Plastic surgery

Plastic and reconstructive surgery is a medical specialty that uses a number of surgical and nonsurgical techniques to change the appearance and function of a person's body. Plastic surgery procedures include both cosmetic enhancements as well as functionally reconstructive operations. In the former case, where aesthetics are considered more of the concern than changing the functionality, plastic surgery is also sometimes incorrectly referred to as "cosmetic surgery". Some procedures however involve both aesthetic and functional elements. 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. Plastic surgeons typically mold and reshape the following tissues of the body: bone, cartilage, muscle, fat, and skin.

History

Plastic surgery reaches back to the 700s BCE. Physicians in ancient India including Sushruta were utilizing skin grafts for reconstructive work as early as the 8th century BC. In 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).

The Romans were able to perform simple techniques such as repairing damaged penises from around the 1st century BC. 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 (Kitabul Cerrahiye-i Ilhaniye -Cerrahname-Tip Tarihi Enstitüsü, Istanbul) 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 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.

In 1791, Chopart performed operative procedure of a lip using a flap from the neck. In 1814, Joseph Carpue successfully performed operative procedure in 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 U.S.'s first plastic surgeon was Dr. John Peter Mettauer. In 1827, he performed the first cleft palate operation with instruments that he designed himself. The New Zealander Sir Harold Gillies, an otolaryngologist, developed many of the techniques of modern plastic surgery in caring for those who suffered facial injuries in World War I. 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. Plastic surgery as a specialty evolved tremendously during the 20th Century in the United States. One of the founders of the specialty, Dr. 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 taught many surgeons who became leaders in the field of plastic surgery[1].

Techniques and procedures

Common techniques used in plastic surgery are:

• incision
• excision
• microsurgery
• chemosurgery
• electrosurgery
• laser surgery
• dermabrasion
• liposuction

In plastic surgery the transfer of skin tissue (skin grafting) is one of the most common procedures. (In traditional surgery a “graft” is a piece of living tissue, organ, etc., that is transplanted.

• Autografts: Skin grafts taken from the recipient. If absent or deficient of natural tissue, alternatives can be:
  • Cultured Sheets of epithelial cells in vitro.
  • Synthetic compounds (e.g., Integra--a 2 layered dermal substitute consisting superficially of silicone and deeply of bovine tendon collagen with glycosaminoglycans).
• Allografts: Skin grafts taken from a donor of the same species.
• Xenografts: Skin grafts 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.
• Early removal of exposed sutures so that the wound is held closed by buried sutures.

Reconstructive plastic surgery

Reconstructive Plastic Surgery is performed to correct functional impairments caused by:

• burns
• traumatic injuries, such as facial bone fractures
• congenital abnormalities, such as cleft lip, or cleft palate
• developmental abnormalities
• infection or disease
• removal of cancers or tumors, such as a mastectomy

Reconstructive plastic surgery is usually performed to improve function, but it may be done to approximate a normal appearance. It is generally covered by insurance coverage but this may change according to the procedure required.

Common reconstructive surgical procedures are: breast reconstruction for women who have had a mastectomy, cleft lip and palate surgery, contracture surgery for burn survivors; one of the complication of severe burns.[2] [3]) , creating a new outer ear when one is congenitally absent, and closing skin and mucosa defects after removal of tumors in the head and neck region.

Plastic surgeons 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.

Cosmetic surgery

Cosmetic surgery is a very popular form of plastic surgery. In 2006, nearly 11 million cosmetic plastic surgeries were performed in the United States alone.

Within the U.S., it is legal for any doctor, regardless of speciality, to perform cosmetic 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 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, refers to surgery that is designed to improve cosmetics, or appearance. In several countries including the United States and Australia, many doctors who are not qualified as surgeons also perform cosmetic procedures.

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
• Blepharoplasty (or "eyelid surgery"): Reshaping of the eyelids or the application of permanent eyeliner, including Asian blepharoplasty
• Mammoplasty
  • Breast augmentation (or "breast enlargement" or "boob job"): Augmentation of the breasts. This can involve either saline or silicone gel prosthetics.
  • Breast reduction: Removal of skin and glandular tissue. Indicated to reduce back and shoulder pain or for psychological benefit in women with macromastia.
  • Breast lift (Mastopexy): 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.
• 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.
• 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 (e.g. hyaluronic acid)
• Laser skin resurfacing
• Injection of dermal fillers (collagen, hyaluronic acid, fat, and others)

In recent years, a growing number of patients seeking cosmetic surgery have visited other countries to find doctors with lower costs. These medical tourists seek to get their procedures done for a cost savings in countries including Cuba, Thailand, Argentina, India, and some areas of eastern Europe. The risk of complications and the lack of after surgery support are often overlooked by those simply looking for the cheapest option.

Plastic surgery sub-specialities

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. This field is also practiced by oral and maxillofacial surgeons. Because these children have multiple issues, the best approach to providing care to them is an interdisciplinary approach which also includes otolaryngologists, speech therapists, occupational therapists and geneticists.

• Hand surgery is a field that is also practiced by general surgeons and orthopedic surgeons (see Hand surgeon). Plastic surgeons receive 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.

• Microsurgery

• Burn surgery

• Aesthetic or cosmetic surgery is a growing component of general plastic surgeons. However, a select few promising graduates are chosen for an extra year of advanced fellowship training in aesthetic surgery.

• Pediatric plastic surgery. 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.

Further reading

• Fraser, Suzanne (2003). Cosmetic surgery, gender and culture. Palgrave. ISBN 1-4039-1299-8.
• Gilman, Sander (2005). Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery. Duke University Press. ISBN 0-8223-2144-0.
• Haiken, Elizabeth (1997). Venus Envy: A History of Cosmetic Surgery. Johns Hopkins University Press. ISBN 0-8018-5763-5.

References

See also

• Body modification
• Botox
• Breast reconstruction, Breast reduction, Breast implant, Breast lift
• Facial feminization surgery
• Microsurgery
• Orthopedic surgery

External links

• Template:Dmoz

Category:Plastic surgeons