Plastic surgery is a medical specialty that uses a number of surgical and nonsurgical techniques to change the appearance and function of a person's body.[1] Plastic surgery procedures include both cosmetic enhancements as well as functionally reconstructive operations. In the former case, where aesthetics are considered more of the concern than changing the functionality, plastic surgery is also sometimes incorrectly referred to as " cosmetic surgery". Some procedures however involve both aesthetic and functional elements. The word "plastic" derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with the synthetic polymer material known as plastic. Plastic surgeons typically mold and reshape the following tissues of the body: bone, cartilage, muscle, fat, and skin.

Plastic surgery sub-specialities

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. This field is also practiced by oral and maxillofacial surgeons. Because these children have multiple issues, the best approach to providing care to them is an interdisciplinary approach which also includes otolaryngologists, speech therapists, occupational therapists and geneticists.
Hand surgery is a field that is also practiced by general surgeons and orthopedic surgeons (see Hand surgeon). Plastic surgeons receive training in hand surgery. There is the option to complete a fellowship in this area afterwards. In particular, plastic surgeons receive training in microvascular surgery, which is needed to replant an amputated hand or digit. Examples of hand operations include reconstruction of injuries, replantations, rheumatoid surgery and surgery of congenital defects.
Microsurgery
Burn surgery
Aesthetic or cosmetic surgery
Pediatric plastic surgery. Children often face medical issues unique 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, cleft lip and palate and congenital hand deformities.

History

Plastic surgery reaches back to the 700s BCE. Physicians in ancient India including Sushruta were making use of skin grafts for reconstructive work as early as the 8th century BC. In his work Sushruta Samhita describes rhinoplasty and otoplasty. This knowledge of plastic surgery existed in India up to the late 18th century as can be seen from the reports published in Gentleman's Magazine (October 1794).[2][3]

The Romans were able to perform simple techniques such as repairing damaged ears from around the 1st century BC. In 1465, Sabuncuoglu's book, description, and classification of hypospadias was more informative and up to date. Localization of urethral meatus was described in detail. Sabuncuoglu also detailed the description and classification of ambiguous genitalia (Kitabul Cerrahiye-i Ilhaniye -Cerrahname-Tip Tarihi Enstitüsü, Istanbul) 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 commonplace.

Up until the techniques of anesthesia became established, all surgery on healthy tissues involved great pain. Infection from surgery was reduced once sterile technique and disinfectants were introduced. The invention and use of antibiotics beginning with sulfa drugs and penicillin was another step in making elective surgery possible.

In 1791, Chopart performed operative procedure of a lip using a flap from the neck. In 1814, Joseph Carpue successfully performed operative procedure in 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. In 1845, Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty, entitled Operative Chirurgie, and introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose. 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 1928, Jacques Joseph published Nasenplastik und Sonstige Gesichtsplastik.

The U.S.'s first plastic surgeon was Dr. John Peter Mettauer. In 1827, he performed the first cleft palate operation with instruments that he designed himself. The New Zealander Sir Harold Gillies, an otolaryngologist, developed many of the techniques of modern plastic surgery in caring for those who suffered facial injuries in World War I. His work was expanded upon during World War II by one of his former students and cousin, Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns. McIndoe's radical, experimental treatments, lead to the formation of the Guinea Pig Club. Plastic surgery as a specialty evolved tremendously during the 20th Century in the United States. One of the founders of the specialty, Dr. Vilray Blair, was the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis, Missouri. In one of his many areas of clinical expertise, Blair treated World War I soldiers with complex maxillofacial injuries, and his paper on “Reconstructive Surgery of the Face” set the standard for craniofacial reconstruction. He was also one of the first surgeons without a dental background to be elected to the American Association of Oral and Plastic Surgery (later the organizations split to be renamed the American Association of Plastic Surgeons and the American Association of Oral and Maxillofacial Surgeons) and taught many surgeons who became leaders in the field of plastic surgery[