Plastic Surgery

What is Plastic Surgery?

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. 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.

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.

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.

Craniofacial surgery
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.

Ethnic plastic surgery
Ethnic plastic surgery is plastic surgery performed to change ethnic attributes, often considered used as a way of “passing”.

Hand surgery
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.

Microsurgery
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.

Pediatric plastic 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 (webbing of the fingers and toes), Polydactyly (excess fingers and toes at birth), cleft lip and palate, and congenital hand deformities.

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. 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. 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. 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

In 1949, 15,000 Americans underwent cosmetic surgery procedures and by 1969 this number rose to almost half a million people. 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. 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. 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. 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).

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.” 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; cited estimates include a 10% increase in the United States and a 20% increase in France.

The most popular aesthetic/cosmetic procedures include:

• Abdominoplasty (“tummy tuck”): reshaping and firming of the abdomen
• Blepharoplasty (“eyelid surgery”): reshaping of upper/lower eyelids including Asian blepharoplasty

• Phalloplasty (“penile surgery”): construction (or reconstruction) of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes

• Mammoplasty:
  • Breast augmentations (“breast implant” or “boob job”): augmentation of the breasts by means of fat grafting, saline, or silicone gel prosthetics, which was initially performed for women with micromastia
  • 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. The SAM technique involves invaginating and tacking the tissues first, in order to previsualize the result, before making any surgical incisions to the breast.

• 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
• Labiaplasty: surgical reduction and reshaping of the labia
• Lip augmentation: alter the appearance of the lips by increasing their fullness through surgical enlargement with lip implants or nonsurgical enhancement with injectable fillers
• Cheiloplasty: surgical reconstruction of the lip
• Rhinoplasty (“nose job”): reshaping of the nose sometimes used to correct breathing impaired by structural defects.
• Otoplasty (“ear surgery”/”ear pinning”): reshaping of the ear, most often done by pinning the protruding ear closer to the head.
• Rhytidectomy (“face lift”): removal of wrinkles and signs of aging from the face
  • Neck lift: tightening of lax tissues in the neck. This procedure is often combined with a facelift for lower face rejuvenation.
  • Browplasty (“brow lift” or “forehead lift”): elevates eyebrows, smooths forehead skin
  • 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
  • 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.
• Cheek augmentation (“cheek implant”): implants to the cheek
• Orthognathic Surgery: altering the upper and lower jaw bones (through osteotomy) to correct jaw alignment issues and correct the teeth alignment
• Fillers injections: collagen, fat, and other tissue filler injections, such as hyaluronic acid
• Brachioplasty (“Arm lift”): reducing excess skin and fat between the underarm and the elbow
• Laser Skin Rejuvenation or laser resurfacing: the lessening of depth of facial pores and exfoliation of dead or damaged skin cells
• Liposuction (“suction lipectomy”): removal of fat deposits by traditional suction technique or ultrasonic energy to aid fat removal
• Zygoma reduction plasty: reducing the facial width by performing osteotomy and resecting part of the zygomatic bone and arch
• Jaw reduction: reduction of the mandible angle to smooth out an angular jaw and creating a slim jaw
• Buccal Fat Extraction: extraction of the buccal pads
• 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) once it has been stretched past capacity and is unable to recoil back to its standard position against the body and also with age.
• Sclerotherapy: removing visible ‘spider veins’ (Telangiectasia), which appear on the surface of the skin.
• 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.
• 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. 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).

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. 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. In 2011 FDA stated that one in five patients who received implants for breast augmentation will need them removed within 10 years of implantation.

Source : https://en.wikipedia.org/wiki/Plastic_surgery