Feature Article
The principal areas of plastic surgery include two broad fields.
* Reconstructive surgery, including microsurgery, focuses on undoing or
masking the destructive effects of trauma, surgery or disease. Reconstructive
surgery may include closing defects with flaps - that is by moving tissue
from other parts of the body.
* Cosmetic (or aesthetic) surgery is most often performed in order to
change features the patient finds unflattering. In a few cases, however,
there may be medical reasons (for example, breast reduction when orthopedic
problems are present).
History
The history of cosmetic surgery spans back to the ancient world. The Romans were able to perform simple techniques such as repairing damaged ears. In the Middle Ages, there were techniques to restore a severed nose by attaching the arm to the face and letting a blood supply form, then removing the arm from the new nose. Nevertheless, it was not until modern times that its use became commonplace.
Physicians in ancient India were utilizing skin grafts for reconstructive work as early as 800 B.C. However, it didn’t move very quickly so it wasn’t really until the 19th and 20th centuries that it was actually performed. 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.
Reconstructive surgery
Reconstructive surgical techniques were developed rapidly in the period after the First World War when patients with survivable but disfiguring injuries required new approaches. The English military hospitals of the period trained surgeons from the world over in these new techniques. These surgeons then returned to the Americas, the Pacific and to Europe to propagate their advances. The main advances were with flap surgery—moving tissue from one location to another with an intact blood supply.
Ultimately, plastic surgeons have championed the use of microsurgical techniques to transfer remote tissue. They have for the past several decades been able to connect blood vessels that may be as small as 1-2mm in diameter to reperfuse the transferred tissue, thereby allowing coverage of a soft tissue defect when no local tissue is available.
Common cases of reconstructive surgery are breast reconstruction for women who have had a mastectomy, facial- and contracture surgery for burn victims, closing skin- or mucosa defects after removal of tumors in the head and neck region.
Sex reassignment surgery for transsexual people is another example of reconstructive surgery.
Foreskin restoration for men who have undergone circumcision is sometimes performed using reconstructive surgery.
There is a definite gray area between reconstructive and cosmetic surgery. For instance a "bat ear" correction is not considered cosmetic surgery, even though having prominent ears is not a debilitating or dangerous condition.
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. Although some may harbor a dim view of cosmetic surgery, seeing it as frivolous, the upsurge in number of procedures performed annually shows that cosmetic surgery has become acceptable to the mainstream American household.
However, it should be noted that elective procedures involve risk like any operation, and should therefore not be undertaken lightly. Within the US, critics of plastic surgery have noted that it is legal for any doctor (regardless of speciality) to perform plastic surgery; a practice which may lead to a suboptimal result. It is best to check a physician's credentials, looking for those MD's most commonly trained in cosmetic techniques (such as Board Certified Plastic Surgeons, Otolaryngologists, and Opthalmologists).
In addition, there is increasing concern about cosmetic surgeries not done in the United States, especially liposuctions performed at the Dominican Republic: while that type of surgery there is considerably cheaper, six women were reported in 2004 to have returned to the United States from the Dominican Republic with an infection after having liposuctions there, and, in 2001, a Puerto Rican woman died, in a very widely publicized case by Puerto Rican newspapers, after contracting an infection during liposuction surgery, also in the Dominican Republic.
Cosmetic surgery is becoming more popular as less expensive and better techniques are being developed. There are numerous types of cosmetic surgery that can be performed. The most prevalent 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
* Augmentation Mammaplasty (or "breast enlargement" or "boob
job"): Augmentation of the breasts
* Chemical peel: Removal of acne scars and sagging skin—not technically
surgery and can be performed by a cosmetologist
* Mastopexy (or "breast lift"): Raising of sagging breasts
* 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
* Circumcision: Removal of the foreskin of the penis, esp. without any diagnosis
* Chin augmentation: Augmentation of the chin with an implant (e.g. silicone)
or by sliding genioplasty of the jawbone.
* Cheek augmentation
* Collagen injections
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