Plastic, reconstructive, and cosmetic surgery
Definition
Plastic, reconstructive, and cosmetic surgery refers to a variety of operations performed
in order to repair or restore body parts to look normal, or to change a body part to look
better. These types of surgery are highly specialized. They are characterized by careful
preparation of a person's skin and tissues, by precise cutting and suturing techniques,
and by care taken to minimize scarring. Recent advances in the development of
miniaturized instruments, new materials for artificial limbs and body parts, and
improved surgical techniques have expanded the range of plastic surgery procedures
that can be performed.
Purpose
Although these three types of surgery share some common techniques and approaches,
they have somewhat different emphases. Plastic surgery is usually performed to treat
birth defects and to remove skin blemishes such as warts, acne scars, or birthmarks.
Cosmetic surgery procedures are performed to make persons look younger or enhance
their appearance in other ways. Reconstructive surgery is used to reattach body parts
severed in combat or accidents, to perform skin grafts after severe burns, or to
reconstruct parts of person's body that were missing at birth or removed by surgery.
Reconstructive surgery is the oldest form of plastic surgery, having developed out of the
need to treat wounded soldiers in wartime.
Demographics
The top 10 most commonly performed elective cosmetic surgeries in the United States
include the following:

liposuction

breast augmentation

eyelid surgery

face lift

tummy tuck

collagen injections

chemical peel

laser skin resurfacing

rhinoplasty

forehead lift
There were approximately 29 million surgical procedures performed in the United
States in 2001. Because many plastic and reconstructive surgical procedures are
performed in private professional offices or as outpatient procedures, accurate statistics
concerning the number of procedures performed are not available.
Description
Plastic surgery
Plastic surgery includes a number of different procedures that usually involve skin.
Operations to remove excess fat from the abdomen ("tummy tucks"), dermabrasion to
remove acne scars or tattoos, and reshaping the cartilage in children's ears ( otoplasty )
are common applications of plastic surgery.
Cosmetic surgery
Most cosmetic surgery is done on the face. It is intended either to correct disfigurement
or to enhance a person's features. The most common cosmetic procedure for children is
correction of a cleft lip or palate. In adults, the most common procedures are
remodeling of the nose (rhinoplasty), removal of baggy skin around the eyelids
( blepharoplasty ), face lifts (rhytidectomy), or changing the size or shape of the
breasts (mammoplasty). Although many people still think of cosmetic surgery as only
for women, growing numbers of men are choosing to have facelifts and eyelid surgery,
as well as hair transplants and "tummy tucks."
Reconstructive surgery
Reconstructive surgery is often performed on burn and accident victims. It may involve
the rebuilding of severely fractured bones, as well as skin grafting . Reconstructive
surgery includes such procedures as the reattachment of an amputated finger or toe, or
implanting a prosthesis. Prostheses are artificial structures and materials that are used
to replace missing limbs or teeth, or arthritic hip and knee joints.
Diagnosis/Preparation
General preparation
Preparation for nonemergency plastic or reconstructive surgery includes individual
education, as well as medical considerations. Some operations, such as nose reshaping
or the removal of warts, small birthmarks, and tattoos can be done as outpatient
procedures under local anesthesia. Most plastic and reconstructive surgery, however,
involves a stay in the hospital and general anesthesia.
Medical preparation
Preparation for plastic surgery includes the surgeon's detailed assessment of the parts of
an individual's body that will be involved. Skin grafts require evaluating suitable areas of
skin for the right color and texture to match the skin at the graft site. Face lifts and
cosmetic surgery in the eye area require very close attention to the texture of the skin
and the placement of surgical cuts (incisions).
Persons scheduled for plastic surgery under general anesthesia will be given a physical
examination , blood and urine tests, and other tests to make sure that they do not
have any previously undetected health problems or blood clotting disorders. The
surgeon will check the list of prescription medications that the prospective patient may
be taking to make sure that none of them will interfere with normal blood clotting or
interact with the anesthetic.
Individuals are asked to avoid using aspirin or medications containing aspirin for a
week to two weeks before surgery, because these drugs lengthen the time of blood
clotting. Smokers are asked to stop smoking two weeks before surgery because smoking
interferes with the healing process. For some types of plastic surgery, individuals may be
asked to donate several units of their own blood before the procedure, in case a
transfusion is needed during the operation. The prospective patient will be asked to
sign a consent form before the operation.
Personal education
The surgeon will meet with the prospective patient before the operation is scheduled, in
order to explain the procedure and to be sure that the individual is realistic about the
expected results. This consideration is particularly important for people undergoing
cosmetic surgery.
Medical considerations
Some people should not have plastic surgery because of certain medical risks. These
groups include:

persons recovering from a heart attack, severe infection (for example,
pneumonia), or other serious illnesses

people with infectious hepatitis or HIV infections

individuals with cancer whose cancer might spread (metastasize)

people who are extremely overweight (Individuals who are more than 30%
overweight should not have liposuction.)

persons with blood clotting disorders
Psychological
Plastic, cosmetic, and reconstructive surgeries have an important psychological
dimension because of the high value placed on outward appearance in Western society.
Many people who are born with visible deformities or disfigured by accidents later in life
develop emotional problems related to social rejection. Other people work in fields such
as acting, modeling, media journalism, and even politics, where their employment
depends on how they look. Some people have unrealistic expectations of cosmetic
surgery and think that it will solve all their life problems. It is important for anyone
considering nonemergency plastic or cosmetic surgery to be realistic about its results.
One type of psychiatric disorder, called body dysmorphic disorder, is characterized by
an excessive preoccupation with imaginary or minor flaws in appearance. Persons with
this disorder frequently seek unnecessary plastic surgery.
Aftercare
Medical
Medical aftercare following plastic surgery under general anesthesia includes bringing
patients to a recovery room , monitoring their vital signs , and giving medications to
relieve pain as necessary. Persons who have had fat removed from the abdomen may be
kept in bed for as long as two weeks. Individuals who have had mammoplasties, breast
reconstruction , and some types of facial surgery typically remain in the hospital for a
week after the operation. Those who have had liposuction or eyelid surgery are usually
sent home in a day or two.
People who have had outpatient procedures are usually given antibiotics to prevent
infection and are sent home as soon as their vital signs are normal.
Psychological
Some individuals may need follow-up psychotherapy or counseling after plastic or
reconstructive surgery. These people typically include children whose schooling and
social relationships have been affected by birth defects, as well as persons of any age
whose deformities or disfigurements were caused by trauma from accidents, war
injuries, or violent crimes.
Risks
The risks associated with plastic, cosmetic, and reconstructive surgery include the
postoperative complications that can occur with any surgical operation under anesthesia.
These complications include wound infection, internal bleeding, pneumonia, and
reactions to the anesthesia.
In addition to these general risks, some plastic, cosmetic, and reconstructive surgical
procedures carry specific risks:

formation of undesirable scar tissue

development of persistent pain, redness, or swelling in the area of the surgery

infection inside the body related to inserting a prosthesis (These infections can
result from contamination at the time of surgery or from bacteria migrating into
the area around the prosthesis at a later time.)

anemia or fat embolisms from liposuction

rejection of skin grafts or tissue transplants

loss of normal feeling or function in the area of the operation (For example, it is
not unusual for women who have had mammoplasties to lose sensation in their
nipples.)

complications resulting from unforeseen technological problems (The bestknown example of this problem was the discovery in the mid-1990s that breast
implants made with silicone gel could leak into the recipient's body.)
Normal results
Normal results include an individual's recovery from the surgery with satisfactory
results and without complications.
Morbidity and mortality rates
Morbidity and mortality rates vary with the complexity and severity of different
procedures. Mortality is similar to that associated with all surgical procedures.
Morbidity is influenced by personal expectations. From a surgical perspective, most
morbidity is due to errors associated with anesthesia, procedure, pain medications, and
after care. From an individual's perspective, morbidity involves the degree to which
actual results compared to expected outcomes. The latter distinction is very subjective.
Alternatives
Alternatives to plastic, reconstructive, and cosmetic surgical procedures include using
various products that may be affixed to articles of clothing or the surface of the body.