Plastic surgery
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"Facial reconstruction" redirects here. For the identification of skeletal remains, see Forensic facial reconstruction.
Plastic surgery is a specialty that uses surgical techniques to improve the appearance and function of patients' bodies.[1] Some of these operations are called "cosmetic", and others are called "reconstructive". Nearly all of the operations that plastic surgeons themselves consider the highest achievements within their profession are in that second category: reconstructive.
Descriptions of plastic surgery that depict reconstructive plastic surgery and cosmetic plastic surgery as two entirely different fields within the specialty can be misleading.Whether or not a procedure is "only" cosmetic has a lot to do with the reason behind its performance. For example, a facelift that undermines the soft tissues of the face and redrapes them to tighten the flesh is not always cosmetic rather than reconstructive. A facelift performed to tighten the normal skin of a seventy-year old is called a cosmetic surgery procedure because it is only aimed to provide a more youthful appearance. Yet a facelift in that same person would be considered reconstructive if it was part of a procedure to remove a skin cancer, and was used to close the defect left where the cancer was excised (cut out). The reconstructive facelift would avoid leaving the two sides of the face strikingly uneven (asymmetric) at the end of the operation, and even though the patient would likely end up looking younger, this would not be considered a cosmetic procedure because its main purpose is to give the patient a more normal appearance after cancer surgery.
- Reconstructive surgery corrects or masks birth defects and the destructive effects of trauma, surgery or disease.
- Cosmetic (or aesthetic) surgery changes features the patient finds unflattering.
Whether cosmetic or reconstructive, plastic surgery is almost always elective surgery : the patient chooses to have the procedure- or not. All surgery has risks and potential complications. In non-elective surgery the risks are so small as compared to the benfits that no reasonable person would refuse it unless very special circumstances applied. For example, if a person's appendix became increasingly obstructed and inflamed in a case of acute appendicitis, removal of the appendix (appendectomy) would be not be elective. The risks of not having the surgery include such a good chance of death, while the risk of having the surgery itself harm the patient is so small, that it is likely that legal action would be resorted to if a person refused the operation. Almost all statements in medicine are relative rather than absolute, and the last sentence is no exception. Even in acute appendicitis, appendectomy is not always non-elective. If a person who was dying of incurable cancer, for example, suddenly became ill with acute appendicitis and asked not to have surgery, appendectomy would be elective in that very special circumstance.
Plastic surgery includes both operations that pose little risk to the patient and also more major procedures that include larger risks. Major plastic surgery sometimes uses grafts or flaps to move tissue from one part of the body to another, and can involve the need to cut bone and to provide blood transfusions, as well as risk of injury to the parts of the body where grafts and flaps are taken. These kinds of operations can last many hours and require more than one team of surgeons. Because ethical surgeons and thoughtful patients do not engage in elective surgery that poses these significant risks in an effort to increase beauty, cosmetic surgery less commonly involves the use of such techniques.
Case histories are given later in this article to further illustrate scope of plastic surgery. In each case, putting oneself in the place of the patient can give insight into the issues faced by plastic surgeons and plastic surgery patients.
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.
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[edit] History
The history of plastic 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).[2][3]
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.
Up until the techniques of anesthesia became established, all surgery on healthy tissues involved great pain. Infection from surgery was reduced once sterile technique and disinfectants were introduced. The invention and use of antibiotics beginning with sulfa drugs and penicillin was another step in making elective surgery possible.
The technique of microvascular surgery was made practical by the Frenchman Dr.Alex Carrel who did most of his work in Chicago and New York. He received the Nobel Prize for Medicine and Physiology in 1912, in recognition of his methods of vascular suture and in organ transplantation. The ability to connect severed arteries and veins that his techniques allowed made free-grafts of living tissues like fingers and complex tissue grafts possible.
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.
[edit] 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.
[edit] 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. In several countries including Australia, many doctors who are not qualified as surgeons also perform cosmetic procedures.[4]
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
- Vaginoplasty: (this is usually performed by urological surgeons), a procedure to tighten the enlarged vaginal tunnel after childbirth
- 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 phosphatidyl choline (the fat-dissolving component of bile, but in this case made from soy beans) and other substances are injected to break down and dissolve the fat.
[edit] 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.
[edit] 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.
[edit] See also
- microsurgery
- breast reconstruction, Breast reduction, Breast implant, Breast lift
- Operation Good Samaritan[1]
- Operation Smile
- Body modification
- Botox
- Dr. 90210
- Extreme Makeover
- Nip/Tuck
[edit] Plastic surgeons
[edit] References
- ^ Johnson D, Whitworth I (2002). "Recent developments in plastic surgery.". BMJ 325 (7359): 319-22. PMID 12169510.
- ^ Rana RE, Arora BS (Jan-Mar 2002). "History of plastic surgery in India.". J Postgrad Med (India) 48 (1): 76-8. PMID 12082339. Retrieved on 2006-11-19.
- ^ Paul O'Keeffe. Rhinoplasty Overview. Retrieved on 2006-11-19.
- ^ Anderson, Laurence (2006). Looking Good, the Australian guide to skin care, cosmetic medicine and cosmetic surgery. Sydney: AMPCo. ISBN 0-85557-044-X..
[edit] Further readings
- Gilman, Sander (2005). Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery. Duke University Press. ISBN 0822321440.
- Haiken, Elizabeth (1997). Venus Envy: A History of Cosmetic Surgery. Johns Hopkins University Press. ISBN 0801857635.
[edit] 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
