Plastic surgery
Encyclopedia
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery
, hand surgery
, microsurgery
, and the treatment of burn
s.
.
Reconstructive surgery techniques were being carried out in India
by 800 BC. Sushruta, the father of Surgery, made important contributions to the field of plastic and cataract surgery in 6th century BC. The medical works of both Sushruta and Charak originally in Sanskrit
were translated into Arabic language
during the Abbasid Caliphate in 750 AD. The Arabic translations made their way into Europe
via intermediaries. In Italy
the Branca family of Sicily
and Gaspare Tagliacozzi
(Bologna
) became familiar with the techniques of Sushruta.
British
physicians traveled to India to see rhinoplasties
being performed by native methods. Reports on Indian rhinoplasty performed by a Kumhar
vaidya were published in the Gentleman's Magazine by 1794. Joseph Constantine Carpue
spent 20 years in India studying local plastic surgery methods. Carpue was able to perform the first major surgery in the Western world
by 1815. Instruments described in the Sushruta Samhita were further modified in the Western world.
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.
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. 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 common.
Up until the techniques of anesthesia
became established, surgeries involving 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.
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 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.
, 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. Gillies was from England but volunteered in France with the Red Cross. During that time, he learned about plastic surgery. He became particularly successful in the field and was well known for his work. Kazanjian and Blair, two men hired for plastic surgery by the United States army, learned from Gillies in England. 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 1946, Gillies carried out the first female-to-male sex reassignment surgery.
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.
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.
or tumor
s. 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 use 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 to 2 millimeters in diameter.
In 2006, nearly 11 million cosmetic procedures 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 procedures were performed in 2007, with the five most common surgeries being breast augmentation, liposuction, nasal surgery, eyelid surgery and abdominoplasty. The American Society for Aesthetic Plastic Surgery looks at the statistics for thirty-four different cosmetic procedures. Nineteen of the procedures are surgical, such as rhinoplasty or facelift. The nonsurgical procedures include Botox and laser hair removal
. In 2010, their survey revealed that there were 9,336,814 total procedures in the United States. Of those, 1,622,290 procedures were surgical (p. 5). They also found that a large majority, 81%, of the procedures were done on Caucasian people (p. 12).
The increased use of cosmetic procedures 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. Cosmetic surgery is now very common in countries such as the United Kingdom, France, and Germany. In Asia, cosmetic surgery has become an accepted practice, and China, followed by India has become Asia's biggest comestic surgery markets. Children undergoing cosmetic eye surgery can be seen in Japan and South Korea.
The most prevalent aesthetic/cosmetic procedures include:
includes mastery of the following as well:
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.
Cosmetic
Aesthetic surgery is an essential component of plastic surgery. Plastic surgeons use cosmetic surgical principles in all reconstructive surgical procedures as well as isolated operations to improve overall appearance.
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. Adult craniofacial surgery deals mostly with fractures and secondary surgeries (such as orbital reconstruction) along with orthognathic surgery. Craniofacial surgery is an important part of all plastic surgery training programs, further training and subspecialisation is obtained via a craniofacial fellowship.
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. The Hand surgery field is also practiced by orthopedic surgeons
and general surgeons
(see Hand surgeon). Scar tissue formation after surgery can be problematic on the delicate hand, causing loss of dexterity and digit function if severe enough.
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.
Pediatric
Children often face medical issues very different 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.
Though media and advertising do play a large role in influencing many people's lives, researchers believe that plastic surgery obsession is linked to psychological disorders. Body dysmorphic disorder
is seen as playing a large role in the lives of those who are obsessed with going under the knife in order to achieve physical perfection.
BDD is when someone becomes “preoccupied with what they regard as defects in their bodies or faces.” In the United States, 2% of people suffer from body dysmorphic disorder and 15% of patients seeing dermatologist and cosmetic surgeons. This disorder can also lead to suicide in some of its sufferers.Half of the patients with the disorder who get cosmetic surgery are not pleased with the result. Surgery does not treat BDD but could make the problem worse. The exact problem is actually not easily identified causing the treatment to be even more difficult. Some say its depression or depending on what part the patient is preoccupied with it could be a sub-disorder like anorexia or muscle dysmorphia.
In some cases, people whose doctors refuse to perform any further surgeries, have turned to "do it yourself
" plastic surgery, injecting themselves and running extreme safety risks.
Reconstructive surgery
Reconstructive surgery is, in its broadest sense, the use of surgery to restore the form and function of the body, although Maxillo-Facial Surgeons, Plastic Surgeons and Otolaryngologists do reconstructive surgery on faces after trauma and to reconstruct the head and neck after cancer.Other...
, hand surgery
Hand surgery
The field of hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity including injury and infection. Hand surgery may be practiced by graduates of general surgery, orthopedic surgery and plastic surgery...
, microsurgery
Microsurgery
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and...
, and the treatment of burn
Burn
A burn is an injury to flesh caused by heat, electricity, chemicals, light, radiation, or friction.Burn may also refer to:*Combustion*Burn , type of watercourses so named in Scotland and north-eastern England...
s.
Etymology
In the term plastic surgery, the adjective plastic denotes sculpting, and derives from the Greek πλαστική (τέχνη), plastikē (tekhnē), “the art of modelling” of malleable fleshTissue (biology)
Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...
.
History
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
by 800 BC. Sushruta, the father of Surgery, made important contributions to the field of plastic and cataract surgery in 6th century BC. The medical works of both Sushruta and Charak originally in Sanskrit
Sanskrit
Sanskrit , is a historical Indo-Aryan language and the primary liturgical language of Hinduism, Jainism and Buddhism.Buddhism: besides Pali, see Buddhist Hybrid Sanskrit Today, it is listed as one of the 22 scheduled languages of India and is an official language of the state of Uttarakhand...
were translated into Arabic language
Arabic language
Arabic is a name applied to the descendants of the Classical Arabic language of the 6th century AD, used most prominently in the Quran, the Islamic Holy Book...
during the Abbasid Caliphate in 750 AD. The Arabic translations made their way into Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
via intermediaries. In Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
the Branca family of Sicily
Sicily
Sicily is a region of Italy, and is the largest island in the Mediterranean Sea. Along with the surrounding minor islands, it constitutes an autonomous region of Italy, the Regione Autonoma Siciliana Sicily has a rich and unique culture, especially with regard to the arts, music, literature,...
and Gaspare Tagliacozzi
Gasparo Tagliacozzi
Gaspare Tagliacozzi was an Italian surgeon.Tagliacozzi was born in Bologna. He studied at the University of Bologna under Gerolamo Cardano and others, and, at the age of twenty-four, earned his degree in philosophy and medicine. First he was appointed professor of surgery and later was appointed...
(Bologna
Bologna
Bologna is the capital city of Emilia-Romagna, in the Po Valley of Northern Italy. The city lies between the Po River and the Apennine Mountains, more specifically, between the Reno River and the Savena River. Bologna is a lively and cosmopolitan Italian college city, with spectacular history,...
) became familiar with the techniques of Sushruta.
British
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
physicians traveled to India to see rhinoplasties
Rhinoplasty
Rhinoplasty , also nose job, is a plastic surgery procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose, by resolving nasal trauma , congenital defect, respiratory impediment, and a failed primary rhinoplasty...
being performed by native methods. Reports on Indian rhinoplasty performed by a Kumhar
Kumhar
Kumhar or Kumbhar ; also known as Prajapati, is a caste or community of India, mainly belonging to the Hindu religion. The word "Kumhar" literally means "potter" in Indian languages, pottery being the traditional occupation of the Kumhars....
vaidya were published in the Gentleman's Magazine by 1794. Joseph Constantine Carpue
Joseph Constantine Carpue
Joseph Constantine Carpue was an English surgeon who was born in London. He was associated with St. George's Hospital and Duke of York Hospital in Chelsea. He was a skilled surgeon and popular lecturer of anatomy....
spent 20 years in India studying local plastic surgery methods. Carpue was able to perform the first major surgery in the Western world
Western world
The Western world, also known as the West and the Occident , is a term referring to the countries of Western Europe , the countries of the Americas, as well all countries of Northern and Central Europe, Australia and New Zealand...
by 1815. Instruments described in the Sushruta Samhita were further modified in the Western world.
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
Ancient Greece
Ancient Greece is a civilization belonging to a period of Greek history that lasted from the Archaic period of the 8th to 6th centuries BC to the end of antiquity. Immediately following this period was the beginning of the Early Middle Ages and the Byzantine era. Included in Ancient Greece is the...
predecessors. Notwithstanding, Aulus Cornelius Celsus
Aulus Cornelius Celsus
Aulus Cornelius Celsus was a Roman encyclopedist, known for his extant medical work, De Medicina, which is believed to be the only surviving section of a much larger encyclopedia. The De Medicina is a primary source on diet, pharmacy, surgery and related fields, and it is one of the best sources...
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.
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. 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
History of surgery
Surgery is the branch of medicine that deals with the physical manipulation of a bodily structure to diagnose, prevent, or cure an ailment. Ambroise Paré, a 16th century French surgeon, stated that there were to perform surgery: "To eliminate that which is superfluous, restore that which has been...
that such surgery became common.
Up until the techniques of anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
became established, surgeries involving healthy tissues involved great pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
. 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
Penicillin
Penicillin is a group of antibiotics derived from Penicillium fungi. They include penicillin G, procaine penicillin, benzathine penicillin, and penicillin V....
, was another step in making elective surgery
Elective surgery
Elective surgery is surgery that is scheduled in advance because it does not involve a medical emergency...
possible.
In 1792, Chopart performed operative procedure on a lip using a flap from the neck. In 1814, Joseph Carpue
Joseph Constantine Carpue
Joseph Constantine Carpue was an English surgeon who was born in London. He was associated with St. George's Hospital and Duke of York Hospital in Chelsea. He was a skilled surgeon and popular lecturer of anatomy....
successfully performed operative procedure on a British military officer who had lost his nose to the toxic effects of mercury
Mercury (element)
Mercury is a chemical element with the symbol Hg and atomic number 80. It is also known as quicksilver or hydrargyrum...
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.
The first American plastic surgeon was John Peter Mettauer
John Peter Mettauer
John Peter Mettauer was an American surgeon and gynecologist born in Prince Edward County, Virginia. He was the son of surgeon Francis Joseph Mettauer....
, who, in 1827, performed the first cleft palate operation with instruments that he designed himself. In 1845, Johann Friedrich Dieffenbach
Johann Friedrich Dieffenbach
Johann Friedrich Dieffenbach was a German surgeon who specialized in skin transplantation and plastic surgery. His work in rhinoplastic and maxillofacial surgery established many modern techniques of reconstructive surgery. He endeavours comprehended subcutaneous operations such as tenotomy, the...
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
James Israel
James Adolf Israel was a German surgeon who was a native of Berlin. In 1870 he received his medical doctorate from Friedrich-Wilhelms-Universität. He studied under von Bernhard Rudolf Konrad von Langenbeck and Ludwig Traube...
, 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.
20th century
In World War IWorld War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
, a New Zealand otolaryngologist working in London, Harold Gillies
Harold Gillies
Sir Harold Delf Gillies was a New Zealand-born, and later London based, otolaryngologist who is widely considered as the father of plastic surgery.-Personal life:Gillies was born in Dunedin, New Zealand...
, developed many of the techniques of modern plastic surgery in caring for soldiers suffering from disfiguring facial injuries. Gillies was from England but volunteered in France with the Red Cross. During that time, he learned about plastic surgery. He became particularly successful in the field and was well known for his work. Kazanjian and Blair, two men hired for plastic surgery by the United States army, learned from Gillies in England. His work was expanded upon during World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
by his cousin and former student Archibald McIndoe
Archibald McIndoe
Sir Archibald McIndoe CBE FRCS was a pioneering New Zealand plastic surgeon who worked for the Royal Air Force during World War II. He greatly improved the treatment and rehabilitation of badly burned aircrew.-Background:...
, who pioneered treatments for RAF
Royal Air Force
The Royal Air Force is the aerial warfare service branch of the British Armed Forces. Formed on 1 April 1918, it is the oldest independent air force in the world...
aircrew suffering from severe burns. McIndoe's radical, experimental treatments, led to the formation of the Guinea Pig Club
Guinea Pig Club
The Guinea Pig Club was formed of patients of Archibald McIndoe at Queen Victoria Hospital, East Grinstead, Sussex who underwent reconstructive plastic surgery during World War II, generally after receiving burn injuries in aircraft....
. In 1946, Gillies carried out the first female-to-male sex reassignment surgery.
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
St. Louis, Missouri
St. Louis is an independent city on the eastern border of Missouri, United States. With a population of 319,294, it was the 58th-largest U.S. city at the 2010 U.S. Census. The Greater St...
. 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.
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 cells in vitro or synthetic compounds, such as integraIntegraIntegra may refer to:* Honda Integra a compact car* Integra Air, a Canadian airline* Integra Bank, a regional bank headquartered in Evansville, Indiana* Integra Hellsing, a main character of the manga and anime series Hellsing...
, which consists of siliconeSiliconeSilicones are inert, synthetic compounds with a variety of forms and uses. Typically heat-resistant and rubber-like, they are used in sealants, adhesives, lubricants, medical applications , cookware, and insulation....
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 plastic surgery is performed to correct functional impairments caused by burns; traumatic injuries, such as facial bone fractures and breaks; congenital abnormalities, such as cleft palates or cleft lips; developmental abnormalities; infection and disease; and cancerCancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
or tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
s. 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
Hand surgery
The field of hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity including injury and infection. Hand surgery may be practiced by graduates of general surgery, orthopedic surgery and plastic surgery...
, and breast reduction
Breast reduction
Reduction mammoplasty is the plastic surgery procedure for correcting over-sized breasts...
. 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
Breast reconstruction
Breast reconstruction is the rebuilding of a breast, usually in women. It involves using autologous tissue or prosthetic material to construct a natural-looking breast. Often this includes the reformation of a natural-looking areola and nipple...
after a mastectomy
Mastectomy
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
, cleft lip and palate surgery, contracture
Burn scar contracture
Burn scar contracture refers to the tightening of the skin after a second or third degree burn. When skin is burned, the surrounding skin begins to pull together, resulting in a contracture. It needs to be treated as soon as possible because the scar can result in restriction of movement around the...
surgery for burn
Burn (injury)
A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction. Most burns affect only the skin . Rarely, deeper tissues, such as muscle, bone, and blood vessels can also be injured...
survivors, and creating a new outer ear when one is congenitally absent.
Plastic surgeons use microsurgery
Microsurgery
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and...
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 to 2 millimeters in diameter.
Cosmetic surgery
Aesthetic plastic 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 procedures 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 procedures were performed in 2007, with the five most common surgeries being breast augmentation, liposuction, nasal surgery, eyelid surgery and abdominoplasty. The American Society for Aesthetic Plastic Surgery looks at the statistics for thirty-four different cosmetic procedures. Nineteen of the procedures are surgical, such as rhinoplasty or facelift. The nonsurgical procedures include Botox and laser hair removal
Laser hair removal
Laser hair removal was performed experimentally for about 20 years before it became commercially available in the mid 1990s. One of the first published articles describing laser hair removal was authored by the group at Massachusetts General Hospital in 1998...
. In 2010, their survey revealed that there were 9,336,814 total procedures in the United States. Of those, 1,622,290 procedures were surgical (p. 5). They also found that a large majority, 81%, of the procedures were done on Caucasian people (p. 12).
The increased use of cosmetic procedures 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. Cosmetic surgery is now very common in countries such as the United Kingdom, France, and Germany. In Asia, cosmetic surgery has become an accepted practice, and China, followed by India has become Asia's biggest comestic surgery markets. Children undergoing cosmetic eye surgery can be seen in Japan and South Korea.
The most prevalent aesthetic/cosmetic procedures include:
- AbdominoplastyAbdominoplastyAbdominoplasty or "tummy tuck" is a cosmetic surgery procedure used to make the abdomen more firm. The surgery involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall...
("tummy tuck"): reshaping and firming of the abdomenAbdomenIn vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity... - BlepharoplastyBlepharoplastyBlepharoplasty is surgical modification of the eyelid. Excess tissue such as skin and fat are removed or repositioned, and surrounding muscles and tendons may be reinforced. It can be both a functional and cosmetic surgery.-Indications:...
("eyelid surgery"): reshaping of the eyelids or the application of permanent eyeliner, including Asian blepharoplastyAsian blepharoplastyAsian blepharoplasty, also known as "double eyelid surgery", is a type of cosmetic surgery where the skin around the eye is reshaped . The purpose of the procedure is to create an upper eyelid with a crease from an eyelid that is naturally without a crease... - PhalloplastyPhalloplastyPhalloplasty refers to the construction of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes. It is also occasionally used to refer to penis enlargement....
("penile liposuction") : construction (or reconstruction) of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes - MammoplastyMammoplastyMammoplasty or mammaplasty can refer to the surgical procedure to insert cheek implants or augmentation mammoplasty, an enlarging of the breasts via implants...
:- Breast augmentationBreast augmentationBreast augmentation denotes the breast implant and fat-graft mammoplasty procedures for correcting the defects, and for enhancing the size, form, and feel of a woman’s breasts...
s ("breast implant" or "boob job"): augmentation of the breastBreastThe breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...
s by means of fat grafting, saline, or silicone gel prosthetics, which was initially performed to women with micromastiaMicromastiaMicromastia, or breast hypoplasia, is a medical term describing the postpubertal underdevelopment of a woman's breast tissue. Just as it is impossible to define 'normal' breast size, there is no objective definition of micromastia. Breast development is commonly asymmetric and one or both breasts... - Reduction mammoplasty ("breast reduction"): removal of skin and glandular tissue, which is done to reduce back and shoulder pain in women with gigantomastiaGigantomastiaHypertrophy of the breast is a rare disease of the breast connective tissues; the indication is a breast weight increase that exceeds , which enlargement causes muscular discomfort and over-stretching of the skin envelope, leading to ulceration...
and/or for psychological benefit men with gynecomastiaGynecomastiaGynecomastia or Gynaecomastia, , is the abnormal development of large mammary glands in males resulting in breast enlargement. The term comes from the Greek γυνή gyné meaning "woman" and μαστός mastós meaning "breast"... - 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
- Breast augmentation
- Buttock augmentationButtock augmentationthumb|right|250px|Gluteoplasty: the pre-operative, back and oblique-right aspects , and the like post-operative aspects , of a combined procedure of buttocks augmentation and thigh contouring.Gluteoplasty thumb|right|250px|Gluteoplasty: the pre-operative, back and oblique-right aspects (left), and...
("butt implant"): enhancement of the buttocks using silicone implants or fat grafting ("Brazilian butt lift") and transfer from other areas of the body- Buttock lift: lifting, and tightening of the buttocks by excision of redundant skin
- Chemical peelChemical peelA chemical peel is a body treatment technique used to improve and smooth the texture of the facial skin using a chemical solution that causes the dead skin to slough off and eventually peel off. The regenerated skin is usually smoother and less wrinkled than the old skin. Thus the term chemical...
: minimizing the appearance of acneAcne vulgarisAcne vulgaris is a common human skin disease, characterized by areas of skin with seborrhea , comedones , papules , pustules , Nodules and possibly scarring...
, chicken pox, 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 photodamageSkin cancerSkin neoplasms are skin growths with differing causes and varying degrees of malignancy. The three most common malignant skin cancers are basal cell cancer, squamous cell cancer, and melanoma, each of which is named after the type of skin cell from which it arises...
in general. Chemical peels commonly involve carbolic acid (Phenol), trichloroacetic acidTrichloroacetic acidTrichloroacetic acid is an analogue of acetic acid in which the three hydrogen atoms of the methyl group have all been replaced by chlorine atoms....
(TCA), glycolic acidGlycolic acidGlycolic acid is the smallest α-hydroxy acid . This colorless, odorless, and hygroscopic crystalline solid is highly soluble in water. It is used in various skin-care products. Glycolic acid is found in some sugar-crops...
(AHA), or salicylic acidSalicylic acidSalicylic acid is a monohydroxybenzoic acid, a type of phenolic acid and a beta hydroxy acid. This colorless crystalline organic acid is widely used in organic synthesis and functions as a plant hormone. It is derived from the metabolism of salicin...
(BHA) as the active agent. - LabiaplastyLabiaplastyLabiaplasty is a plastic surgery procedure for altering the labia minora and the labia majora, the paired tissue structures bounding the vestibule of the vulva. The indications for the correction of labial hypertrophy are two-fold: the correction of defect and deformity, and the cosmetic...
: surgical reduction and reshaping of the labia - Lip enhancementLip enhancementLip enhancement is a type of cosmetic surgery or non-surgical procedure that aims to improve the appearance of the lips by increasing their fullness through enlargement.-History:...
: surgical improvement of lips' fullness through enlargement - RhinoplastyRhinoplastyRhinoplasty , also nose job, is a plastic surgery procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose, by resolving nasal trauma , congenital defect, respiratory impediment, and a failed primary rhinoplasty...
("nose job"): reshaping of the noseHuman noseThe visible part of the human nose is the protruding part of the face that bears the nostrils. The shape of the nose is determined by the ethmoid bone and the nasal septum, which consists mostly of cartilage and which separates the nostrils... - OtoplastyOtoplastyOtoplasty denotes the surgical and non-surgical procedures for correcting the deformities and defects of the pinna ; and for reconstructing a defective, or deformed, or absent external ear, consequent to congenital conditions and trauma...
("ear surgery"/"ear pinning"): reshaping of the earEarThe ear is the organ that detects sound. It not only receives sound, but also aids in balance and body position. The ear is part of the auditory system....
, most often done by pinning the protruding ear closer to the head. - RhytidectomyRhytidectomyA facelift, technically known as a rhytidectomy , is a type of cosmetic surgery procedure used to give a more youthful appearance...
("face lift"): removal of wrinkles and signs of aging from the face- Browplasty ("brow lift" or "forehead lift"): elevates eyebrows, smooths forehead skin
- Midface lift ("cheek lift"): tightening of the cheeks
- Chin augmentationChin augmentationChin augmentation using surgical implants can alter the underlying structure of the face, providing better balance to the facial features. This operation is often, but not always, performed at the time of rhinoplasty to help balance the facial proportions...
("chin implant"): augmentation of the chinChinIn the human anatomy, the chin is the lowermost part of the face.It is formed by the lower front of the mandible.People show a wide variety of chin structures. See Cleft chin....
with an implant, usually silicone, by sliding genioplasty of the jawbone or by suture of the soft tissue - Cheek augmentationCheek augmentationCheek augmentation is a cosmetic surgical procedure that is intended to emphasize the cheeks on a person's face. To augment the cheeks, a plastic surgeon may place a solid implant over the cheekbone. Injections with the patients' own fat or a soft tissue filler, like Restylane, are also popular....
("cheek implant"): implants to the cheek - Orthognathic SurgeryOrthognathic surgeryOrthognathic surgery is surgery to correct conditions of the jaw and face related to structure, growth, sleep apnea, TMJ disorders, malocclusion problems owing to skeletal disharmonies, or other orthodontic problems that cannot be easily treated with braces. Originally coined by Dr. Harold...
: manipulation of the facial bones through controlled fracturing - Fillers injections: collagenCollagenCollagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...
, fatFatFats consist of a wide group of compounds that are generally soluble in organic solvents and generally insoluble in water. Chemically, fats are triglycerides, triesters of glycerol and any of several fatty acids. Fats may be either solid or liquid at room temperature, depending on their structure...
, and other tissue filler injections, such as hyaluronic acid - LaserLaserA laser is a device that emits light through a process of optical amplification based on the stimulated emission of photons. The term "laser" originated as an acronym for Light Amplification by Stimulated Emission of Radiation...
skin resurfacing - LiposuctionLiposuctionLiposuction, also known as lipoplasty , liposculpture suction lipectomy or simply lipo is a cosmetic surgery operation that removes fat from many different sites on the human body...
("suction lipectomy"): removal of fat deposits by traditional suction technique or ultrasonic energy to aid fat removal
Sub-specialties
Plastic surgery is a broad field, and may be subdivided further. Plastic surgery training and approval by the American Board of Plastic SurgeryAmerican Board of Plastic Surgery
The American Board of Plastic Surgery, Inc. was organized as a subsidiary of the American Board of Surgery in 1938. The American Board of Plastic Surgery, Inc. was given the status of a major specialty board in 1941...
includes mastery of the following as well:
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.
Cosmetic
Aesthetic surgery is an essential component of plastic surgery. Plastic surgeons use cosmetic surgical principles in all reconstructive surgical procedures as well as isolated operations to improve overall appearance.
Craniofacial
Craniofacial surgery
Craniofacial surgery
Craniofacial surgery is a surgical subspecialty of maxillofacial surgery, plastic surgery, and ENT that deals with congenital and acquired deformities of the skull, face, and jaws. Although craniofacial treatment often involves manipulation of bone, craniofacial surgery is not tissue-specific,...
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. Adult craniofacial surgery deals mostly with fractures and secondary surgeries (such as orbital reconstruction) along with orthognathic surgery. Craniofacial surgery is an important part of all plastic surgery training programs, further training and subspecialisation is obtained via a craniofacial fellowship.
Hand
Hand surgery
Hand surgery
The field of hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity including injury and infection. Hand surgery may be practiced by graduates of general surgery, orthopedic surgery and plastic 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. The Hand surgery field is also practiced by orthopedic surgeons
Orthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...
and general surgeons
General surgery
General surgery, despite its name, is a surgical specialty that focuses on abdominal organs, e.g., intestines including esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder and bile ducts, and often the thyroid gland . They also deal with diseases involving the skin, breast, soft...
(see Hand surgeon). Scar tissue formation after surgery can be problematic on the delicate hand, causing loss of dexterity and digit function if severe enough.
Micro
Microsurgery
Microsurgery
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and...
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.
Pediatric
Children often face medical issues very different 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
Craniofacial team
A craniofacial team is a team of medical specialists that treat children and adults who have facial deformities such as cleft lip, cleft palate, and cleft lip with cleft palate....
, cleft lip and palate and congenital hand deformities.
Plastic surgery obsession
With increased media attention on beauty and perfection, celebrities and those alike are turning to plastic surgery more and more. Some take out loans for this purpose; one woman spent over $83,000 for 14 surgeries.Though media and advertising do play a large role in influencing many people's lives, researchers believe that plastic surgery obsession is linked to psychological disorders. Body dysmorphic disorder
Body dysmorphic disorder
Body Dysmorphic Disorder is a type of mental illness, a somatoform disorder, wherein the affected person is exclusively concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of his or her physical features...
is seen as playing a large role in the lives of those who are obsessed with going under the knife in order to achieve physical perfection.
BDD is when someone becomes “preoccupied with what they regard as defects in their bodies or faces.” In the United States, 2% of people suffer from body dysmorphic disorder and 15% of patients seeing dermatologist and cosmetic surgeons. This disorder can also lead to suicide in some of its sufferers.Half of the patients with the disorder who get cosmetic surgery are not pleased with the result. Surgery does not treat BDD but could make the problem worse. The exact problem is actually not easily identified causing the treatment to be even more difficult. Some say its depression or depending on what part the patient is preoccupied with it could be a sub-disorder like anorexia or muscle dysmorphia.
In some cases, people whose doctors refuse to perform any further surgeries, have turned to "do it yourself
Self-surgery
Self-surgery is the act of performing a surgical procedure on oneself. It can be a rare manifestation of a psychological disorder, an attempt to avoid embarrassment or legal action, or an act taken in extreme circumstances out of necessity.- Genital :...
" plastic surgery, injecting themselves and running extreme safety risks.
See also
- BiomaterialBiomaterialA biomaterial is any matter, surface, or construct that interacts with biological systems. The development of biomaterials, as a science, is about fifty years old. The study of biomaterials is called biomaterials science. It has experienced steady and strong growth over its history, with many...
- Body modificationBody modificationBody modification is the deliberate altering of the human body for any non-medical reason, such as aesthetics, sexual enhancement, a rite of passage, religious reasons, to display group membership or affiliation, to create body art, shock value, or self expression...
- Botox
- Breast reconstructionBreast reconstructionBreast reconstruction is the rebuilding of a breast, usually in women. It involves using autologous tissue or prosthetic material to construct a natural-looking breast. Often this includes the reformation of a natural-looking areola and nipple...
, Breast reductionBreast reductionReduction mammoplasty is the plastic surgery procedure for correcting over-sized breasts...
, Breast implant, Breast liftBreast liftMastopexy is the mammoplasty procedure for correcting the size, contour, and elevation of sagging breasts upon the chest... - Journal of Cutaneous and Aesthetic SurgeryJournal of Cutaneous and Aesthetic SurgeryThe Journal of Cutaneous and Aesthetic Surgery is a peer-reviewed open-access medical journal published on behalf of the Association of Cutaneous Surgeons of India. The journal publishes articles on the subject of skin surgery and aesthetic surgery....
- MicrosurgeryMicrosurgeryMicrosurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and...
- Reconstructive surgeryReconstructive surgeryReconstructive surgery is, in its broadest sense, the use of surgery to restore the form and function of the body, although Maxillo-Facial Surgeons, Plastic Surgeons and Otolaryngologists do reconstructive surgery on faces after trauma and to reconstruct the head and neck after cancer.Other...
- Laser Resurfacing
- Oral and Maxillofacial SurgeryOral and maxillofacial surgeryOral and maxillofacial surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. It is an internationally recognized surgical specialty...