in our training institutions, more clients will be attracted that will translate to greater exposure and hands-on training for the plastic surgery trainees. Ultimately, local fellowships in cosmetic surgery will evolve in our institutions and the future dimensions can only be imagined.


  Conclusion Top


The increasing demand for cosmetic surgery in Nigeria is a challenge for plastic surgeons to upgrade their skills in cosmetic surgery through clinical fellowships and exposures in aesthetic surgery. The cosmetic surgery fellowship undertaken at the Ivo Pitanguy Institute, Rio de Janeiro, helped in no small way in achieving this aim. A holistic approach of skills acquisition, infrastructural upgrade, curriculum review, and industry flexibility will help significantly in building the much needed capacity for aesthetic surgery not only in Nigeria but also in the subregion. The potential clients are already out there; what will determine their increased willingness to embrace cosmetic surgery will be the quality of care that they receive and our enthusiasm for excellence.


  Acknowledgement Top


I wish to thank the Director of the Ivo Pitanguy Institute Rio de Janeiro, Brazil Prof Francesco Mazzaroni for waiving the training fees for two out of the three months that I spent at the institute. I am also grateful to all the supervising consultants and the administrative staff at the institute for their help. I sincerely thank and appreciate Dr Barbara Machado, Dr Mario Bonfatti, Dr Paulo Muller, Dr George Soares and Dr Angela Fausto – all accomplished and top rated Plastic Surgeons who allowed me to join them for the cosmetic surgery procedures on their private patients and for the various instructions and tips that they offered. To Dr Eduardo Monte, a great anaesthesiologist who linked me up with some of the afore mentioned surgeons, I remain ever grateful. I thank Dr Saulo Gontijo, the Chief Resident at the Institute and all the other Plastic Surgery Residents for all their kind assistance.

I thank my wife and children for their love and support and I am grateful to the Lord for life and for the opportunity.

Financial support and sponsorship

I wish to thankfully appreciate the financial support of Prof O. B. Shittu, Consultant Urological Surgeon UCH Ibadan toward the Fellowship. I also thank my parents Mr. and Mrs E. A. Olawoye for their constant support.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Capacity building. Available from: https://en.wikipedia.org/wiki/Capacity_building#In_local_communities. [Accessed September 5, 2018].  Back to cited text no. 1
    
2.
United Nations Committee of Experts on Public Administration. Definition of basic concepts and terminologies in governance and public administration. United Nations Economic and Social Council; 2006. http://unpan1.un.org/intradoc/groups/public/documents/un/unpan022332.pdf [Accessed September 5, 2018].  Back to cited text no. 2
    
3.
American Society of Plastic Surgeons. Plastic Surgery Statistics Report − 2016. Cosmetic Plastic Surgery Statistics. Chicago, 2016. Available at https://www.plasticsurgery.org/news/plastic-surgery-statistics. [Accessed September 6, 2018].  Back to cited text no. 3
    
4.
Corlew DS. Perspectives on plastic surgery and global health. Ann Plast Surg 2009;62:473-7.  Back to cited text no. 4
    
5.
Henry JA, Windapo O, Kushner AL, Groen RS, Nwomeh BC. A survey of surgical capacity in rural Southern Nigeria: opportunities for change. World J Surg 2012;36:2811-8.  Back to cited text no. 5
    
6.
Chukwuanuku TOG. Plastic surgery in Nigeria − scope and challenges. Niger J Surg 2011;17:68-72.  Back to cited text no. 6
    
7.
Nthumba PM. Blitz surgery: redefining surgical needs, training, and practice in sub-Saharan Africa. World J Surg 2010;34:433-7.  Back to cited text no. 7
    
8.
Ibrahim A. Sub-specialization in plastic surgery in sub-Saharan Africa: capacities, gaps and opportunities. Available at http://www.panafrican-med-journal.com/content/article/19/13/full/. [Accessed September 6, 2018].  Back to cited text no. 8
    
9.
Semer NB, Sullivan SR, Meara JG. Plastic surgery and global health: how plastic surgery impacts the global burden of surgical disease. J Plast Reconstr Aesthet Surg 2010;63:1244-8.  Back to cited text no. 9
    
10.
Grimes CE, Law RS, Borgstein ES, Mkandawire NC, Lavy CB. Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa. World J Surg 2012;36:8-20. http://www.worldometers.info/world-population/nigeria-population. [Accessed September 5, 2018].  Back to cited text no. 10
    
11.
Available from: https://www.worldometers.info/world-population/nigeria-population/. [Accessed September 5, 2018].  Back to cited text no. 11
    
12.
Camp MC, Wong WW, Mussman JL, Gupta SC. The battle for hearts and minds: who is communicating most effectively with the cosmetic marketplace? Aesthetic Surg J 2010;30:614-7. https://www.isaps.org/wpcontent/uploads/2017/10/GlobalStatistics.PressRelease2016-1.pdf. [Accessed September 6, 2018].  Back to cited text no. 12
    
13.
The International Study on Aesthetic/Cosmetic Procedures Performed in 2016. Available from: https://www.isaps.org/wp-content/uploads/2017/10/GlobalStatistics2016-1.pdf. [Cited 6 September 2018].  Back to cited text no. 13
    
14.
Lloyd MS. An elective with a top plastic surgeon in Brazil. BMJ 2005;330s:190.  Back to cited text no. 14
    


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Introduction
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