Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery covers a wide range of specialties, including craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. This category of surgery focuses on restoring a body part or improving its function. In contrast, cosmetic (or aesthetic) surgery focuses solely on improving the physical appearance of the body.[1][2] A comprehensive definition of plastic surgery has never been established, because it has no distinct anatomical object and thus overlaps with practically all other surgical specialties. An essential feature of plastic surgery is that it involves the treatment of conditions that require or may require tissue relocation skills.
The word plastic in plastic surgery is in reference to the concept of "reshaping" and comes from the Greek πλαστική (τέχνη), plastikē (tekhnē), "the art of modelling" of malleableflesh.[3] This meaning in English is seen as early as 1598.[4] In the surgical context, the word "plastic" first appeared in 1816 and was established in 1838 by Eduard Zeis,[5] preceding the modern technical usage of the word as "engineering material made from petroleum" by 70 years.[6]
Treatments for the plastic repair of a broken nose are first mentioned in the c.1600 BC Egyptian medical text called the Edwin Smith papyrus.[8][9] The early trauma surgery textbook was named after the American Egyptologist, Edwin Smith.[9] Reconstructive surgery techniques were being carried out in India by 800 BC.[10]Sushruta was a physician who made contributions to the field of plastic and cataract surgery in the 6th century BC.[11]
The Roman scholar Aulus Cornelius Celsus recorded surgical techniques, including plastic surgery, in the first century AD.
The Romans also performed plastic cosmetic surgery, using simple techniques, such as repairing damaged ears, from around the 1st century BC.[12] For religious reasons, they did not dissect either human beings or animals, thus, their knowledge was based in its entirety on the texts of their Greek predecessors. Notwithstanding, Aulus Cornelius Celsus left some accurate anatomical descriptions,[13] some of which—for instance, his studies on the genitalia and the skeleton—are of special interest to plastic surgery.[14]
Several ancient Sanskrit medical treatise mentions some types of plastic surgery in India such as the works of Sushruta and Charaka. These works were translated into the Arabic language during the Abbasid Caliphate in 750 AD.[15] The Arabic translations made their way into Europe via intermediaries.[15] In Italy, the Branca family[16] of Sicily and Gaspare Tagliacozzi (Bologna) became familiar with the techniques of Sushruta.[15]
Illustration of an 18th-century nose reconstruction method from Poona performed by an Indian potter, from The Gentleman's Magazine, 1794
All fields of surgery, the Arab physician, surgeon, and chemist Al-Zahrawi talks of the use of silk thread suture to achieve good cosmesis. He describes what is thought to be the first attempt at reduction mammaplasty for the management of gynaecomastia. He gives detailed descriptions of other basic surgical techniques such as cautery and wound management.[17]
British physicians travelled to India to see rhinoplasties being performed by Indian methods.[18][19] Reports on Indian rhinoplasty performed by a Kumhar (potter) vaidya were published in the Gentleman's Magazine by 1794.[18]Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods.[18] Carpue was able to perform the first major surgery in the Western world in the year 1815.[20] Instruments described in the Sushruta Samhita were further modified in the Western world.[20]
In 1465, Sabuncu's book, description, and classification of hypospadias were more informative and up to date. Localization of the urethral meatus was described in detail. Sabuncuoglu also detailed the description and classification of ambiguous genitalia. 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 surgery became common.
In 1814, Joseph Carpue successfully performed an operative procedure on a British military officer who had lost his nose to the toxic effects of mercury treatments. In 1818, German surgeon Carl Ferdinand von Graefe published his major work entitled Rhinoplastik. Von Graefe modified the Italian method using a free skin graft from the arm instead of the original delayed pedicle flap.
The first American plastic surgeon was John Peter Mettauer, who, in 1827, performed the first cleft palate operation with instruments that he designed himself.
Johann Friedrich Dieffenbach specialized in skin transplantation and early plastic surgery. His work in rhinoplastic and maxillofacial surgery established many modern techniques of reconstructive surgery. In 1845, Dieffenbach wrote a comprehensive text on rhinoplasty, titled Operative Chirurgie, and introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose. Dieffenbach has been called the "father of plastic surgery".[21][22]
In 1891, American otorhinolaryngologist John Roe presented an example of his work: a young woman on whom he reduced a dorsal nasal hump for cosmetic indications. In 1892, Robert Weir experimented unsuccessfully with xenografts (duck sternum) in the reconstruction of sunken noses. In 1896, James Israel, a urological surgeon from Germany, and in 1889 George Monks of the United States each described the successful use of heterogeneous free-bone grafting to reconstruct saddle nose defects. In 1898, Jacques Joseph, the German orthopaedic-trained surgeon, published his first account of reduction rhinoplasty. In 1910, Alexander Ostroumov, the Russian pharmacist, and perfume and cosmetics manufacturer, founded a unique plastic surgery department in his Moscow Institute of Medical Cosmetics.[24] In 1928, Jacques Joseph published Nasenplastik und Sonstige Gesichtsplastik.[25]
The development of weapons such as machine guns and explosive shells during World War I created trench warfare, which led to a rapid increase in the number of mutilations to the faces and the heads of soldiers because the trenches mainly offered protection to the body. The surgeons, who were not prepared for these injuries, were even less prepared for a large number of injuries and had to react quickly and intelligently to treat the greatest number. Facial injuries were hard to treat on the front line because of the sanitary conditions many infections could occur. Sometimes, some stitches were made on a jagged wound without thinking about the amount of flesh that had been lost, so scars after were hideous and disfigured soldiers. Some injured had important injuries and the stitches were not sufficient so some became blind, or were left with gaping holes instead of their nose. Harold Gillies, scared by the number of new facial injuries and the lack of good surgical techniques decided to dedicate an entire hospital to the reconstruction of facial injuries as fully as possible. He took into account the psychological dimension. Gillies introduced skin grafts to the treatments of soldiers, so they would be less horrified by looking at themselves in the mirror.[26][27][28]
It is the multidisciplinary approach to the treatment of facial lesions, bringing together plastic surgeons, dental surgeons, technicians, and specialized nurses, which has made it possible to develop techniques leading to the reconstruction of injured faces. Harold Gillies identified the need to advance the specialty of maxillofacial surgery which would be directly dedicated to the management of war wounds at this time. He has developed a new technique using rotational and transposition flaps but also bone grafts from the ribs and tibia to reconstruct facial defects caused by the weapons during the war Gillies experimented with this technique so he knew that he had to start by moving back healthy tissue to its normal position and then he will be able to fill with tissue from another place on the body of the soldier. One of the most successful techniques in skin grafting had the aim of not completely severing the connection to the body. It was possible by releasing and lifting a flap of skin from the wound. The flap of skin, still connected to the donor site would then be swung over the site of the wound, this technique allows the maintenance of physical connection and ensures that blood is supplied to the skin and increases the chances of the skin graft being accepted by the body. At this time, we assisted also to improving in treating infections also meant that important injuries had become survivable mostly thanks to the new technique of Gillies. Some soldiers arrived at the hospital of Gillies without noses, chins, cheekbones, or even eyes. But for them, the most important trauma was psychological.[29][30]
Walter Yeo, a sailor injured at the Battle of Jutland, is assumed to have received plastic surgery in 1917. The photograph shows him immediately following (right) the flap surgery by SirHarold Gillies, and after healing (left).
The father of modern plastic surgery is generally considered to have been Sir Harold Gillies. A New Zealand otolaryngologist working in London, he developed many of the techniques of modern facial surgery in caring for soldiers with disfiguring facial injuries during the First World War.[31]
During World War I, he worked as a medical minder with the Royal Army Medical Corps. After working with the renowned French oral and maxillofacial surgeonHippolyte Morestin on skin grafts, he persuaded the army's chief surgeon, Arbuthnot-Lane, to establish a facial injury ward at the Cambridge Military Hospital, Aldershot, later upgraded to a new hospital for facial repairs at Sidcup in 1917. There Gillies and his colleagues developed many techniques of plastic surgery; more than 11,000 operations were performed on more than 5,000 men (mostly soldiers with facial injuries, usually from gunshot wounds).[32] After the war, Gillies developed a private practice with Rainsford Mowlem, including many famous patients, and travelled extensively to promote his advanced techniques worldwide.
In 1930, Gillies' cousin, Archibald McIndoe, joined the practice and became committed to plastic surgery. When World War II broke out, plastic surgery provision was largely divided between the different services of the armed forces, and Gillies and his team were split up. Gillies himself was sent to Rooksdown House near Basingstoke, which became the principal army plastic surgery unit; Tommy Kilner (who had worked with Gillies during the First World War, and who now has a surgical instrument named after him, the kilner cheek retractor) went to Queen Mary's Hospital, Roehampton; and Mowlem went to St Albans. McIndoe, consultant to the RAF, moved to the recently rebuilt Queen Victoria Hospital in East Grinstead, Sussex, and founded a Centre for Plastic and Jaw Surgery. There, he treated very deep burns, and serious facial disfigurement, such as loss of eyelids, typical of those caused to aircrew by burning fuel.[33]
McIndoe is often recognized for not only developing new techniques for treating badly burned faces and hands but also for recognising the importance of the rehabilitation of the casualties and particularly of social reintegration back into normal life. He disposed of the "convalescent uniforms" and let the patients use their service uniforms instead. With the help of two friends, Neville and Elaine Blond, he also convinced the locals to support the patients and invite them to their homes. McIndoe kept referring to them as "his boys" and the staff called him "The Boss" or "The Maestro".[34]
His other important work included the development of the walking-stalk skin graft, and the discovery that immersion in saline promoted healing as well as improving survival rates for patients with extensive burns—this was a serendipitous discovery drawn from observation of differential healing rates in pilots who had come down on land and in the sea. His radical, experimental treatments led to the formation of the Guinea Pig Club at Queen Victoria Hospital, Sussex. Among the better-known members of his "club" were Richard Hillary, Bill Foxley and Jimmy Edwards.[35]
Plastic surgery is a broad field, and may be subdivided further. In the United States, plastic surgeons are board certified by American Board of Plastic Surgery.[36] Subdisciplines of plastic surgery may include:
Aesthetic surgery
Aesthetic surgery is a central component of plastic surgery and includes facial and body aesthetic surgery. Plastic surgeons use cosmetic surgical principles in all reconstructive surgical procedures as well as isolated operations to improve overall appearance.[37]
Burn surgery
Burn surgery generally takes place in two phases. Acute burn surgery is the treatment immediately after a burn. Reconstructive burn surgery takes place after the burn wounds have healed.[38]
Craniofacial surgery is divided into pediatric and adult craniofacial surgery. Pediatric craniofacial surgery mostly revolves around the treatment of congenital anomalies of the craniofacial skeleton and soft tissues, such as cleft lip and palate, microtia, craniosynostosis, and pediatric fractures. Adult craniofacial surgery deals mostly with reconstructive surgeries after trauma or cancer and revision surgeries along with orthognathic surgery and facial feminization surgery. Craniofacial surgery is an important part of all plastic surgery training programs. Further training and subspecialisation is obtained via a craniofacial fellowship. Craniofacial surgery is also practiced by maxillofacial surgeons.
Hand surgery is concerned with acute injuries and chronic diseases of the hand and wrist, correction of congenital malformations of the upper extremities, and peripheral nerve problems (such as brachial plexus injuries or carpal tunnel syndrome). Hand surgery is an important part of training in plastic surgery, as well as microsurgery, which is necessary to replant an amputated extremity. The hand surgery field is also practiced by orthopedic surgeons and general surgeons. Scar tissue formation after surgery can be problematic on the delicate hand, causing loss of dexterity and digit function if severe enough. There have been cases of surgery on women's hands in order to correct perceived flaws to create the perfect engagement ring photo.[39]
Microsurgery is generally concerned with the reconstruction of missing tissues by transferring a piece of tissue to the reconstruction site and reconnecting blood vessels. Popular subspecialty areas are breast reconstruction, head and neck reconstruction, hand surgery/replantation, and brachial plexus surgery.
Children often face medical issues very different from the experiences of an adult patient. Many birth defects or syndromes present at birth are best treated in childhood, and pediatric plastic surgeons specialize in treating these conditions in children. Conditions commonly treated by pediatric plastic surgeons include craniofacial anomalies, Syndactyly[40] (webbing of the fingers and toes), Polydactyly (excess fingers and toes at birth), cleft lip and palate, and congenital hand deformities.
Plastic surgery performed on an incarcerated population in order to affect their recidivism rate, a practice instituted in the early 20th century that lasted until the mid-1990s. Separate from surgery performed for medical need.
Techniques and procedures
In plastic surgery, the transfer of skin tissue (skin grafting) is a very common procedure. Skin grafts can be derived from the recipient or donors:
Autografts are taken from the recipient. If absent or deficient of natural tissue, alternatives can be cultured sheets of epithelial cellsin vitro or synthetic compounds, such as integra, which consists of silicone and bovine tendon collagen with glycosaminoglycans.
Allografts are taken from a donor of the same species. Kidney transplants are an example of allograft transfer. Joseph Murray, American Plastic Surgeon, is credited for completing the first successful kidney transplantation in 1954.
Xenografts are taken from a donor of a different species.
Usually, good results would be expected from plastic surgery that emphasize careful planning of incisions so that they fall within the line of natural skin folds or lines, appropriate choice of wound closure, use of best available suture materials, and early removal of exposed sutures so that the wound is held closed by buried sutures.[original research?][41]
Navy doctors perform reconstructive surgery on a 21-year-old patient.
Reconstructive plastic surgery is performed to correct functional impairments caused by burns; traumatic injuries, such as facial bone fractures and breaks; congenital abnormalities, such as cleft palates or cleft lips; developmental abnormalities; infection and disease; and cancer or tumors. The goal of reconstructive plastic surgery is to restore both form and function.
The most common reconstructive procedures are tumor removal, laceration repair, maxillofacial surgery, scar revision, hand surgery and breast reduction plasty. According to the American Society of Plastic Surgeons, the number of reconstructive breast reductions for women decreased in 2018 by 4 percent from the year before. Breast reduction in men decreased in 2018 by 8 percent. In 2018, there were 57,535 performed.
Some other common reconstructive surgical procedures include breast reconstruction after a mastectomy for the treatment of cancer, cleft lip and palate surgery, contracture surgery for burn survivors, and creating a new outer ear when one is congenitally absent.
Plastic surgeons use microsurgery to transfer tissue for coverage of a defect when no local tissue is available. Free flaps 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 to 2 millimeters in diameter.
Cosmetic surgery procedures
Cosmetic surgery is a voluntary or elective surgery that is performed on normal parts of the body with the only purpose of improving a person's appearance or removing signs of aging. Some cosmetic surgeries such as breast reduction are also functional and can help to relieve symptoms of discomfort such as back ache or neck ache. Cosmetic surgeries are also undertaken following breast cancer and mastectomy to recreate the natural breast shape which has been lost during the process of removing the cancer. In 2014, nearly 16 million cosmetic procedures were performed in the United States alone.[42] The number of cosmetic procedures performed in the United States has almost doubled since the start of the century. 92% of cosmetic procedures were performed on women in 2014, up from 88% in 2001.[43] 15.6 million cosmetic procedures were performed in 2020, with the five most common surgeries being Nose Reshaping, Eyelid surgery, Facelift, Liposuction, and breast augmentation. Breast augmentation continues to be one of the top 5 cosmetic surgical procedures and has been since 2006. Silicone implants were used in 84% and saline implants in 16% of all breast augmentations in 2020.[44] The American Society for Aesthetic Plastic Surgery looks at the statistics for 34 different cosmetic procedures. Nineteen of the procedures are surgical, such as rhinoplasty or facelift. The nonsurgical procedures include Botox and laser hair removal. In 2010, their survey revealed that there were 9,336,814 total procedures in the United States. Of those, 1,622,290 procedures were surgical (p.5). They also found that a large majority, 81%, of the procedures were done on Caucasian people (p.12).[45]
In 1949, 15,000 Americans underwent cosmetic surgery procedures and by 1969[46] this number rose to almost half a million people.[47] The American Society of Plastic Surgeons (ASPS) estimates that more than 333,000 cosmetic procedures were performed on patients 18 years of age or younger in the US in 2005 compared to approx. 14,000 in 1996. In 2018, more than 226,994 patients between the ages of 13 and 19 underwent plastic surgery compared to just over 218,900 patients in the same age group in 2010.[46][48] Concerns about young people undergoing plastic surgery include the financial burden of additional surgical procedures needed to correct problems after the initial cosmetic surgery, long-term health complications from plastic surgery, and unaddressed mental health issues that may have led to surgery.[49] The increased use of cosmetic procedures crosses racial and ethnic lines in the U.S., with increases seen among African-Americans, Asian Americans and Hispanic Americans as well as Caucasian Americans. In Asia, cosmetic surgery has become more popular, and countries such as China and India have become Asia's biggest cosmetic surgery markets.[50] South Korea is also rising in popularity in Asian and Western countries due to their expertise in facial bone surgeries (see cosmetic surgery in South Korea).[51]
Plastic surgery is increasing slowly, rising 115% from 2000 to 2015. "According to the annual plastic surgery procedural statistics, there were 15.9 million surgical and minimally-invasive cosmetic procedures performed in the United States in 2015, a 2 percent increase over 2014."[52] A study from 2021 found that requests for cosmetic procedures had increased significantly since the beginning of the COVID-19 pandemic, possibly due to the increase in videoconferencing;[53] cited estimates include a 10% increase in the United States and a 20% increase in France.[54]
The most popular aesthetic/cosmetic procedures include:
Phalloplasty ("penile surgery"): construction (or reconstruction) of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes
Reduction mammoplasty ("breast reduction"): removal of skin and glandular tissue, which is done to reduce back and shoulder pain in women with gigantomastia and for men with gynecomastia
Mastopexy ("breast lift"): Lifting or reshaping of breasts to make them less saggy, often after weight loss (after a pregnancy, for example). It involves removal of breast skin as opposed to glandular tissue
Augmentation mastopexy ("breast lift with breast implants"): Lifting breasts to make them less saggy, repositioning the nipple to a higher location, and increasing breast size with saline or silicone gel implants. Recent studies of a newer technique for simultaneous augmentation mastopexy (SAM) indicate that it is a safe surgical procedure with minimal medical complications.[55] The SAM technique involves invaginating and tacking the tissues first, in order to previsualize the result, before making any surgical incisions to the breast.[56]
Buttock augmentation ("butt implant"): enhancement of the buttocks using silicone implants or fat grafting ("Brazilian butt lift") where fat is transferred from other areas of the body
Cryolipolysis: refers to a medical device used to destroy fat cells. Its principle relies on controlled cooling for non-invasive local reduction of fat deposits to reshape body contours.
Cryoneuromodulation: Treatment of superficial and subcutaneous tissue structures using gaseous nitrous oxide, including temporary wrinkle reduction, temporary pain reduction, treatment of dermatologic conditions, and focal cryo-treatment of tissue
Calf Augmentation: done by silicone implants or fat transfer to add bulk to calf muscles
Lip augmentation: alter the appearance of the lips by increasing their fullness through surgical enlargement with lip implants or nonsurgical enhancement with injectable fillers
Midface lift ("cheek lift"): tightening of the cheeks
Genioplasty: augmentation of the chin with an individual's bones or with the use of an implant, usually silicone, by suture of the soft tissue[57]
Mentoplasty: surgery to the chin. This can involve either enhancing or reducing the size of the chin. Enhancements are achieved with the use of facial implants. Reduction of the chin involved reducing the size of the chin bone.[58]
Body contouring: the removal of this excess skin and fat from numerous areas of the body, restoring the appearance of skin elasticity of the remaining skin. The surgery is prominent in those who have undergone significant weight loss resulting in excess sagging skin being present around areas of the body. The skin loses elasticity (a condition called elastosis[59]) once it has been stretched past capacity and is unable to recoil back to its standard position against the body and also with age.[60]
Dermal fillers: Dermal fillers are injected below the skin to give a more fuller, youthful appearance of a feature or section of the face. One type of dermal filler is Hyaluronic acid. Hyaluronic acid is naturally found throughout the human body. It plays a vital role in moving nutrients to the cells of the skin from the blood. It is also commonly used in patients with Arthritis as it acts like a cushion to the bones which have depleted the articular cartilage casing. Development within this field has occurred over time with synthetic forms of hyaluronic acid is being created, playing roles in other forms of cosmetic surgery such as facial augmentation.[62]
Micropigmentation: is the creation of permanent makeup using natural pigments to places such as the eyes to create the effect of eye shadow, lips creating lipstick and cheek bones to create a blush like look. The pigment is inserted beneath the skin using a machine which injects a small needle at a very fast rate carrying pigment into the skin, creating a lasting colouration of the desired area.
In 2015, the most popular surgeries were Botox, liposuction, eyelid surgery, breast implants, nose jobs, and facelifts.[63] According to the 2020 Plastic Surgery Statistics Report, which is published by the American Society of Plastic Surgeons, the most surgical procedure performed in the U.S. was Rhinoplasty (Nose reshaping) accounting for 15.2% of all cosmetic surgical procedures that year, followed by Blepharoplasty (Eyelid surgery), which accounted for 14% of all procedures. The third most populous procedure was Rhytidectomy (Facelift) (10% of all procedures), then Liposuction (9.1% of all procedures).[64]
Complications, risks, and reversals
All surgery has risks. Common complications of cosmetic surgery includes hematoma, nerve injury, infection, scarring, implant failure and end organ damage.[65][66]Breast implants can have many complications, including rupture. In a study of his 4761 augmentation mammaplasty patients, Eisenberg reported that overfilling saline breast implants 10–13% significantly reduced the rupture-deflation rate to 1.83% at 8-years post-implantation.[67] In 2011 FDA stated that one in five patients who received implants for breast augmentation will need them removed within 10 years of implantation.[68]
Psychological disorders
Though media and advertising do play a large role in influencing many people's lives, such as by making people believe plastic surgery to be an acceptable course to change our identities to our liking,[69] researchers believe that plastic surgery obsession is linked to psychological disorders like body dysmorphic disorder.[70] There exists a correlation between those with BDD and the predilection toward cosmetic plastic surgery in order to correct a perceived defect in their appearance.[71]
BDD is a disorder resulting in the individual becoming "preoccupied with what they regard as defects in their bodies or faces". Alternatively, where there is a slight physical anomaly, then the person's concern is markedly excessive.[71] While 2% of people have body dysmorphic disorder in the United States, 15% of patients seeing a dermatologist and cosmetic surgeons have the disorder. Half of the patients with the disorder who have cosmetic surgery performed are not pleased with the aesthetic outcome. BDD can lead to suicide in some people with the condition. While many with BDD seek cosmetic surgery, the procedures do not treat BDD, and can ultimately worsen the problem. The psychological root of the problem is usually unidentified; therefore causing the treatment to be even more difficult. Some say that the fixation or obsession with correction of the area could be a sub-disorder such as anorexia or muscle dysmorphia.[72] The increased use of body and facial reshaping applications such as Snapchat and Facetune have been identified as a potential triggers of BDD. Recently, a phenomenon referred to as 'Snapchat dysmorphia' has appeared to describe people who request surgery to resemble the edited version of themselves as they appear through Snapchat Filters.[73] As a protest to the detrimental trend, Instagram banned all augmented reality (AR) filters that depict or promote cosmetic surgery.[74]
In some cases, people whose physicians refuse to perform any further surgeries, have turned to "do it yourself" plastic surgery, injecting themselves and running extreme safety risks.[75]
With the growing popularity of plastic surgery, has also come a widespread increase in minimally invasive alternatives involving intradermal and intramusclular injectables, including various neurotoxins such as Botox, Dysport, Xeomin, and Jeuveau, amongst others, alongside hyaluronic acid based dermal fillers.
Rhinoplasty, commonly called nose job, medically called nasal reconstruction, is a plastic surgery procedure for altering and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that changes the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery can also treat birth defects, breathing problems, and failed primary rhinoplasties. Rhinoplasty may remove a bump, narrow nostril width, change the angle between the nose and the mouth, or address injuries, birth defects, or other problems that affect breathing, such as a deviated nasal septum or a sinus condition. Surgery only on the septum is called a septoplasty.
Mammaplasty refers to a group of surgical procedures, the goal of which is to reshape or otherwise modify the appearance of the breast. There are three main types of mammoplasty:
Augmentation mammaplasty is commonly performed to increase the size, change the shape, and/or alter the texture of the breasts. This usually involves the surgical implantation of breast implants.
Reduction mammaplasty is commonly performed to reduce the size, change the shape, and/or alter the texture of the breasts. This involves the removal of breast tissue.
Reconstructive mammoplasty is breast reconstruction that is done after mastectomy to give the breasts an appearance that is more normal/familiar.
Facial feminization surgery (FFS) is a set of reconstructive surgical procedures that alter typically male facial features to bring them closer in shape and size to typical female facial features. FFS can include various bony and soft tissue procedures such as brow lift, rhinoplasty, cheek implantation, and lip augmentation.
Breast augmentation and augmentation mammoplasty is a cosmetic surgery procedure, which uses breast-implants and/ or fat-graft mammoplasty technique to increase the size, change the shape, and alter the texture of the breasts. Although in some cases augmentation mammoplasty is applied to correct congenital defects of the breasts and the chest wall in other cases it is performed purely for cosmetic reasons.
Oral and maxillofacial surgery is a surgical specialty focusing on reconstructive surgery of the face, facial trauma surgery, the mouth, head and neck, and jaws, as well as facial plastic surgery including cleft lip and cleft palate surgery.
A facelift, technically known as a rhytidectomy, is a type of cosmetic surgery procedure intended to give a more youthful facial appearance. There are multiple surgical techniques and exercise routines. Surgery usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient's face and neck. Exercise routines tone underlying facial muscles without surgery. Surgical facelifts are effectively combined with eyelid surgery (blepharoplasty) and other facial procedures and are typically performed under general anesthesia or deep twilight sleep.
Chin augmentation using surgical implants alter the underlying structure of the face, intended to balance the facial features. The specific medical terms mentoplasty and genioplasty are used to refer to the reduction and addition of material to a patient's chin. This can take the form of chin height reduction or chin rounding by osteotomy, or chin augmentation using implants. Altering the facial balance is commonly performed by modifying the chin using an implant inserted through the mouth. The intent is to provide a suitable projection of the chin as well as the correct height of the chin which is in balance with the other facial features.
Reconstructive surgery is surgery performed to restore normal appearance and function to body parts malformed by a disease or medical condition.
Lip augmentation is a cosmetic procedure that modifies the shape of the lips using fillers, such as collagen or implants. The procedure may be performed to increase lip size, correct asymmetry, create protrusion, or adjust the ratio of the top and bottom lips. The procedure typically involves surgical injection, though temporary non-surgical alternatives exist.
Gluteoplasty denotes the plastic surgery and the liposuction procedures for the correction of congenital, traumatic, and acquired defects/deformities of the buttocks and the anatomy of the gluteal region; and for the aesthetic enhancement of the contour of the buttocks.
Mastopexy is the plastic surgery mammoplasty procedure for raising sagging breasts upon the chest of the woman, by changing and modifying the size, contour, and elevation of the breasts. In a breast-lift surgery to re-establish an aesthetically proportionate bust for the woman, the critical corrective consideration is the tissue viability of the nipple-areola complex (NAC), to ensure the functional sensitivity of the breasts for lactation and breast-feeding.
Pediatric plastic surgery is plastic surgery performed on children. Its procedures are predominantly conducted for reconstructive purposes, although some cosmetic procedures are performed on children as well. In children, the line between cosmetic and reconstructive surgery is often blurred, as many congenital deformities impair physical function as well as aesthetics.
Aesthetic medicine is a branch of modern medicine that focuses on altering natural or acquired unwanted appearance through the treatment of conditions including scars, skin laxity, wrinkles, moles, liver spots, excess fat, cellulite, unwanted hair, skin discoloration, spider veins and or any unwanted externally visible appearance. Traditionally, it includes dermatology, oral and maxillofacial surgery, reconstructive surgery and plastic surgery, surgical procedures, non-surgical procedures, and a combination of both. Aesthetic medicine procedures are usually elective. There is a long history of aesthetic medicine procedures, dating back to many notable cases in the 19th century, though techniques have developed much since then.
A lip lift is the most common plastic surgery procedure that modifies the cosmetic appearance of the lips, by reshaping them to increase the prominence of the vermilion border and to enhance the facial area above the lips into a more aesthetically pleasing shape. In corrective praxis, a lip lift procedure is distinguished from lip enhancement, the augmentation of the lips, which can be affected with a non-surgical procedure.
Non-surgical rhinoplasty is a medical aesthetic procedure in which injectable fillers, most commonly hyaluronic acid ones like Restylane and Juvederm or calcium hydroxyapatite (Radiesse), are used to alter and shape a person's nose without a surgery. The procedure fills in depressed areas on the nose, lifting the angle of the tip or smoothing the appearance of bumps on the bridge. Non surgical rhinoplasty is an augmentation procedure, so it cannot reduce the size of someone's nose. The cosmetic procedure carries the risk of causing serious skin damage or distant complications like blindness. If the filler product is injected into an artery, filler can travel in the arteries and blocks smaller size arteries like ophthalmic artery and cause blindness. If blood vessels of the skin is blocked, skin necrosis can develop. Hyaluronic acid based fillers can be reversed even if injected into a blood vessel with an enzyme called hyaluronidase, which can be also injected like fillers.
Cosmetic surgery, also referred to as aesthetic surgery, is a surgical procedure which endeavours to improve the physical aspects of one's appearance to become more aesthetically pleasing. The continuously growing field of cosmetic surgery is closely linked with plastic surgery, the difference being, cosmetic surgery is an elective surgery with the sole purpose to enhance the physical features of one's appearance. Plastic surgery is performed in order to rectify defects to reinstate normality to function and appearance. Cosmetic surgical procedures are generally performed on healthy functioning body parts, with the procedure being optional not medically necessary. The inevitable aim of cosmetic surgery is to enhance one's image, encompassing reducing the signs of aging and/or correction of a believed deviation on one's body in turn it is surrounded by controversy. Although the implementation of cosmetic surgery within Australian society is growing, the trade has struggled to find its place within the Australian culture.
Alloplasty is a surgical procedure performed to substitute and repair defects within the body with the use of synthetic material. It can also be performed in order to bridge wounds. The process of undergoing alloplasty involves the construction of an alloplastic graft through the use of computed tomography (CT), rapid prototyping and "the use of computer-assisted virtual model surgery." Each alloplastic graft is individually constructed and customised according to the patient's defect to address their personal health issue. Alloplasty can be applied in the form of reconstructive surgery. An example where alloplasty is applied in reconstructive surgery is in aiding cranial defects. The insertion and fixation of alloplastic implants can also be applied in cosmetic enhancement and augmentation. Since the inception of alloplasty, it has been proposed that it could be a viable alternative to other forms of transplants. The biocompatibility and customisation of alloplastic implants and grafts provides a method that may be suitable for both minor and major medical cases that may have more limitations in surgical approach. Although there has been evidence that alloplasty is a viable method for repairing and substituting defects, there are disadvantages including suitability of patient bone quality and quantity for long term implant stability, possibility of rejection of the alloplastic implant, injuring surrounding nerves, cost of procedure and long recovery times. Complications can also occur from inadequate engineering of alloplastic implants and grafts, and poor implant fixation to bone. These include infection, inflammatory reactions, the fracture of alloplastic implants and prostheses, loosening of implants or reduced or complete loss of osseointegration.
Culture of cosmetic surgery is a set of attitudes and behavior regarding making changes to one's appearance via plastic surgery. World War I left thousands of soldiers with unprecedented levels of facial damage, creating a massive need for reconstructive surgery. Harold Gillies of New Zealand developed methods to restore function and structure to the faces of soldiers and these processes rapidly gained popularity. During the 1940s and 50s, personal appearance became more emphasized in the United States. As beauty standards changed, new products and techniques were developed to meet those demands.
Fat transfer, also known as fat graft, lipomodelling, or fat injections, is a surgical process in which a person's own fat is transferred from one area of the body to another area. The major aim of this procedure is to improve or augment the area that has irregularities and grooves. Carried out under either general anesthesia or local anesthesia, the technique involves 3 main stages: fat harvesting, fat processing and fat injection.
Derek Steinbacher is an American cosmetic plastic, rhinoplasty, and maxillofacial surgeon who is Professor of Plastic Surgery at Yale New Haven Health in Connecticut. He was also the chief of the Dental Department and Oral and Maxillofacial Surgery at Yale New Haven Health. He is known for his clinical work, research and incorporation of 3D analysis and printing into jaw surgery, craniofacial surgery and rhinoplasty.
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Fraser S (2003). Cosmetic surgery, gender and culture. Palgrave. ISBN978-1-4039-1299-2.
Gilman S (2005). Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery. Duke University Press. ISBN978-0-8223-2144-6.
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