Plastic Surgery

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Plastic Surgery

Plastic surgery is the specialized branch of surgery concerned with repairing deformities, correcting functional deficits, and enhancing appearance. Unlike most surgical specialties, plastic surgery is not confined to one specific area of the body. Also, plastic surgery can be done to reconstruct a deformed or damaged region, or can be done by choice as an attempt to alter ones’ appearance in a way that is thought to be more beautiful than prior to the surgery.

History Of Plastic Surgery

The word plastic was first applied in 1818 to denote surgery largely concerned with the patient’s appearance. But, even before that time, physicians performed a number of reconstructive procedures on the noses and ear lobes of soldiers who were injured during battle. As far back as 25 BC to 50 AD, physicians were taking tissue from one part of the body and using it to correct physical defects in other areas. Much of the ancient pioneering efforts in plastic surgery took place in the ancient Arab and Hindu schools of medicine.

During the early part of the sixteenth century, the Branca family in Sicily began practicing plastic surgery procedures, including using flaps or masses of tissue from patient’s arms to repair mutilated ears and lips. However, Gaspare Tagliacozzi of Bologna, Italy, is generally credited with initiating the modern era of plastic surgery during the latter half of the sixteenth century.

After Tagliacozzi’s death in 1599, the art of plastic surgery languished for nearly two centuries, partly because many surgeons tried unsuccessfully to use donor flaps and skin from slaves and others. The transplantation of tissue between two individuals would not be successfully achieved until the second half of the twentieth century, when scientists learned more about differences in blood types and immune systems and the role these differences played in hindering transplantation of tissues between two people.

A resurgence of interest in plastic surgery began in the nineteenth century with renewed interest in reconstruction of the nose, lips, and other areas of the human body. During this time, a number of surgeons throughout Europe refined techniques for performing a variety of procedures. One of the most beneficial was the development of skin grafting on humans in 1817 to repair burnt or scarred skin.

The next major advances in plastic surgery would not take place until well into the next century, when various new flap techniques were developed in the 1960s and 1970s. The first successful reattachment of a severed arm was accomplished in 1970. During the 1970s, refinements in microsurgical techniques enabled surgeons to reattach minute nerves and blood vessels, which allowed plastic surgery to become more intricate. It was during this time that cosmetic plastic surgery also began to bloom, as new techniques were refined to enhance physical appearances, including breast implants and face lifts.

Reconstructive Plastic Surgery

The primary aim of reconstructive plastic surgery is to restore the normal appearance and functioning of disfigured and/or impaired areas of the human body. Craniofacial reconstructive surgery, for example, focuses on face and skull defects. These defects may be congenital (birth) or due to trauma (an injury or wound). Craniofacial surgeons also reconstruct parts of the face deformed by cancer and other diseases. The cleft palate, a split in the bony roof of the mouth that usually runs from the front of the mouth to the back, is one of the most common birth defects corrected by craniofacial plastic surgery.

Vascular, microvascular, and peripheral nerve surgery focuses on reestablishing the complex connections of nerve and blood vessels that may have been severed or otherwise damaged. Plastic surgeons also transplant muscles and tendons from one part of the body to another to restore common functions such as walking or other activities that incorporate these anatomical structures.

Skin grafting is a reconstructive surgical technique that transplants skin from one part of the body to another damaged area where the skin grows again. This technique is used to treat burned or otherwise damaged skin.

Flaps are large masses of tissue that may include fat and muscle. Flaps are taken from one place on the body and then attached to another area. These operations are much more complex than skin grafts because they involve the need to reestablish various vascular, or blood, connections.

A pedicle flap graft involves connecting the tissue and/or muscle to the new site while keeping part of it attached to the original site. This technique maintains the old blood vessel connections until the flap naturally creates new connections (revascularization) at the transplanted site. For example, a mass of tissue on an undamaged finger can be partially peeled back and connected to an adjacent finger until revascularization takes place. Then the flap can be totally severed from its original site.

A free flap is when tissue or muscles are completely severed from the body and then transplanted to the new site where the blood vessels are then reconnected surgically. An advantage of the free flap procedure is that the transplanted tissue can be taken from anywhere on the body and does not have to be in an area close to (or can be placed close to) the new site.

The advancement of microsurgical techniques have greatly improved the success of free flap surgical procedures. Using a microscope, tiny needles, and nearly invisible thread, the surgeon can painstakingly reconstruct the vascular web that supplies nourishment in the form of blood to the transplanted tissues.

Aesthetic Plastic Surgery

Aesthetic plastic surgery procedures are as varied as the many areas of the body they seek to enhance. They range from reshaping the nose and enlarging women’s breasts to hair transplants for balding men and liposuction to remove unwanted fat from the body. For many years aesthetic plastic surgery, popularly known as cosmetic surgery, was held in low esteem by many within the plastic surgery field. This disdain was largely because aesthetic surgery was generally not a necessary procedure based on medical need or gross deformity, but rather on the patient’s vanity or desire to have his or her looks surgically enhanced.

Today, hundreds of thousands of aesthetic plastic surgery procedures are conducted each year. Many of the operations are outpatient procedures, meaning they require no hospitalization overnight. However, the complexity of the procedures vary. Breast enlargements, for example, are made with a simple incision in the breast in which a bag like structure filled with either silicone or saline is inserted and sewn into place. Facelifts, on the other hand, involve cutting the skin from the hairline to the back of the ear. The loosened skin can then be stretched upward from the neck and stitched together for a tighter, wrinkle free appearance. Another aesthetic surgery for facial skin is called skin peeling, which is used primarily on patients with scarred faces due to acne or some other disease. A surgical skin peel involves removal of the skin’s surface layers with mechanical devices that scrape off the skin or grind it down.

If a person desires a new nose, they can undergo a procedure that involves making incisions inside the nose to reduce scarring and then breaking and reshaping the nasal bone. Another facial cosmetic surgery is the eyelid tuck, which removes fleshy bags under the eyes.

In recent years, a cosmetic surgery called liposuction has rapidly grown in popularity. Developed in France, this procedure involves removing fat from

KEY TERMS

Aesthetic surgery— Surgery designed primarily to enhance or improve the looks of an individual who may not have a gross deformity or physical impairment. This type of surgery is often referred to as cosmetic surgery.

Craniofacial— Having to do with the face and skull.

Flap— A mass of tissue used for transplantation.

Graft— Bone, skin, or other tissue taken from one place on the body (or, in some cases, from another body), and then transplanted to another place where it begins to grow again.

Reconstructive surgery— Surgery designed to restore the normal appearance and functioning of disfigured and/or impaired areas of the human body.

Transplantation— Moving cells or tissues from their point of origin in one organism to a secondary site in the same or a different organism.

specific areas of the body by vacuuming it out through a long metal probe that is connected to a pump.

Drawbacks to aesthetic surgery

There are some troubling ethical issues associated with aesthetic plastic surgery. Since all surgical procedures carry a risk of infections or death from some surgical malfunction, those who elect aesthetic surgery choose to risk their lives to look better. The use of defective silicone breast implants during the 1970s caused problems with the appearance of the breasts and, for some women, more serious complications due to the leakage of silicone. As a result, most implants are now filled with a saline solution similar to that naturally produced in the body. Despite this history, the use of silicone breast implants has again been approved in 2006.