ASPS Honorary Citation: A curious mind leads the search for answers

By Keith Loria

Growing up as the son of a urologist, Mark Constantian, MD, saw firsthand the importance of medicine and was drawn to the idea of helping people from an early age.

“I didn’t like being ignorant about the body and injuries to it,” he recalls. “If someone from school got a cut, I didn’t know what to do and I didn’t like that feeling – that ignorance bothered me.”

His interest in plastic surgery took root during his third year of medical school. After two years at Dartmouth, Dr. Constantian was finishing his degree at the University of Virginia, where he met Milton Edgerton, MD, who came from Johns Hopkins to start the university’s first Department of Plastic Surgery.

“Everyone was intimidated by him, but I was just fascinated by what he did,” Dr. Constantian says. “I had always thought of plastic surgery as being cosmetic surgery, but he did all kinds of stuff – craniofacial, hand surgery, etc. – and he was a wonderful teacher. He was on the edge of plastic surgery. He was one of the first to do immediate reconstruction after head and neck cancer, which was considered crazy in those days.”

Dr. Edgerton laid footprints that Dr. Constantian sought to follow, and since 1978, he’s been in private practice in New Hampshire, as well as serving as an adjunct professor of surgery at the University of Wisconsin and visiting professor of surgery at the University of Virginia. The decision to open shop in New Hampshire, he says, was driven by patient need.

“When I came to New Hampshire, there were only four plastic surgeons in the state, and three of them were at Dartmouth, two hours away,” he remembers. “There were over 1 million people in the state at the time. I was determined to go to an unserved area, and I liked the idea of it being in New England.”

Early in his career, Dr. Constantian had no designs on teaching, much less becoming wellknown in the field. In fact, he turned down three academic offers because he wanted to go into private practice – and he immediately took on his share of unique cases.

“I was busy right away, doing tons of hand surgery, because no one had done any sophisticated hand surgery in this area, and I was seeing fascinating cases,” he says. “I did lower extremity trauma, facial trauma and the first breast reconstruction in this region.”

Before he went into practice, Dr. Constantian spent two months studying for his boards. During that time, he decided to learn about rhinoplasty from up-and-coming surgeon Jack Sheen, MD, who shared Dr. Constantian’s Armenian ethnic background.

“I had very little exposure to rhinoplasty in my residency, so I went to Los Angeles and watching him was an amazing experience,” Dr. Constantian says. “It was like Eric Clapton hearing Robert Johnson for the first time – something clicked. I thought, ‘This guy is so good and what he’s doing is so interesting. I love the way he thinks, he’s technically wonderful and doing a lot of things that were novel and effective.’ We’re still friends – he’s 94 years old and I visit him a couple of times a year.”

Although he didn’t think he would do many rhinoplasty procedures, Dr. Constantian felt he could use Dr. Sheen’s way of thinking and efficient organization of the O.R. and apply it to other procedures. After about six years in practice, he renewed his interest in studying rhinoplasty.

“I had some interesting thoughts, wrote up a manuscript and sent it in to PRS, and the results were good enough that they published it,” Dr. Constantian says. “I wrote another paper, and then another, and in the 1980s, someone asked me to teach an instructional course at ASPS. So even though I continued a broad practice until five years ago, my reputation became increasingly that of a rhinoplasty surgeon.”

Over his long and distinguished career, Dr. Constantian has authored more than 100 text chapters and peer-reviewed papers; completed a 600-patient airflow study; invented a simulator (before the concept became more well-known); appeared on numerous panels; and he has three books to his credit, including the recently-released Childhood Abuse, Body Shame, and Addictive Plastic Surgery, written for surgeons and patients.

“I continued to generate ideas. What I loved during my five years in immunology research was seeing something brand new and telling people about it,” he says. “That became my public persona, but in real life, I was still a local guy in a medium-sized town in New Hampshire.”

‘An original’

Dr. Constantian’s continued work to advance the specialty led to him receiving the ASPS Honorary Citation Award at Plastic Surgery The Meeting 2019 in San Diego. He says he was surprised by the award, as it’s something he had not considered in his years of service.

“It’s an honor to serve and to teach, but I’ve always seen myself as a working stiff in private practice,” he says. “To me, the leaders are those who train young surgeons day-in and day-out. Being recognized for something that I’m happy to do and would be doing anyway is somewhat amazing. I feel it should be me giving, and not them giving.”

ASPS immediate-past President Alan Matarasso, MD, has known Dr. Constantian for a quarter-century and says he was an easy choice for the honor, as Dr. Constantian represents the level to which all plastic surgeons should aspire and admire.

“He’s erudite, prolific and an original contributor to plastic surgery,” Dr. Matarasso says. “His seminal work on rhinoplasty surgery is internationally noted for its importance. He represents the link from Dr. Sheen’s original rhinoplasty work to today’s standards. Dr. Constantian’s name, in many ways, has become a metonym for the operation.”

He adds that Dr. Constantian’s work in other areas – including body dysmorphic disorder (BDD), his research and textbook writings, as well as teaching colleagues on critical issues faced on an everyday basis – only fortified the list of reasons to honor him.

“When the Affordable Care Act was introduced, Dr. Constantian was one of the only people who read every word of the legislation and published an acclaimed op-ed piece in The Wall Street Journal about it,” Dr. Matarasso says.

This year’s annual meeting saw ASPS partner with The Rhinoplasty Society for the first time – a society Dr. Constantian helped conceive and bring to fruition.

“Everything Dr. Constantian does is done with complete dedication, keen insight and the highest standards,” Dr. Matarasso says. “He’s been recognized as an award recipient at numerous medical societies, and he’s even received the key to the city where he lives.”

Away from the office

Dr. Constantian has been married to his wife, Charlotte, for 26 years – a second marriage for both – and between them they have four boys and seven grandchildren. When not at work or with family, he can usually be found swimming or target shooting, or indulging in his passion for the guitar.

“I was in a band when I was in school and sang in the college’s octet – which became Sha Na Na after I graduated,” Dr. Constantian notes. “Once I got into medical school, I would only play for maybe someone’s wedding. I still play and have a little studio in my house. One of my retirement projects is to finish writing enough songs to fill a CD and send them to a friend of mine in Austin, who has a recording studio. I want to go down there, lay some tracks down and produce a CD for myself.”

Looking back

Dr. Constantian doesn’t think of himself as a technically innovative surgeon, but more of a “concept” person.

“I think that a lot of Dr. Sheen’s ideas are still extremely good, and he was a very intuitive operator who wrote two excellent textbooks,” he says. “What I try to do when I write is expound on what his ideas were and explain them in a different way that may reach new surgeons.”

His recent research into BDD, he says, brings him right back to the days on the playground when one of his classmates would be injured and he didn’t know what to do.

“I followed the trail until I was able to link the body shame that people have to childhood abuse and neglect – it starts way before BDD starts,” Dr. Constantian says. “The paper I’m writing now shows that the body shame is what separates patients who are addicted to plastic surgery and unhappy with the surgery from others.”

Nevertheless, of everything he’s achieved in his career, Dr. Constantian says he’s most proud of simply serving New Hampshire for all these years.

“The state has been very good to me,” he says. “I was lucky to practice largely before the internet and managed care – when patients came to you because of your reputation and results. It’s not that way so much anymore, and I’m glad that I experienced it – because that’s the only kind of medicine that I understand.”