Plastic surgery

Plastic surgery is "an extremely diverse surgical specialty whose chief purpose is to restore form and function".(reference for quote:John L. Burns, M. D. , Steven J. Blackwell, M. D.,Chapter 72 – Plastic Surgery, in: Townsend: Sabiston Textbook of Surgery, 17th ed., Copyright © 2004 Saunders, An Imprint of Elsevier)

The word "plastic" derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with modern plastics.

Plastic surgery is unusual among modern surgical specialties because the entire body, with the exception of the Central Nervous System, is potentially within the province of the General Plastic Surgeon. The principal areas of plastic surgery include two broad fields.

• Reconstructive surgery, including microsurgery, focuses on undoing or masking the destructive effects of trauma, surgery or disease. Reconstructive surgery may include closing defects using skin grafts or with local, regional or distant flaps—that is, by moving tissue from other parts of the body.
• Cosmetic (or aesthetic) surgery is most often performed in order to change features the patient finds unflattering. In many cases, however, there are medical reasons (for example, breast reduction when orthopedic problems are present).

History

The history of cosmetic surgery reaches back to the ancient world. Physicians in ancient India including the great Indian surgeon Susrutha were utilizing skin grafts for reconstructive work as early as the 8th century BC. His work Sushruta Samhita describes rhinoplasty and otoplasty. This knowledge of plastic surgery existed in India up to the late 18th century as can be seen from the reports published in Gentleman's Magazine (October 1794). [1] [2]

The Romans were able to perform simple techniques such as repairing damaged ears from around the 1st century BC. In mid-15th century Europe, Heinrich von Pfolspeundt described a process "to make a new nose for one who lacks it entirely, and the dogs have devoured it" by removing skin from the back of the arm and suturing it in place. However, because of the dangers associated with surgery in any form, especially that involving the head or face, it was not until the 19th and 20th centuries that such surgeries became commonplace.

The U.S.'s first plastic surgeon was Dr. John Peter Mettauer. He performed the first cleft palate operation in 1827 with instruments that he designed himself. The New Zealander Sir Harold Gillies developed many of the techniques of modern plastic surgery in caring for those who suffered facial injuries in World War I, he is considered to be the father of modern plastic surgery. His work was expanded upon during World War II by one of his former students and cousin, Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns. McIndoe's radical, experimental treatments, lead to the formation of the Guinea Pig Club.

Reconstructive surgery

Common reconstructive surgeries are: breast reconstruction for women who have had a mastectomy, cleft lip and palate surgery, contracture surgery for burn survivors, and closing skin and mucosa defects after removal of tumors in the head and neck region. Sex reassignment surgery for transsexual people is another example of reconstructive surgery.

Plastic surgeons have developed the use of microsurgery to transfer tissue for coverage of a defect when no local tissue is available. Tissue "flaps" comprised of skin, muscle, bone, fat or a combination, may be removed from the body, moved to another site on the body and reconnected to a blood supply by suturing arteries and veins as small as 1-2 mm in diameter.

There is a definite gray area between reconstructive and cosmetic surgery. Many of the techniques of cosmetic surgery are utilized in reconstructive surgery to improve cosmesis.

Cosmetic surgery

Cosmetic surgery is a very popular avenue for personal enhancement, as demonstrated by the 11.9 million cosmetic procedures performed in the U.S. alone in 2004. As for any operation, cosmetic procedures involve risk, and should therefore not be undertaken lightly. Within the US, critics of plastic surgery note that it is legal for any doctor, regardless of speciality, to perform "cosmetic surgery", but not "plastic surgery". It is thus important to distinguish the terms "plastic surgery" and "cosmetic surgery": Plastic Surgery is recognized by the American Board of Medical Specialties (the only official entity overseeing physician certification in the United States) as the subspecialty dedicated to the surgical repair of defects of form or function -- this includes cosmetic (or aesthetic) surgery, as well as reconstructive surgery. The term "cosmetic surgery" however, simply refers to surgery that is designed to improve cosmetics, or appearance. (One could argue that reconstructive surgery always has some cosmetic aspect to it, because form and function are often both important in plastic surgery repairs.) Thus there is no real art of "cosmetic surgery": it is a catch-all commercial phrase that laypeople understand easily and non-plastic surgeons eagerly use because they are not allowed to use the term "plastic surgery".

The most prevalent aesthetic/cosmetic procedures are listed below. Most of these types of surgery are more commonly known by their "common names." These are also listed when pertinent.

• Abdominoplasty (or "tummy tuck"): reshaping and firming of the abdomen
• Abdominal etching (or "ab etching": Specialized and trademarked liposuction surgery for male and female patients that affords six-pack abs or a flat, athletic, or countoured stomach.
• Blepharoplasty (or "eyelid surgery"): Reshaping of the eyelids or the application of permanent eyeliner, including Asian blepharoplasty
• Augmentation Mammaplasty (or "breast enlargement" or "boob job"): Augmentation of the breasts. This can involve either saline or silicone gel prosthetics.
• Buttock Augmentation (or "butt augmentation" or "butt implants"): Enhancement of the buttocks. This procedure can be performed by using silicone implants or fat grafting and transfer from other areas of the body.
• Chemical peel: Minimizing the appearance of acne, pock, and other scars as well as wrinkles (depending on concentration and type of agent used, except for deep furrows), solar lentigines (age spots, freckles), and photodamage in general. Chemical peels commonly involve carbolic acid (Phenol), trichloroacetic acid (TCA), glycolic acid (AHA), or salicylic acid (BHA) as the active agent.
• Mastopexy (or "breast lift"): Raising of sagging breasts
• Labiaplasty: Surgical reduction and reshaping of the labia
• Rhinoplasty (or "nose job"): Reshaping of the nose
• Otoplasty (or ear surgery): Reshaping of the ear
• Rhytidectomy (or "face lift"): Removal of wrinkles and signs of aging from the face
• Suction-Assisted Lipectomy (or liposuction): Removal of fat from the body
• Chin augmentation: Augmentation of the chin with an implant (e.g. silicone) or by sliding genioplasty of the jawbone.
• Cheek augmentation
• Collagen, fat, and other tissue filler injections (eg hyaluronic acid)
• Mesotherapy : An alternative to liposuction where fluids are injected to break down and dissolve the fat (still a speculative treatment).

Related disciplines

Plastic surgery is a broad field, and may be subdivided further. Plastic surgery training and approval by the American Board of Plastic Surgery includes mastery of the following as well:

• Craniofacial surgery mostly revolves around the treatment of pediatric congenital anomalies, such as cleft lip and palate, craniosynostosis, and other disturbances in facial growth and development. Because these children have multiple issues, they are often taken care of in an interdisciplinary approach which include oral surgeons, otolaryngologists, speech therapists, occupational therapists, geneticists.

• Hand surgery is a field that has some overlap with general surgeons and orthopedic surgeons (see Hand surgeon). Plastic surgeons receive full training in hand surgery, with some trainees deciding even to do an additional full-year hand fellowship afterwards (this fellowship can also be pursued by general surgeons and orthopedic surgeons). In particular, plastic surgeons receive training in microvascular surgery, which is needed to replant an amputated hand or digit. Many hand operations (such as reconstruction of injuries, replantations, rheumatoid surgery and surgery of congenital defects) are performed by plastic surgeons.

• Maxillofacial surgery is surgery of the "maxilla" (which means jaw) and face, and is an important aspect of plastic surgery. This field grew from contributions by both the plastic surgeons and oral surgeons. Examples of repairs here would be traumatic fractures of the jaw and face (such as from fights or vehicle accidents), tumors of the jaw and face.

Addiction to cosmetic surgery

Some people appear to become addicted to cosmetic surgery, possibly because of body dysmorphic disorder. Sufficient amounts of repeated cosmetic surgery can lead to irreversible damage to the normal body structure. However, due to the high cost of repeated cosmetic surgery, this disorder is generally one limited to the wealthy. However, others have been known to take out loans for repeat procedures.

See also

• microsurgery
• breast reconstruction, Breast reduction, Breast implant, Breast lift
• Operation Good Samaritan[3]
• Operation Smile
• Body modification
• Botox
• Dr. 90210
• Extreme Makeover
• Nip/Tuck

Plastic surgeons

• Harry J. Buncke
• Wallace Chang
• Harold Gillies
• G. Patrick Maxwell
• Archibald McIndoe
• Joseph Murray
• Ivo Pitanguy

External links

• The American Society of Plastic Surgeons
• The American Society for Aesthetic Plastic Surgery
• The American Board of Plastic Surgery
• Emedicine's History of Plastic Surgery entry