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The Internet .Journal of Plastic Surgery TN]Millard's 33 Commandments of Plastic SurgerySanjay Saraf MS, MCh. (Plastic Surgery), Dip. National Board (Plastic Surgery),MNAMSDept. of Plastic SurgeryNMC Specialty HospitalDubai, UAE

Citation:Sanjay Saraf: Millard's 33 Commandments of Plastic Surgery: The Internet Journalof Plastic Surgery. 2007; Volume 4, Number 1.

AbstractThe breadth and depth of plastic surgery has been distilled into 33 fundamental principlesby Dr. D RalphMillard. These principles have stood the test of time and still haverelevance today.

D Ralph l\/lillard, 11'.,iv1.D.More than four hundred years past, Ambroise Pare1in 1564 conceived andpublished the five basic Plastic Surgery principles, namely, take away what issuperfluous, restore to their places things which are displaced, separate those thingswhich are joined together, to join those which are separated and to supply thedefects of the nature. In 1950, Millard published Sir Harold Gillies' Principles as theten commandments namely, thou shalt make a plan, thou shalt have a style, honorthat which is normal and return it to normal position, thou shalt not throwaway aliving thing, thou shalt not bear false witness against thy defect, thou shalt treat theprimary defect before worrying about the secondary one, thou shalt provide thyselfwith a lifeboat, thou shalt not do today what you canst put off until tomorrow, thoushalt not haVea routine, thou shalt not cover thy neighbor's plastic

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unit,handmaidens,forehead flaps, Thiersch graft, ox cartilage nor anything that is thyneighbor's 1,2.In 1957, six more principles were added in the book 'The Principlesand Art of Plastic Surgery" by Gillies and Millard3.Dr. Millard tested these principles again and again and found these principlesapplicability not just only to solve plastic surgery problems but also appreciated theirbasic applicability in routine life .Later, Dr. Millard crystallized the breadth and depthof plastic surgery into proverbs of 33 fundamental principles of Plastic Surgery andcompiled them in Millard's 'Principlization of Plastic Surgery' in 19861.These philosophical but practical plastic surgical pearls have stood the test of timeand still pertinent today. The real value of these principles lies in their truths fromwhich answers can be derived by logic for any variety of problems rather thandepending on memorized blueprints1.The principles have been categorized asPreoperational Principles, Executional Principles, Innovational Principles,Contributional Principles and Inspirational Principles.All of the following 33principles1are self-explanatory and in spite of present day technological evolutionand advancements in plastic surgery, these principles have stood the test of timeand their present day applicability is the testament of their basic truth.Preoperational Principles1. Correct the Order of Priorities2. Aptitude Should Determine Specialization3. MobilizeAuxiliary Capabilities4. Acknowledge Your Limitations so as do no harm5. ExtendYour Abilities to Do the Most Good6. Seek Insight into the Patient's True Desires7. Have a Goal and a Dream8. Knowthe Ideal Beautiful Normal9. Be Familiarwith the Literature10.Keep anAccurate Record11.Attend to Physical Condition & Comfort of Position12. DoNot Underestimate the EnemyExecutional Principles13. Diagnose Before Treating14. Returnwhat is Normal to Normal Position& Retain it There15. Tissue Losses Should be Replaced in Kind16. Reconstruct by Units17. Make a Plan, a Pattern, & a Second Plan (Lifeboat)18. Invoke a Scot's Economy19. Use Robin Hood's Tissue Apportionment20. Consider the Secondary Donor Area21. Learn to Control Tension22. PerfectYour Craftsmanship23. When in Doubt, Don'tInnovational Principles

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24. Follow-upwith a Critical Eye25. Avoid the Rut of Routine26. ImaginationSparks Innovation27. Think While Down and Turn a Setback into a Victory28. ResearchBasic Truths by Laboratory ExperimentationContributional Principles29. GainAccess to Other Specialties' Problems30. Teaching our Specialty is Its Best Legacy31. Participate in Reconstructive MissionsInspirational Principles32. Go for Broke33. Think principles Until They Become Instinctively Automatic in Your ModusoperandiKnow the Ideal, Beautiful, Normal.Diagnose what is present, what is diseased,destroyed, displaced, or distorted and what is in excess. Thenguided by the normalin your mind's eye, utilize what you have to make what you want - and whenpossible, go for even better than what would have been! D Ralph MillardCorresponding AuthorDr. Sanjay SarafDept. of Plastic SurgeryNMCSpecialty HospitalDubai, UAE.E-mail: drsaraf@hotmail.comReferences1.Millard DR Jr. Principlization of Plastic Surgery. 1st Ed. Boston / Toronto: LittleBrown & Co.; 1986.2. Millard DRJr. Plastic Peregrinations. Plast Reconstr Surg 1950; 5:26-53.3. Gillies HD and Millard DR Jr. The Principles and Art of Plastic Surgery. 1st Ed.Boston: Little, Brown & Co.; 1957.References

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