It is always amazing how we learn what we do. The senior author (R.J.R.) has trained residents and taught plastic surgery for over 20 years, and yet is amazed every day by the newest generation of residents. What is fascinating are the vast differences in how residents learn and the variations in the speed at which they learn: some learn by seeing, some by doing, some by reading, and others by seemingly endless measuring and repetition. For many residents (and other people), piecing things together over a long period of time finally brings enlightenment, but a rare few seem to “get it” almost immediately. A resident's thought processes in becoming a plastic surgeon evolve by the resident emulating those whom he or she feels can make him or her a better and more skilled and competent surgeon. Plastic surgery and art are closely related fields in many ways, and two artists who have captivated our attention over the years are the High Renaissance masters Leonardo da Vinci and Michelangelo Buonarroti. Although contemporaneous, they manifested vastly different learning styles, artistic abilities, and work temperaments. Leonardo da Vinci (1452–1519) was very much one who tinkered and measured over and over. He was easily distracted and often took extended periods of time to complete his works. Does this sound familiar to you or remind you of someone you know? Leonardo left behind numerous unfinished “cartoons,” rough (or refined) outlines of paintings; many of these sketches are masterpieces in their own right. Although his output of work was impressive, he was a procrastinator who left much of his work incomplete; where his mind wandered, he went and left work unfinished. Nevertheless, Leonardo was instrumental in developing numerous ideas and techniques in the fields of painting, architecture, and warfare and in the methods of scientific inquiry and investigation. Michelangelo Buonarroti (1475–1564), in contrast, represented someone quite different. Steeped in the Neo-Platonic thought of Marsilio Ficino and the Neo-Platonic Academy (and sponsored by the wealthy and powerful Medici family), Michelangelo's art was guided by philosophy. In his sculpture, he was “freeing” the forms that lay within, and as the chips of marble flew off the block, the image emerged. Michelangelo represented a “true artist,” mastering the diverse fields of painting, sculpture, literature, and architecture. He was focused and saw the end goal at all times. Does this remind you of someone you know or have trained with in plastic surgery? A brief review of both of these men and their methods of thinking will prove insightful for us today. LEONARDO DA VINCI Leonardo and Michelangelo both were influenced by the Early Renaissance's achievements in art, language, politics, and philosophy. The High Renaissance men of genius were thought to be set apart from ordinary mortals by the divine inspiration guiding their efforts, and a cult of genius (as well as a culture of high expectations, aspirations, and financial reward for success) spurred them onward to vast goals.1 Leonardo loved light and explored how light worked in paintings. As H. W. Janson observes, Leonardo thought “not of outlines, but of three-dimensional bodies made visible in varying degrees by the incidence of light.”1 In his Last Supper, he began with the figure composition as the central focus and used the architectural setting in a supporting role, a break from Medieval and early Renaissance artists.1 Each disciple in the Last Supper reveals his own unique personality, and all of them become dynamically alive and vibrant on the flat surface. The Mona Lisa stands as Leonardo's most famous portrait, and perhaps the most famous portrait of all time. The forms of the background, and of the subject herself, “are built from layers of glazes so gossamer-thin that the entire panel seems to glow with a gentle light from within …. Even more intriguing is the psychological fascination of the sitter's personality.”1 The smile on her face is mysterious, teasing, universal yet undeniably unique to the woman herself. “In his later years, Leonardo devoted himself more and more to his scientific interests. Art and science … were first united [by] … Brunelleschi … Leonardo's work is the climax of this trend …. The extraordinary scope of his … inquiries is attested in the hundreds of drawings and notes that he hoped to incorporate into an encyclopedic set of treatises.”1 He set his mind to devising and drawing advanced weapons of war, including aircraft, the helicopter, and the armored tank. Leonardo “created the modern scientific illustration …. [His] drawing … combines his own vivid observation with the analytic clarity of a diagram—or, to paraphrase Leonardo's own words, sight and insight.”1 Truly, we owe much to Leonardo, and stand rightfully in awe of his artistic, analytic, and imaginative abilities. MICHELANGELO BUONARROTI To understand key elements of Neo-Platonic philosophy is to understand the core of Michelangelo. Reality was at the core of art and life. In its attempt to provide a sound, intellectual basis for existence, Neo-Platonism proposed that an ultimate One lies behind all existence; dualism between thought and reality had to be overcome. Achieving reality required stripping away the imprecise.2 “Michelangelo was a sculptor—more specifically, a carver of marble statues—to the core. Art, for him, was not a science but ‘the making of men,’ analogous (however imperfectly) to divine creation …. Only the ‘liberation’ of real, three-dimensional bodies from recalcitrant matter could satisfy his urge …. Painting, for him, should imitate the roundness of sculptured forms, and architecture, too, must partake of the organic qualities of the human figure.”1 Three sculptures highlight Michelangelo's Neo-Platonic views and that “he conceived his statues to be human bodies released from their marble prison, [just as] the body was the earthly prison of the soul—noble, but a prison nevertheless.”1 The first statue is the Pietà of 1499, completed when he was just 24 years old. It is a depiction of the body of Jesus on the lap of his mother, Mary, after the crucifixion. Out of the static rock the artist has set free intense calm, immense subterranean emotion, stillness, and tense agony. The viewer is unexpectedly pulled into the death—and life—of the scene, at once feeling both privileged to bear witness to the beauty of the moment and yet somehow embarrassed to come across a moment so very private and tender. Similar elements are seen in the David of 1501–1504. “Vibrant with pent-up energy, [David] faces the world … not [as] a victorious hero but [as] the champion of a just cause.”1 With his “heroic scale … superhuman beauty and power … David, at once calm and tense, shows the action-in-repose so characteristic of Michelangelo.”1Moses (1513–1515) was part of a vast sculptural program for the tomb of Pope Julius II,1 and in this sculpture we continue to see a tenseness and energy pouring from Moses, who sits at rest. “The majestic Moses … has the awesome force which the artist's contemporaries called terribilità …. His pose, both watchful and meditative, suggests a man capable of wise leadership as well as towering wrath.”1 Although he considered himself primarily a sculptor, Michelangelo was a supremely capable painter. His two immense masterpieces are both in the Sistine Chapel: the Sistine Chapel ceiling fresco and The Last Judgment. Michelangelo completed the entire ceiling in 4 years, producing an organism with hundreds of figures painted with a profound theological scheme. As Janson asks, “What greater theme could he wish than the Creation of the World, the Expulsion from the Garden of Eden, and our ultimate reconciliation with the Lord?”1 His color scheme on the ceiling, restored to its original vibrancy, is full of light, richness, and energy. In contrast to the radiant vitality of the ceiling, Michelangelo painted the wall of the Sistine Chapel with The Last Judgment fully 20 years later with a dramatically altered mood. Somber, brutal, even shocking, “the Blessed and the Damned alike huddle together … pleading for mercy before a wrathful God. Straddling a cloud just below the Lord is the apostle Bartholomew, holding a human skin …. The face on that skin … is Michelangelo's own. In this grimly sardonic portrait … the artist has left his personal confession of guilt and unworthiness.”1 THE PLASTIC SURGEON TODAY: WHICH TYPE OF ARTIST ARE YOU? Which type of artist, of surgeon, do you represent? How do you learn, and how do you express your abilities and talents as a surgeon and scientist? Do you love to tinker, to measure, to read and then do, letting what you observe and find by experimentation guide you? The senior author began his plastic surgery career and residency as more of a measurer and tinker (the da Vinci type), but as he evolved into a more experienced and mature plastic surgeon, he became more artistic (the Michelangelo type), with a three-dimensional focus on the end goal of his work. Or have you developed a philosophy or theoretical position on surgery, and strive to meet an ideal that you hold in your mind? As Michelangelo mused, there is no effect in nature without a reason; understand the reason, and you do not need to experiment. Perhaps you are one who strives to understand “unifying and organizing principles,” which, once found, will guide you in your surgery and science. “Spontaneous innovation” marks this sort of surgeon. Innovation comes from both types of people and learning. There are numerous take-home messages for plastic surgeons from these two High Renaissance artists. One is that we need to devote ourselves to as broad and deep a training process as possible. Excellent training in medicine, anatomy, surgical skills, and scientific experimentation techniques will equip us to explore and learn wherever our interests lead. We should be diligent to learn all we can and to perfect our techniques to the highest level possible. If we are gripped by an idea, we should pursue it (either analytically and logically, or in a dynamic manner to apply practice to our theory) and take it as far as it will go. We should work hard and as long in our careers as possible, because real learning, skill, and breakthroughs usually come only through long and hard-earned experience and work. And despite any personal idiosyncrasies or emotional temperaments, we should persevere and trust ourselves, knowing that we are helping patients and furthering scientific knowledge for the next generation. Which are you, a Leonardo or a Michelangelo? First and foremost, be yourself! You may find it interesting to track yourself, wherever you are in your plastic surgery career, to see which Leonardo-type and which Michelangelo-type traits describe you, if they do at all. The key element is not which one or type of plastic surgeon you are but that you perfect your own way and style and become the best plastic surgeon you can be, using your innate talents and acquired skills on a daily basis. Rod J. Rohrich, M.D. Editor-in-Chief Plastic and Reconstructive Surgery 5959 Harry Hines Boulevard P.O. Box 1, Suite 300 Dallas, Texas 75390-8820 [email protected]
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Rohrich et al. (2011) studied this question.