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History of Facial Plastic Surgery in the Netherlands

History of facial plastic surgery in the Netherlands  / Jan de Jong

J.F.S. Esser ( 1877  –  1946 ) was a  doctor and a collector of art. He also  was a famous chess player and was Dutch champion in his  days.

In 1914 he was attracted to war surgery  and left Rotterdam for a hospital with more than 3000 beds full of wounded soldiers in Brno, in Austria.

There he operated many patients with head wounds. He used arterial flaps  in facial reconstructive surgery. He was the first to use  the bilobe flap on the nose.

 

Doctor Esser standing amongst his patients

 

After WW1 he went to Berlin, like Joseph, to continue his work untill 1924, when he left for Holland again.

He was the founder of reconstructive facial plastic surgery in Holland, and had published about it.

He went to America in 1939 where he died in Chicago in 1946.

Looking back the maxillofacial surgeons claim him to be one of theirs because he started  as a dentist, but the plastic surgeons think he belongs tot them because of the vast reconstuctive operations he performed.

Every year there is an Esser symposium at the departement for Plastic Surgery in the Rotterdam University hospital.

 

Plastic Surgery

After WW2 there were three plastic surgeons, who had their education in England, and started in the Netherlands. They were not accepted by the general surgeons and had to fight their way in. They succeeded and in 1950 the society for plastic surgery was there.

One of them was Honig, who became professor in Utrecht in 1973.

In university clinics there was only reconstructive surgery.

Facelifts were not performed in university hospitals.

The Dutch Society for aesthetic plastic surgery was founded in 1984, and only plastic surgeons could become a member. They wanted to learn  more about cosmetic procedures and organised meetings with international speakers like  the Brasilian plastic surgeon Pitangi.

Professor B.D. de Jong was a plastic surgeon and a member of the Joseph Society for many years.

 

ENT

Besides the oncology and parotis surgery facial plastic surgery was not performed.

It was possible to do a fellowship for 6 months in facial plastic surgery in clinics where an  ENT surgeon was qualified in rhinoplasty and performed surgery of skin tumors.

Vuyk was the first one in 1995, Lohuis and Ingels followed.

Inside  the Dutch ENT society  interested collegues started a workgroup on facial plastic surgery, and in 2013 an examination was  introduced , so ENT doctors could officially be registered as  ENT- and facial plastic surgeon.

 

Dermatology

As the dermatologists had no surgery in their education, they did not perform facial plastic surgery.

 

Maxillo- facial surgery

In 1940 dr. Tjebbes from  Utrecht started a clinic for maxilla surgery and schizis patients and led it till 1973. Professor Eggedi continued the university clinic in Utrecht, and after him professor Koolen.

All surgery was reconstructive ; esthetic operations were not performed.

There was a long struggle with the plastic surgeons because of the schizis operations in children.

 

In the sixties and seventies plastic surgeons only performed reconstructive surgery. The Social Health system did not alow cosmetic procedures, and assurance companies did not pay for it.

In the eighties things changed rapidly.

Not only did waitinglists occur for patients, the plastic surgeons did not want any other doctor to perform operations with the name  ending on :  -plasty!

They  warned the public for doctors operating outside the hospital in villas, who possibly were not qualified.

There was one plastic surgeon, well known to the public, who performed cosmetic surgery.

He had learned it in New York in the clinic of Converse. His name was  Molenaar and he also had a column in the biggest, national newspaper, what gave him a huge platform for his  cosmetic surgery. His collegues were disgusted.  Actually it was “jalousie de metier”, because doctors were not aloud to advertise.

So clinics started advertising for cosmetic procedures and facelifts were performed and later on the foreheadlifts were introduced.

There was a combined course on nasal tip surgery  in 1983 in Leiden for ENT and plastic surgeons. Claus Walter had a magnificent lecture on facial plastic  surgery, and that was a big help, because plastic surgeons felt superior to others in the field.

 

Front row: Mackay,Huizing,Bull,Reijntjes,Verwoerd,Molenaar,de Jong

In 1981 the first private clinic started in den Haag by a housedoctor, who had been to Paris to learn liposuction.

The name was MCEG  (Medisch Centrum voor Esthetische Geneeskunde).

It became the biggest clinic and stayed that for more than twenty years.

 

The nineties

 The Velthuis clinic started in Eindhoven, and soon had two more clinics in Rotterdam and Hilversum.

As Peter Velthuis was a dermatologist, no plastic surgeon wanted to work in his clinic.

He introduced the laser for skin surfacing in 1995, and was the first to use injectables. In 1999 I met dermatologist Peter Velthuis, who’s clinic in the meantime was famous for  lasersurfacing and injectables.

As no plastic surgeon wanted to work in a clinic run by a dermatologist, Peter asked a fellow dermatologist and myself to start up facial plastic surgery in his clinics.

So next to blepharoplasties we started to perform minifacelifts in local anesthesia and in 2002 I gave a lecture at the EAFPS meeting organised by Jarl Bunaess in Lofoten / Norway concerning 50 minilifts in local anesthesia.

 Then there was a plastic surgeon in Amsterdam,  who performed cosmetic surgery at his home.

When he died, an investor bought his clinic name and started the Bergman clinic in Bilthoven, near Utrecht.

Both Velthuis and Bergman clinics nowadays have more clinics throughout the country, with many surgeons performing facial plastic surgery.

 

University –  Private Clinics

University courses

In Leiden professor van Dishoeck started the annual Cottle courses  for septal surgery in 1963.


Many ENT surgeons attended  it and became acquinted with nose surgery.

In that time it was not uncommon that patients ended with a kind of saddlenose deformity, but no one paid to much attention to the outside of the nose.

 

Later on there were other nose courses:

1982   Utrecht          –    Huizing                      Functional nose surgery

1994   Amsterdam   –   Nolst Trenite             Rhinoplasty.

1989   Maastricht     –  Vuyk and Zijlker        Open approach

1999   Nijmegen       –   Ingels                          Around the nose

 

In the University clinics there was no teaching in cosmetic procedures. So it depended on whether a surgeon had the opportunity of working in a private clinic.

In 1997 Nolst Trenite became president of the EAFPS and he was known for his courses and his contibution in open approach technique.

There were also personal contacts  with collegues from  Europe and the  USA, who came to the Netherlands and gave lectures and performed operations.

Claus Walter operating in the Netherlands

 

In 2000 Ted Cook was the guest of Honour  at the course Around the nose  in Nijmegen and he was the first to talk about facelift surgery.

Ted Cook, Claus Walter

 

Books  were published by Vuyk : Facial Reconstructive Surgery,  Nolst Trenite: Rhinoplasty  and Lohuis: Advanced caucasian and mediterranean rhinoplasty.

HD Vuyk belonged to the first facial plastic surgeons in the Netherlands, and it is interesting to hear his vision on how things developed in a short video I made in the summer of 2018.

 

Video of HD Vuyk

https://www.youtube.com/watch?v=s815y4AtNo8

 

Vision of Tammo Zylker, former ENT surgeon in Heerlen, the Netherlands.

 

In the late eighties we became aware that Facial Plastic and Reconstructive Surgery was not even a limited part of the training in Otorhinolaryngology in the Netherlands. The open approach for rhinoplasty turned out to be an important eye-opener practised in the US
and Canada already more than 25 years and completely disregarded in Europe.

In 1989 I traveled with Hade Vuyk MD, PhD to Peter Adamson in Toronto (CAN)  and Ted Cook in Portland  (USA) in our search for answers and to satisfy our curiosity about the value of these concepts. Adamson was an excellent host and teacher and became very valuable for many of us. They were eager to teach and share their extensive knowledge.

In 1989 Vuyk and I hosted the First International Course  ‘’The Open Approach in Septorhinoplasty’’ in Maastricht and brought the two worlds together. The scientific discussion started and the expected resistance of the ‘’old-school’’ teachers could be felt, even in our own professional Society of Otolaryngology & HN Surgery.

In 1991 we took the next step to enhance the interest in FPRS and hosted the Course Facial Plastic and Reconstructive Surgery and  added the Facial Soft Tissue Workshop in Maastricht. In 1993 my thesis at the University Maastricht was published emphasising the open approach in Septorhinoplasty.

In 1994 the Dutch Committee of FPRS was founded. Members from Universities and ENT-surgeons from non-university hospitals worked closely together and became part in a longstanding series of teaching events in our country were many famous key-note speakers were invited from all over the world.

The Rhinoplasty courses in the AMC in Amsterdam is a fine example as is the ‘’Around the Nose’’ course in Nijmegen.

More publications appeared, papers and bookchapters were written and invitations for meetings abroad accepted.

In the curriculum of our ENT residents Facial Plastic and Reconstructive surgical deserved a place and it became an excepted  part of our armenmatorium.

Our residents took their experience to their hospitals and the word was spread. A new generation took over the torch which was enlighted in the eighties triggered by curiosity about this interesting and challenging part of our profession.

My experience

I had always been curious about aesthetic surgery and during my ENT education in Utrecht (1977-1981 , prof. Huizing) I saw that one member of staff, Fred ter Horst, tackled the problems in rhinoplasty far more better than the others.

He had been in the clinic of Claus Walter, so I decided also to go to

Dusseldorf. I stayed there for 6 months.

Fred ter Horst was the first regional vice-president of the Joseph Society in the Nertherlands.

Jan de Jong, Claus Walter, Fred ter Horst –

 

Claus was a gifted surgeon and a teacher, and I learned a lot in a short time.

When I had my praxis in Utrecht,  there was no plastic surgeon  in my hospital and  our dermatologist sent all the skintumors to me for excision and reconstruction.

When I came back from Dusseldorf I met the director of the MCEG, mentioned above.  

As outdoor surgery was not done in those times, he asked a plastic surgeon from  France to perform facelifts, and an anesthesist from England!

In those days no plastic surgeons would work outside hospitals and they were very hostile to the idea of a private clinic.

So I became the first Dutch specialist operating in a private clinic in my country (1982).

Three years later plastic surgeons decided to enter the clinic too.

In 1990 I went to Rolf Muncker in Stuttgart for one week. He was a plastic surgeon and a member of the Joseph Society. He showed me how to perform facelifts.

Because the  plastic surgeons in MCEG wanted to stop me performing facelifts and blepharoplasties  I had no choise but to go  to court.

The judge spoke and declared that I, an ENT surgeon, was aloud to perform facial surgery, especially blepharoplasties and facelifts. (2004)

 So that was a very important moment and a precedent for ENT surgeons and others performing facial plastic surgery. 

Nowadays there are several international courses on facial plastic surgery being held in the Netherlands. So interested collegues attend them and can receive  knowlegde of state of the art in this field.

Jan de Jong

 

 

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