Plastic surgery is the branch of medicine concerned with the reconstruction and repair of defects in the body. Reconstructive plastic surgery repairs deformities or disfigurements caused by injuries, disease, or birth defects. It seeks not only to make a person look more normal but to function better as well. Cosmetic plastic surgery is performed solely for the purpose of improving the appearance of the body.
Many people have the mistaken belief that plastic surgery got its name because it involves the use of some sort of plastic or other manmade material. In fact, the term plastic surgery comes from the Greek word "plastikos," which means to mold or to shape. The first published use of that word was by German surgeon Karl Ferdinand von Graefe (1787–1840), one of the pioneers of plastic surgery. Von Graefe operated on the cleft palate (a birth defect in the roof of the mouth) and the eye and developed the first satisfactory procedure to correct the nose, called rhinoplasty (pronounced RYE-no-pla-stee), which he described in his 1818 book Rhinoplastik.
However, von Graefe was by no means the first or the earliest to perform such surgery. In fact, many believe that plastic surgery is one of the oldest forms of surgery. Some say that the earliest known surgery of any type dates back to the Peruvians of about 10,000 B.C. , who performed craniotomies (pronounced kray-nee-AH-toh-meez) or surgery on the skull by burning holes in a person's head. Many of the healed skulls of these patients have been found, suggesting that they survived the operation.
Reconstructive plastic surgery is less old, although there is written evidence that surgeons in ancient India used skin grafts as early as 3300 B.C. to repair noses and ears lost in battle or to certain forms of punishment. Roman medical writer Aulus Cornelius Celsus, who is known to have lived during the reign of Tiberius ( A.D. 14–37), mentioned the reconstructive surgery of the face in his book De re medicina. It is also known that during the Chin dynasty ( A.D. 229–317), Chinese surgeons surgically repaired cleft lips.
Cosmetic plastic surgery: Surgery designed primarily to enhance or improve the looks of an individual who may not have a gross deformity or physical impairment.
Graft: Bone, skin, or other tissue taken from one place on the body (or from another body) and then transplanted to another place on that body where it begins to grow again.
Reconstructive plastic surgery: Surgery designed to restore the normal appearance and functioning of disfigured or impaired areas of the human body.
While surgical techniques developed slowly for many centuries up to the Renaissance (a period of vigorous artistic and intellectual activity that began in Italy in the fourteenth century and soon spread across Europe, lasting into the seventeenth century), the first textbook on plastic surgery was written by Italian surgeon Gasparo Tagliacozzi (1546–1599). His book De curatorum chirurgia contained illustrations as well as words on how to surgically repair or correct the nose. One famous image in that book shows how he placed his patients in a type of straight-jacket in which one of their hands was placed on the back of their head with their nose touching their shoulder or bicep. In this way he used the patient's own skin (on the arm) to graft new skin to the repaired nose.
Surgical techniques continued to progress very slowly, yet in 1775, American surgeon John Jones (1729–1791) published the first surgical textbook in the American colonies, Plain, Concise, Practical Remarks on the Treatment of Wounds and Fractures. This book introduced plastic surgery techniques to the American colonies and became the military surgeon's bible when the Revolutionary War (1775–81) broke out. However, the first American plastic surgeon is considered to be Virginia surgeon John Peter Mettauer (1787–1875). By the time Mettauer had performed his first cleft palate operation in 1827, progress also was being made in Europe as surgeons in Italy and Germany performed skin graft experiments on animals. In the United States, the battles of the Civil War (1861–65) produced large numbers of injured and disfigured soldiers, and many surgical techniques were discovered or developed out of necessity.
Finally, it took another war, World War I (1914–18), to produce the father of modern plastic surgery, British surgeon Harold Delf Gillies (1882–1960). Since this war was conducted mostly in trenches, there were huge numbers of head and face injuries (since the rest of a soldier's body was usually below ground level and therefore protected). Gillies established the first hospital devoted to reconstructive surgery, and in 1917, he introduced the pedicle (pronounced PED-ih-kul) type of skin graft that uses the patient's own skin and the tissue below it to nourish the repaired site. Many of his discoveries and techniques formed the basics of modern plastic surgery. By World War II (1939–45), many of the armed forces had plastic surgeons as part of their medical teams, and following the war, microsurgical techniques had advanced to the point where the public became aware of cosmetic surgery as a way of enhancing their appearance.
Today, plastic surgery has two components: reconstructive plastic surgery and cosmetic plastic surgery. Reconstructive surgery does just what it sounds like, since it reconstructs, repairs, or reshapes abnormal structures of the body. In other words, its goal is to fix things or to restore the function (as well as the appearance) of a body part that may have been injured, diseased, or suffered from some birth defect. Repairs of severe lacerations (deep cuts) and compound bone fractures are typical procedures, as are tissue grafts to repair severe burns. Removing cancerous skin growths and rebuilding lost or deformed parts, such as an ear or a nose, are other examples of reconstructive plastic surgery. The goal is always to restore damaged function by restoring normal form. It is this type of surgery that attempts to reattach severed fingers and limbs and to correct the damage done by the trauma of injury or disease.
Cosmetic plastic surgery is the other type of plastic surgery. Also called aesthetic plastic surgery, it differs from reconstructive plastic surgery in that it is surgery performed on normal structures of the body. In other words, it is surgery performed solely for the purpose of improving the appearance of an otherwise healthy person. Examples of such operations would be "nose jobs," "face lifts," breast enlargement, and fat-suctioning procedures. This type of surgery is called "elective" because it is not necessary from a medical point of view. Rather, it is done to improve a person's self-image by fixing something that person finds objectionable about his or her body. Thus, while some choose to have their large ears put closer to their heads, others may elect to have the drooping skin around their eyes tightened or the wrinkles in their face removed. Hair transplants and chemical face peeling are also considered cosmetic plastic surgery.
Whether reconstructive or cosmetic, plastic surgery is almost always about tissue transplantation. However, this is not surgery that
"transplants" a working donor organ like a kidney into someone who has lost theirs, but instead is the transplantation or grafting of healthy tissue from one part of the body to replace damaged tissue removed from another part. This tissue could be bone, skin, muscle, cartilage, tendons, or even nerves. Thus a surgeon can take cartilage from a patient's rib and "build" an ear or fix a nose. Baseball pitchers sometimes resume their throwing careers after having cartilage taken from their non-throwing arm surgically transplanted into their injured throwing elbow. Skin grafts used to cover a burned area are another common form of transplantation. A new version of this is called a xenograft (pronounced ZEE-no-graft), in which skin from a donor is used temporarily and grafted to a burned area that still has living cells. Although it is eventually rejected, the grafted skin often protects the damaged tissue just long enough, and gives the body time to heal itself. An even newer form of artificial or synthetic skin is being developed that will do the same thing.
Another essential part of all plastic surgery, whether reconstructive or cosmetic, is the planned and careful cutting of the skin in places where it follows or falls in the skin's natural lines or folds. At the end of surgery, an equally planned and careful way of suturing (pronounced SOO-churing) or sewing the wound closed is necessary. Today, plastic surgeons sometimes use lasers instead of scalpels, and often perform an entire operation at such a fine level of detail that they use a microscope the entire time. They can reattach the smallest of blood vessels using this technology. Even before they operate, they have access to such diagnostic technologies as magnetic resonance imaging and computed tomography that allow them to analyze and understand the problem better, and to plan how to repair it.
Despite the increased popularity of cosmetic plastic surgery (it is no longer a luxury only for the rich), reconstructive plastic surgery is still performed three times as often. Corrective eye surgery or blepharoplasty (pronounced BLEH-fer-oh-plas-tee)—in which bags under the eyes or skin on the upper eyelids are removed to give a person a younger, less tired look—is the most common type of cosmetic surgery. Hair transplants and eye surgery are the most popular procedures with men. Many adult women choose breast augmentation, now done with saline or salt water implants instead of the proven-dangerous silicone implants. Teenagers most often receive nose reshaping.
[ See also Surgery ]