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Plastic surgery is a general term for operative manual and instrumental treatment which is performed for functional or aesthetic reasons. The word "plastic" derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with modern plastics.

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 many cases, however, there are medical reasons (for example, breast reduction when orthopedic problems are present).

History

The history of cosmetic 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 and performed nose reconstruction, using a portion of the forehead, during periods where amputation of the nose was a punishment for certain crimes. 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. 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

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 survivors, 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.

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.

As for any operation, elective 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 plastic surgery.

It is vital to check a physician's credentials, looking for those MDs who are actually board-certified by the American Board of Plastic Surgery. Because cosmetic surgery is seen as lucrative, many other specialties have tried to make themselves sound more official and qualified by making up associations or "medical boards", even though their training does not encompass all aspects of reconstructive and cosmetic/aesthetic surgery of plastic surgeons. However, there is only one governing board of American physicians (the American Board of Medical Specialties link), and it only recognizes the American Board of Plastic Surgery.

Other "boards" such as "facial plastic surgery" or "American Cosmetic Surgery" are not officially recognized by the American Board of Medical Specialties. In fact, the term "facial plastic surgery" is particularly deceptive, as it implies there is a "general plastic surgery" field, which of course does not exist. Plastic surgeons who are board-certified or board-eligible by the American Board of Plastic Surgery can of course perform, and often excel in surgery of the face. Just because a non-plastic surgeon claims they have "training" in "facial plastic surgery" does not necessarily mean they can better perform reconstructive and aesthetic procedures of the face.

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
• Augmentation Mammaplasty (or "breast enlargement" or "boob job"): Augmentation of the breasts. This can involve either saline or silicone gel prosthetics.
• Chemical peel: Removal of acne scars and sagging skin—not technically surgery and can be performed by a cosmetologist. Chemical peels commonly involve Phenol, TCA, or Glycolic acid as the active agent. Phenol peels, while the most effective, require cardiac monitoring and require longer recovery periods, thus diminishing their current popularity.
• 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
• Mesotherapy : An alternative to liposuction where fluids are injected to break down and dissolve the fat. This area is still under investigation for both efficacy and safety. There have been many edpisodes of dangerous and deceptive practices involved with mesotherapy as practiced. Currently the American Society of Plastic Surgery does not endorse this procedure outside of controlled trials with IRB oversite.

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. 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). However, hand surgery is particularly suited to plastic surgeons, as when there is hand traumatically amputated that requires a "replant" operation, plastic surgeons are trained to reconstruct all aspects to save the hand: blood vessels, nerves, tendons, muscle, bone. Many hand operations (such as reconstruction of injuries, replantations, rheumatoid surgery and surgery of congenital defects) are performed by plastic surgeons.

• Maxillofacial surgery (surgery involving the jaw) is an important aspect of plastic surgery. This field is shared by both the plastic surgeons and the oral surgeons, with each field contributing each other in order to benefit this area of the body.

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.

See also

• Body modification
• Botox
• Dr. 90210
• Extreme Makeover
• Genital modification and mutilation
• Nip/Tuck and the fomation of the body

External links

• American Society of Plastic Surgeons
• The American Society for Aesthetic Plastic Surgery

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