Since the beginning this relationship has been of utmost importance for the Specialty and of its branch “Aesthetic Surgery”. It is still today and will remain so in the future.

From the beginning, the four Plastic Surgeons who met in Sao Paulo to write the first Constitution and Bylaws expressed the opinion that one of the most important goals was not to separate, but to maintain Aesthetic Surgery within the Specialty of Plastic Surgery. Thus, the International Society to be formed would not only wished to be affiliated with the International Confederation for Plastic and Reconstructive Surgery but would also keep the word “Plastic” in its title to demonstrate the background of its members as Specialists in Plastic Surgery.

Ernesto Malbec had stated that he felt that he preferred that the Society should be called “International Society of Aesthetic Surgery”, eliminating the word “Plastic”. This was opposed in Bogota by Salvador Castañares and by the vote of the majority of those attending(27).

Actually two philosophical concepts were conflicting: on one side, the aim was to strengthen our origin, Plastic Surgery and the Confederation. On the other side, there were doubts about the willingness of the Confederation, at present, to adequately protect Aesthetic Surgery for the Plastic Surgeon. It was necessary to further much more Aesthetic Surgery and its training than previously done by the Confederation and by the National Societies, in order that Aesthetic Surgery could assume its proper place within our Specialty(13,10).

• Concerning the Confederation, the reaction was first of refusal: “The Founding Members did not previously consult the Plastic Surgeons in their countries”(28). “It should have better been formed within the framework of the Confederation”(29,30). Nevertheless, the “fait accompli” was accepted(31).
• Once the possibility of integration of ISAPS as “The Chapter of Aesthetic Surgery of the International Confederation for Plastic and Reconstructive Surgery” was approved by the IPRS in Melbourne, (February, 1971)(31), the future discussions up to the Congress of the IPRS in Paris in 1975 focused on:

  • I. The ISAPS to be allowed to use its own name and emblem, besides that of “The Chapter of …” and logo of the Confederation (32, 33, 34, 35, 36, 37, 38, 39, 40). Although an “Affiliation” was preferred by the ISAPS (41, 42), John Watson informed that “affiliation is not possible, as by definition, all its members are also members of the IPRS, which cannot affiliate its own members”(43). The possibility of a different approach to the relationship of Aesthetic Surgery with Plastic Surgery and of the Society with the IPRS, by means of an “Association” instead of an integrated Chapter, was best reflected in the letter sent by Mario Gonzalez-Ulloa to John R. Lewis(44), on July 19, 1972, in which he acts as the ‘Devil’s Advocate’. “I think we should help the fountainhead of our formation as Surgeons, (for the present as well as for the future ones), to preserve its status, its ability to train, its traditional values, etc. This can be achieved by continuing our association with Plastic and Reconstructive Surgery”. However, “there are many in our group who think that we should preserve our freedom, and eventually – in due time – form our own Confederation, with total freedom to manage our group as is most convenient for the Society and for those we serve”. “I think we are facing a serious problem: many men, from various fields of Surgery, are coming into Aesthetics, and time is now right to build up a sound policy as how to deal, for the benefit of our Specialty, with this ever increasing problem”.

    If an agreement ISAPS-IPRS could be obtained, this was mainly due to the excellent guidance by the first Presidents, but also to the wise management of the Executive Committee of the IPRS by its General Secretary, John Watson(46). It was felt therefore that he fully deserved the nomination of Honorary Member of ISAPS. His opinion is best summarized in his letter of February 14, 1973 to Mario Gonzalez-Ulloa(47). “I believe, as you know, that the specialist training for Aesthetic Surgery should grow from, and be part of the general training of a Plastic and Reconstructive, and that only on this basis will the Surgeon whose practice may be in the main limited to Aesthetic Surgery retain the best possible standing among his medical colleagues and the institutions of the country in which he works. In addition to this, my knowledge of the conditions of countries in various parts of the world, where the structure of practice and availability of hospital posts shows such variation, leads to the believe that unity between Plastic Surgery and Aesthetic Surgery as such (if one can really separate them – purely Reconstructive Surgery must have imagination and aesthetic aspects) is absolutely causal, if recognition of Plastic Surgery as a Monospecialty has to be achieved by the authorities of the country concerned. If “Aesthetic Surgery” were to be hived off as a separate specialty, it would greatly weaken the position of the members of the National Societies straggling for full recognition. We have also the problem of the creation in various parts of the world of Societies of Aesthetic Surgeons whose training and background are quite unacceptable to the National Societies of the International Confederation. It is a free world, and these activities cannot be suppressed, but, at least, we can safeguard the situation by recognizing one body of reputable and well trained surgeons. For these reasons, I will do all I can to maintain the relationship of the ISAPS with the IPRS as an integrated chapter, and I would feel that separation would be a misfortune with long term results which could only weaken both organizations”.

• At the IPRS Congress in Paris, 1975, the ISAPS definitely became the Chapter of Aesthetic Surgery of the IPRS, with full acceptance as far as maintaining its own name and emblem.
  • II. That the President be included as an Ex-Officio Co-opted Member of the Executive Committee of the IPRS, with voice and vote for all matters related to Aesthetic Plastic Surgery (41, 42, 46, 49, 50, 51, 52, 53, 54, 55).
  • This was finally agreed. Although initially not included in the stationery of the IPRS, both Gonzalez-Ulloa -2nd President of the ISAPS- as well as all following Presidents were mentioned in the IPRS Newsletters.
  • III. On how far the ISAPS would be responsible for the Aesthetic Scientific Program of the quadrennial meetings of the IPRS. This was also a matter of long discussions by the ISAPS Presidents up to the fourth, Jack Davis. Again John Watson and thereafter also Roger Mouly showed their good will and wisdom in balancing opposed opinions(49,56,57,58,59).

As a proof, John Watson’s letter to William Manchester: “It was, of course, fully established in Paris that the Host Society must have full control of the overall program and would allocate time and space to the Chapter for scientific and administrative functions, and would also agree on the timing of any independent social program which the Chapter might organize. At the same time the Chapter is an integral part of the IPRS, is its instrument for working in the aesthetic field. I have never envisaged that once the Chapter has been created it would not be used at the Congress, and if I had, I would have suggested a new Bylaw giving them automatically majority representation of the Aesthetic Scientific Program Committee at any World Congress”.