Figure 1

More than four hundred years past, Ambroise Pare₁ in 1564 conceived and published the five basic Plastic Surgery principles, namely, take away what is superfluous, restore to their places things which are displaced, separate those things which are joined together, to join those which are separated and to supply the defects of the nature. In 1950, Millard published Sir Harold Gillies' Principles as the ten commandments namely, thou shalt make a plan, thou shalt have a style, honor that which is normal and return it to normal position, thou shalt not throw away a living thing, thou shalt not bear false witness against thy defect, thou shalt treat the primary defect before worrying about the secondary one, thou shalt provide thyself with a lifeboat, thou shalt not do today what you canst put off until tomorrow, thou shalt not have a routine, thou shalt not cover thy neighbor's plastic unit,handmaidens,forehead flaps,Thiersch graft, ox cartilage nor anything that is thy neighbor's ₁,₂ . In 1957, six more principles were added in the book 'The Principles and Art of Plastic Surgery" by Gillies and Millard₃.

Dr. Millard tested these principles again and again and found these principles applicability not just only to solve plastic surgery problems but also appreciated their basic applicability in routine life .Later, Dr. Millard crystallized the breadth and depth of plastic surgery into proverbs of 33 fundamental principles of Plastic Surgery and compiled them in Millard's 'Principlization of Plastic Surgery' in 1986₁.

These philosophical but practical plastic surgical pearls have stood the test of time and still pertinent today. The real value of these principles lies in their truths from which answers can be derived by logic for any variety of problems rather than depending on memorized blueprints₁. The principles have been categorized as Preoperational Principles, Executional Principles, Innovational Principles, Contributional Principles and Inspirational Principles. All of the following 33 principles₁ are self-explanatory and in spite of present day technological evolution and advancements in plastic surgery, these principles have stood the test of time and their present day applicability is the testament of their basic truth.

Preoperational Principles

1. Correct the Order of Priorities
2. Aptitude Should Determine Specialization
3. Mobilize Auxiliary Capabilities
4. Acknowledge Your Limitations so as do no harm
5. Extend Your Abilities to Do the Most Good
6. Seek Insight into the Patient's True Desires
7. Have a Goal and a Dream
8. Know the Ideal Beautiful Normal
9. Be Familiar with the Literature
10.Keep an Accurate Record
11. Attend to Physical Condition & Comfort of Position
12. Do Not Underestimate the Enemy

Executional Principles

13. Diagnose Before Treating
14. Return what is Normal to Normal Position & Retain it There
15. Tissue Losses Should be Replaced in Kind
16. Reconstruct by Units
17. Make a Plan, a Pattern, & a Second Plan (Lifeboat)
18. Invoke a Scot's Economy
19. Use Robin Hood's Tissue Apportionment
20. Consider the Secondary Donor Area
21. Learn to Control Tension
22. Perfect Your Craftsmanship
23. When in Doubt, Don't

Innovational Principles

24. Follow-up with a Critical Eye
25. Avoid the Rut of Routine
26. Imagination Sparks Innovation
27. Think While Down and Turn a Setback into a Victory
28. Research Basic Truths by Laboratory Experimentation

Contributional Principles

29. Gain Access to Other Specialties' Problems
30. Teaching our Specialty is Its Best Legacy
31. Participate in Reconstructive Missions

Inspirational Principles

32. Go for Broke
33. Think principles Until They Become Instinctively Automatic in Your Modus operandi

Know the Ideal, Beautiful, Normal .Diagnose what is present, what is diseased, destroyed, displaced, or distorted and what is in excess. Then guided by the normal in your mind's eye, utilize what you have to make what you want - and when possible, go for even better than what would have been! .............. D Ralph Millard

Correspondence to

Dr. Sanjay Saraf Dept. of Plastic Surgery NMC Specialty Hospital Dubai, UAE. E-mail: drsaraf@hotmail.com