Plastic, cosmetic, and reconstructive surgery refers to a variety of operations performed in order to repair or restore body parts to look normal, or to change a body part to look better. These types of surgery are highly specialized. They are characterized by careful preparation of the patient's skin and tissues, by precise cutting and suturing techniques, and by care taken to minimize scarring. Recent advances in the development of miniaturized instruments, new materials for artificial limbs and body parts, and improved surgical techniques have expanded the range of plastic surgery operations that can be performed.
Description
Plastic surgery
Plastic surgery includes a number of different procedures that usually involve skin. Operations to remove excess fat from the abdomen ("tummy tucks"), dermabrasion to remove acne scars or tattoos, and reshaping the cartilage in children's ears (otoplasty) are common applications of plastic surgery.
Cosmetic surgery
Most cosmetic surgery is done on the face. It is intended either to correct disfigurement or to enhance the patient's features. The most common cosmetic procedure for children is correction of a cleft lip or palate. In adults, the most common procedures are remodeling of the nose (rhinoplasty), removal of baggy skin around the eyelids (blepharoplasty), facelifts (rhytidectomy), or changing the size of the breasts (mammoplasty). Although many people still think of cosmetic surgery as only for women, growing numbers of men are choosing to have facelifts and eyelid surgery, as well as hair transplants and "tummy tucks."
Reconstructive surgery
Reconstructive surgery is often performed on burn and accident victims. It may involve the rebuilding of severely fractured bones, as well as skin grafting. Reconstructive surgery includes such procedures as the reattachment of an amputated finger or toe, or implanting a prosthesis. Prostheses are artificial structures and materials that are used to replace missing limbs or teeth, or arthritic hip and knee joints.
Who Performs the Procedure and Where Is It Performed?
Plastic, reconstructive, and cosmetic surgical procedures are performed by surgeons with specialized training in plastic and reconstructive surgery. Depending on the complexity of the procedures, they may be performed in hospitals as an inpatient, in outpatient facilities, or in private professional offices.
Questions to Ask the Doctor
Will insurance cover the surgery?
How long will the recovery be?
What will be the resulting appearance?
Is the surgeon board certified in plastic and reconstructive surgery?
How many similar procedures has the surgeon performed?
What is the surgeon's complication rate?
Definition
Plastic, reconstructive, and cosmetic surgery refers to a variety of operations performed in order to repair or restore body parts to look normal, or to change a body part to look better. These types of surgery are highly specialized. They are characterized by careful preparation of a person's skin and tissues, by precise cutting and suturing techniques, and by care taken to minimize scarring. Recent advances in the development of miniaturized instruments, new materials for artificial limbs and body parts, and improved surgical techniques have expanded the range of plastic surgery procedures that can be performed.
Purpose
Although these three types of surgery share some common techniques and approaches, they have somewhat different emphases. Plastic surgery is usually performed to treat birth defects and to remove skin blemishes such as warts, acne scars, or birthmarks. Cosmetic surgery procedures are performed to make persons look younger or enhance their appearance in other ways. Reconstructive surgery is used to reattach body parts severed in combat or accidents, to perform skin grafts after severe burns, or to reconstruct parts of person's body that were missing at birth or removed by surgery. Reconstructive surgery is the oldest form of plastic surgery, having developed out of the need to treat wounded soldiers in wartime.
Demographics
The top 10 most commonly performed elective cosmetic surgeries in the United States include the following:
There were approximately 29 million surgical procedures performed in the United States in 2001. Because many plastic and reconstructive surgical procedures are performed in private professional offices or as outpatient procedures, accurate statistics concerning the number of procedures performed are not available.
Description
Plastic Surgery
Plastic surgery includes a number of different procedures that usually involve skin. Operations to remove excess fat from the abdomen ("tummy tucks"), dermabrasion to remove acne scars or tattoos, and reshaping the cartilage in children's ears (otoplasty) are common applications of plastic surgery.
Cosmetic Surgery
Most cosmetic surgery is done on the face. It is intended either to correct disfigurement or to enhance a person's features. The most common cosmetic procedure for children is correction of a cleft lip or palate. In adults, the most common procedures are remodeling of the nose (rhinoplasty), removal of baggy skin around the eyelids (blepharoplasty), face lifts (rhytidectomy), or changing the size or shape of the breasts (mammoplasty). Although many people still think of cosmetic surgery as only for women, growing numbers of men are choosing to have facelifts and eyelid surgery, as well as hair transplants and "tummy tucks."
Reconstructive Surgery
Reconstructive surgery is often performed on burn and accident victims. It may involve the rebuilding of severely fractured bones, as well as skin grafting. Reconstructive surgery includes such procedures as the reattachment of an amputated finger or toe, or implanting a prosthesis. Prostheses are artificial structures and materials that are used to replace missing limbs or teeth, or arthritic hip and knee joints.
Diagnosis/Preparation
General Preparation
Preparation for nonemergency plastic or reconstructive surgery includes individual education, as well as medical considerations. Some operations, such as nose reshaping or the removal of warts, small birthmarks, and tattoos can be done as outpatient procedures under local anesthesia. Most plastic and reconstructive surgery, however, involves a stay in the hospital and general anesthesia.
Medical Preparation
Preparation for plastic surgery includes the surgeon's detailed assessment of the parts of an individual's body that will be involved. Skin grafts require evaluating suitable areas of skin for the right color and texture to match the skin at the graft site. Face lifts and cosmetic surgery in the eye area require very close attention to the texture of the skin and the placement of surgical cuts (incisions).
Persons scheduled for plastic surgery under general anesthesia will be given a physical examination, blood and urine tests, and other tests to make sure that they do not have any previously undetected health problems or blood clotting disorders. The surgeon will check the list of prescription medications that the prospective patient may be taking to make sure that none of them will interfere with normal blood clotting or interact with the anesthetic.
Individuals are asked to avoid using aspirin or medications containing aspirin for a week to two weeks before surgery, because these drugs lengthen the time of blood clotting. Smokers are asked to stop smoking two weeks before surgery because smoking interferes with the healing process. For some types of plastic surgery, individuals may be asked to donate several units of their own blood before the procedure, in case a transfusion is needed during the operation. The prospective patient will be asked to sign a consent form before the operation.
Personal Education
The surgeon will meet with the prospective patient before the operation is scheduled, in order to explain the procedure and to be sure that the individual is realistic about the expected results. This consideration is particularly important for people undergoing cosmetic surgery.
Medical Considerations
Some people should not have plastic surgery because of certain medical risks. These groups include:
persons recovering from a heart attack, severe infection (for example, pneumonia), or other serious illnesses
people with infectious hepatitis or HIV infections
individuals with cancer whose cancer might spread (metastasize)
people who are extremely overweight (Individuals who are more than 30% overweight should not have liposuction.)
persons with blood clotting disorders
Psychological
Plastic, cosmetic, and reconstructive surgeries have an important psychological dimension because of the high value placed on outward appearance in Western society. Many people who are born with visible deformities or disfigured by accidents later in life develop emotional problems related to social rejection. Other people work in fields such as acting, modeling, media journalism, and even politics, where their employment depends on how they look. Some people have unrealistic expectations of cosmetic surgery and think that it will solve all their life problems. It is important for anyone considering nonemergency plastic or cosmetic surgery to be realistic about its results. One type of psychiatric disorder, called body dysmorphic disorder, is characterized by an excessive preoccupation with imaginary or minor flaws in appearance. Persons with this disorder frequently seek unnecessary plastic surgery.
Aftercare
Medical
Medical aftercare following plastic surgery under general anesthesia includes bringing patients to a recovery room, monitoring their vital signs, and giving medications to relieve pain as necessary. Persons who have had fat removed from the abdomen may be kept in bed for as long as two weeks. Individuals who have had mammoplasties, breast reconstruction, and some types of facial surgery typically remain in the hospital for a week after the operation. Those who have had liposuction or eyelid surgery are usually sent home in a day or two.
People who have had outpatient procedures are usually given antibiotics to prevent infection and are sent home as soon as their vital signs are normal.
Psychological
Some individuals may need follow-up psychotherapy or counseling after plastic or reconstructive surgery. These people typically include children whose schooling and social relationships have been affected by birth defects, as well as persons of any age whose deformities or disfigurements were caused by trauma from accidents, war injuries, or violent crimes.
Risks
The risks associated with plastic, cosmetic, and reconstructive surgery include the postoperative complications that can occur with any surgical operation under anesthesia. These complications include wound infection, internal bleeding, pneumonia, and reactions to the anesthesia.
In addition to these general risks, some plastic, cosmetic, and reconstructive surgical procedures carry specific risks:
development of persistent pain, redness, or swelling in the area of the surgery
infection inside the body related to inserting a prosthesis (These infections can result from contamination at the time of surgery or from bacteria migrating into the area around the prosthesis at a later time.)
anemia or fat embolisms from liposuction
rejection of skin grafts or tissue transplants
loss of normal feeling or function in the area of the operation (For example, it is not unusual for women who have had mammoplasties to lose sensation in their nipples.)
complications resulting from unforeseen technological problems (The best-known example of this problem was the discovery in the mid-1990s that breast implants made with silicone gel could leak into the recipient's body.)
Normal Results
Normal results include an individual's recovery from the surgery with satisfactory results and without complications.
Morbidity and Mortality Rates
Morbidity and mortality rates vary with the complexity and severity of different procedures. Mortality is similar to that associated with all surgical procedures. Morbidity is influenced by personal expectations. From a surgical perspective, most morbidity is due to errors associated with anesthesia, procedure, pain medications, and after care. From an individual's perspective, morbidity involves the degree to which actual results compared to expected outcomes. The latter distinction is very subjective.
Alternatives
Alternatives to plastic, reconstructive, and cosmetic surgical procedures include using various products that may be affixed to articles of clothing or the surface of the body.
American Board of Plastic Surgery. Seven Penn Center, Suite 400, 1635 Market Street, Philadelphia, PA 19103-2204. (215) 587-9322. http://www.abplsurg.org/.
American College of Surgeons. 633 North Saint Claire Street, Chicago, IL, 60611. (312) 202-5000. http://www.facs.org/.
American Society for Aesthetic Plastic Surgery. 11081 Winners Circle, Los Alamitos, California 90720. (800) 364-2147. (562) 799-2356. http://www.surgery.org/.
American Society of Plastic Surgeons. 444 E. Algonquin Rd., Arlington Heights, IL 60005. (888) 475-2784. http://www.plasticsurgery.org/.
Surgery to revise or reconstruct tissue of superficial organs (i.e. those which can be seen easily) in a damaged area. Plastic surgery used solely to improve a person's appearance is more properly called cosmetic surgery.
Branch of medicine that deals with the surgical alteration, replacement, restoration, or reconstruction of a visible part of the body to correct a structural or cosmetic defect.
Surgery to correct disfigurement, restore function, or improve appearance. It may involve reshaping or moving tissues to fill a depression, cover a wound, or improve appearance. Cosmetic surgery solely to improve appearance is not the main focus of plastic surgery. It is utilized after disfigurement by burns or tumour removal or for reconstructive work, and it may involve hiding incisions in skin folds or using buried sutures to hold wounds closed. Reconstructive plastic surgery corrects severe functional impairments, fixes physical abnormalities, and compensates for tissue lost to trauma or surgery. Microsurgery and computerized diagnostic imaging techniques have revolutionized the field.
plastic surgery, surgical repair of congenital or acquired deformities and the restoration of contour to improve the appearance and function of tissue defects. Development of this specialized branch of surgery received impetus from the need to repair gross deformities sustained in World War I. By the grafting of tissue or the use of artificial materials such as silicone, some remarkable restorations have become possible. Severe burns and the removal of fairly extensive skin cancers leave scars that must be covered by skin grafts; breast reconstruction after mastectomy is another application.
In addition to correcting a disfigurement, plastic surgery is often needed to restore vital movement and function of tissues that have been destroyed. It is also performed for purely cosmetic purposes, such as improving the shape of a nose, bringing outstanding ears closer to the head, or lifting the skin to erase wrinkles, and the term cosmetic surgery is often used to refer to such surgical procedures. Modern plastic surgeons often employ CAT scans to produce computer-generated images that are used to plan or simulate complex reconstructive surgeries.
Surgery that repairs or reconstructs a body part. Plastic surgery is used to correct physical defects and to rebuild parts of the body that have been damaged by trauma or disease. Some examples of plastic surgery are breast reconstruction for women who have undergone a mastectomy and skin grafting for burn victims.
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. While famous for aesthetic surgery, plastic surgery also includes two main fields: body modification and reconstructive surgery. The word "plastic" derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with the synthetic polymer material known as plastic.
Walter Yeo, a British soldier, is often cited as the first known person to have benefited from plastic surgery. The photograph shows him during the procedure (left) and after (right) receiving a skin graft performed by Sir Harold Gillies in 1917.
Reconstructive surgery techniques were being carried out in India by 2000 BC.[1]Sushruta, considered the father of surgery, made important contributions to the field of plastic and cataract surgery in 6th century BC.[2] The medical works of both Sushruta and Charak were translated into Arabic language during the Abbasid Caliphate in 750 AD.[3] These Arabic works made their way into Europe via intermediaries.[3] In Italy the Branca family of Sicily and Gaspare Tagliacozzi (Bologna) became familiar with the techniques of Sushruta.[3]
British physicians traveled to India to see rhinoplasties being performed by native methods.[4] Reports on Indian rhinoplasty were published in the Gentleman's Magazine by 1794.[4]Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods.[4] Carpue was able to perform the first major surgery in the Western world by 1815.[5] Instruments described in the Sushruta Samhita were further modified in the Western world.[5]
The ancient Egyptians and Romans also performed plastic cosmetic surgery. The Romans were able to perform simple techniques, such as repairing damaged ears from around the 1st century BC. For religious reasons, they did not dissect either human beings or animals, thus their knowledge was based in its entirety on the texts of their Greek predecessors. Notwithstanding, Aulus Cornelius Celsus left some surprisingly accurate anatomical descriptions, some of which — for instance, his studies on the genitalia and the skeleton — are of special interest to plastic surgery.[6]
In 1465, Sabuncuoglu's book, description, and classification of hypospadias was more informative and up to date. Localization of urethral meatus was described in detail. Sabuncuoglu also detailed the description and classification of ambiguous genitalia.[citation needed] 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 surgery became commonplace.
Up until the techniques of anesthesia became established, all surgery on healthy tissues involved great pain. Infection from surgery was reduced by the introduction of sterile techniques and disinfectants. The invention and use of antibiotics, beginning with sulfa drugs and penicillin, was another step in making elective surgery possible.
In 1792, Chopart performed operative procedure on a lip using a flap from the neck. In 1814, Joseph Carpue successfully performed operative procedure on a British military officer who had lost his nose to the toxic effects of mercury treatments. In 1818, German surgeon Carl Ferdinand von Graefe published his major work entitled Rhinoplastik. Von Graefe modified the Italian method using a free skin graft from the arm instead of the original delayed pedicle flap. In 1845, Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty, entitled Operative Chirurgie, and introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose. In 1891, American otorhinolaryngologist John Roe presented an example of his work, a young woman on whom he reduced a dorsal nasal hump for cosmetic indications. In 1892, Robert Weir experimented unsuccessfully with xenografts (duck sternum) in the reconstruction of sunken noses. In 1896, James Israel, a urological surgeon from Germany, and in 1889 George Monks of the United States each described the successful use of heterogeneous free-bone grafting to reconstruct saddle nose defects. In 1898, Jacques Joseph, the German orthopaedic-trained surgeon, published his first account of reduction rhinoplasty. In 1928, Jacques Joseph published Nasenplastik und Sonstige Gesichtsplastik.
The first American plastic surgeon was John Peter Mettauer, who, in 1827, performed the first cleft palate operation with instruments that he designed himself.
In World War I, a New Zealand otolaryngologist working in London, Harold Gillies, developed many of the techniques of modern plastic surgery in caring for soldiers suffering from disfiguring facial injuries. His work was expanded upon during World War II by his cousin and former student Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns. McIndoe's radical, experimental treatments, led to the formation of the Guinea Pig Club. In 1951, Gillies carried out the first male-to-female sex change operation.
Plastic surgery, as a specialty, evolved remarkably during the 20th century in the United States. One of the founders of the specialty, Vilray Blair, was the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis, Missouri. In one of his many areas of clinical expertise, Blair treated World War I soldiers with complex maxillofacial injuries, and his paper on "Reconstructive Surgery of the Face" set the standard for craniofacial reconstruction. He was also one of the first surgeons without a dental background to be elected to the American Association of Oral and Plastic Surgery (later the organizations split to be renamed the American Association of Plastic Surgeons and the American Association of Oral and Maxillofacial Surgeons), and he taught many surgeons who became leaders in the field of plastic surgery.
Techniques and procedures
In plastic surgery, the transfer of skin tissue (skin grafting) is a very common procedure. Skin grafts can be taken from the recipient or donors:
Autografts are taken from the recipient. If absent or deficient of natural tissue, alternatives can be cultured sheets of epithelial cellsin vitro or synthetic compounds, such as integra, which consists of silicone and bovine tendon collagen with glycosaminoglycans.
Allografts are taken from a donor of the same species.
Xenografts are taken from a donor of a different species.
Usually, good results are expected from plastic surgery that emphasizes careful planning of incisions so that they fall in the line of natural skin folds or lines, appropriate choice of wound closure, use of best available suture materials, and early removal of exposed sutures so that the wound is held closed by buried sutures.
Reconstructive surgery
"Reconstructive" redirects here. For other uses, see Reconstruction.
Reconstructive plastic surgery is performed to correct functional impairments caused by burns; traumatic injuries, such as facial bone fractures; congenital abnormalities; developmental abnormalities; infection or disease; and cancer or tumors. Reconstructive plastic surgery is usually performed to improve function, but it may be done to approximate a normal appearance.
The most common reconstructive procedures are tumor removal, laceration repair, scar repair, hand surgery, and breast reduction. According to the American Society of Plastic Surgeons, the number of reconstructive breast reductions for women increased in 2007 by 2 percent from the year before. Breast reduction in men also increased in 2007 by 7 percent. Some other common reconstructive surgical procedures include breast reconstruction after a mastectomy, cleft lip and palate surgery, contracture surgery for burn survivors, and creating a new outer ear when one is congenitally absent.
Plastic surgeons developed the use of microsurgery to transfer tissue for coverage of a defect when no local tissue is available. Free flaps 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 millimeters in diameter.
Cosmetic surgery
Aesthetic surgery involves techniques intended for the "enhancement" of appearance through surgical and medical techniques, and is specifically concerned with maintaining normal appearance, restoring it, or enhancing it beyond the average level toward some aesthetic ideal.
In 2006, nearly 11 million cosmetic surgeries were performed in the United States alone. The number of cosmetic procedures performed in the United States has increased over 50 percent since the start of the century. Nearly 12 million cosmetic surgeries were performed in 2007, with the five most common being breast augmentation, liposuction, nasal surgery, eyelid surgery and abdominoplasty. The increased use of cosmetic surgery crosses racial and ethnic lines in the U.S., with increases seen among African-Americans and Hispanic Americans as well as Caucasian Americans. In Europe, the second largest market for cosmetic procedures, cosmetic surgery is a $2.2 billion business.[7]
The most prevalent aesthetic/cosmetic procedures include:
Breast augmentations ("breast implant" or "boob job"): augmentation of the breasts by means of fat grafting, saline, or silicone gel prosthetics, which was initially performed to women with micromastia
Reduction mammoplasty ("breast reduction"): removal of skin and glandular tissue, which is done to reduce back and shoulder pain in women with gigantomastia and/or for psychological benefit men with gynecomastia
Mastopexy ("breast lift"): Lifting or reshaping of breasts to make them less saggy, often after weight loss (after a pregnancy, for example). It involves removal of breast skin as opposed to glandular tissue or scarless Serdev suture technique [8]
Buttock augmentation ("butt implant"): enhancement of the buttocks using silicone implants or fat grafting and transfer from other areas of the body
Buttock lift ("Brazilian butt lift"): lifting, projection, and tightening of the buttocks using the scarless Serdev suture technique without implants[9]
Chin augmentation ("chin implant"): augmentation of the chin with an implant, usually silicone, by sliding genioplasty of the jawbone or by suture of the soft tissue
Cryolipolysis experimental treatment in which subcutaneous fat cells are induced into apoptosis by means of suction cup isolation and cooling
Sub-specialties
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
Craniofacial surgery is divided into pediatric and adult craniofacial surgery. Pediatric craniofacial surgery mostly revolves around the treatment of congenital anomalies of the craniofacial skeleton and soft tissues, such as cleft lip and palate, craniosynostosis, and pediatric fractures. Because these children have multiple issues, the best approach to providing care to them is an interdisciplinary approach which also includes otolaryngologists, oral and maxillofacial surgeons, speech therapists, occupational therapists and geneticists. Adult craniofacial surgery deals mostly with fractures and secondary surgeries (such as orbital reconstruction) along with orthognathic surgery. Craniofacial surgery is an integral part of all plastic surgery training programs, and further training is frequently obtained via a craniofacial fellowship for additional expertise.
Hand
Hand surgery is concerned with acute injuries and chronic diseases of the hand and wrist, correction of congenital malformations of the upper extremities, and peripheral nerve problems (such as brachial plexus injuries or carpal tunnel syndrome). Hand surgery is an important part of training in plastic surgery, as well as microsurgery, which is necessary to replant an amputated extremity. Most Hand surgeons will opt to complete a fellowship in Hand Surgery. The Hand surgery field is also practiced by orthopedic surgeons and general surgeons (see Hand surgeon).
Micro
Microsurgery is generally concerned with the reconstruction of missing tissues by transferring a piece of tissue to the reconstruction site and reconnecting blood vessels. Popular subspecialty areas are breast reconstruction, head and neck reconstruction, hand surgery/replantation, and brachial plexus surgery.
Burn
Burn surgery generally takes place in two phases. Acute burn surgery is the treatment immediately after a burn. Reconstructive burn surgery takes place after the burn wounds have healed. Reconstructive surgery generally involves plastic surgery.
Pediatric
Children often face medical issues unique from the experiences of an adult patient. Many birth defects or syndromes present at birth are best treated in childhood, and pediatric plastic surgeons specialize in treating these conditions in children. Conditions commonly treated by pediatric plastic surgeons include craniofacial anomalies, cleft lip and palate and congenital hand deformities.
Santoni-Rugiu, Paolo (2007). A History of Plastic Surgery. Springer. ISBN3540462406.
Fraser, Suzanne (2003). Cosmetic surgery, gender and culture. Palgrave. ISBN1-4039-1299-8.
Gilman, Sander (2005). Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery. Duke University Press. ISBN0-8223-2144-0.
Haiken, Elizabeth (1997). Venus Envy: A History of Cosmetic Surgery. Johns Hopkins University Press. ISBN0-8018-5763-5.
