Plastic surgery is a specialty that uses surgical techniques to improve the appearance and function of
patients' bodies. 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. 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.
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).
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 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.
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.
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 an overlap between reconstructive and cosmetic surgery. Many of the techniques of cosmetic surgery are utilized in reconstructive surgery to improve cosmesis.
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.
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.