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 mould 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 spans back to the ancient world. The Romans were able to perform simple techniques such as repairing damaged ears. Physicians in ancient India including the great Indian surgeon Susrutha were utilizing skin grafts for reconstructive work as early as 800 B.C and performed nose reconstruction, using a portion of the forehead, during periods where amputation of the nose was a punishment for certain crimes. 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

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 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 <www.abms.org>) which only recognizes the American Board of Plastic Surgery and not these other "boards".

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 by the American Board of Plastic Surgery can of course perform and 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/cometic 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
• Muscle sculpting: Removal of the fat layer that is on top of chosen muscle to reveal a more appealing look after surgery (ie: six pack abs revealed through muscle sculpting)
• 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
• Non-surgical Nose Job: A new method of reshaping of the nose without surgery. This non-invasive procedure, developed by Dr. Alexander Rivkin, uses injectable fillers to reshape the nose and hide imperfections.
• 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
• Mesotherapy : An alternative to liposuction where fluids are injected to break down and disolve the fat. This is considered the non-invasive method to fat tissue removal.

In addition, there is increasing concern about cosmetic surgeries not done in the United States, especially liposuctions performed at the Dominican Republic: while liposuction in the Dominican Republic 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.

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

External links

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

sr:Пластична хирурги�а