Aesthetic Surgical Skills for Physicians

Why aesthetic technique needs its own program

A scar is the part of a procedure that the patient keeps. Where it lies, which way it runs and how visible it becomes depend on decisions that are largely technical: how the face or body was analyzed, where the incision was placed, which flap or plasty was chosen for the defect and how the tissue was treated during closure.

Outside plastic surgery, these skills are often picked up in fragments, by observation rather than by design. Aesthetic Surgical Skills for Physicians is designed to teach them as a structured sequence, following the Rafiee Educational Approach: assess the patient and the site, plan the incision and the future scar, handle the tissue with care, close with intent and protect the result. At every step it also teaches the decision not to intervene, and the point at which a case belongs with a plastic surgeon.

From analysis to the final stitch

The five modules follow the order of a real case. The first covers applied aesthetic anatomy and facial and body analysis, with the Frankfurt plane as a reference, so that every technique starts from an aesthetic diagnosis rather than from the defect alone. The second turns that diagnosis into a plan: cosmetic planning, microincisions and topographic camouflage, which places a scar where the anatomy already draws a line.

The third module is dedicated to fine technique: tissue handling, soft-tissue microsurgery, a basic cosmetic closure and the minimally invasive evacuation of a hematoma that threatens a result. These are the hand skills that the last two modules rely on. Local flaps follow (V-Y and A-T advancement, rotation flaps and the rhomboid flap), each taught with its geometry, its limits and the defects it does not suit. The program ends with M-, W- and Z-plasty, used to limit the length of an excision, to change the direction of a scar or to break up a straight line that catches the eye.

How it is taught

Each technique is designed to be demonstrated in full, broken into its steps and rehearsed on simulation models, with specific feedback, before any supervised practice. The sequence follows the Academy’s teaching progression. Case discussion trains what a model cannot: choosing the technique that suits a given patient, site and defect, and recognizing when none of them is appropriate.

Learning will be assessed by direct observation of technique and by structured review of planning decisions, as described in the assessment framework, which is itself in development. How procedural skills are learned and assessed across the curriculum is the subject of a planned program, Clinical Simulation, Procedural Skills & Assessment.

Where it sits in the curriculum

This is the third core program and the most technically advanced of the four. It builds on fundamentals taught elsewhere. Basic sutures and knots belong to Foundations of Clinical & Minimally Invasive Procedural Medicine, the recommended starting point for physicians without procedural experience. Wound management and aesthetic closure belong to Wound-to-Scar™, the foundation of wound closure on which this program rests. Where Wound-to-Scar follows a wound from assessment to the mature scar, this program concentrates on advanced aesthetic surgical technique.

Patient selection, consent and the early recognition of complications are developed in Clinical Aesthetic Practice & Patient Safety, a natural companion to this program.

Current status

The program is in development. It is built on the Rafiee Educational Approach, whose framework has been developed. Format, dates and venue have not been announced and will be published on this page.

Every incision leaves a scar. Where it lies, which way it runs and how it is closed are decisions made before the first cut.