Plastic surgery

The word plastic in plastic surgery means "reshaping" and comes from the Greek πλαστική (τέχνη), plastikē (tekhnē), "the art of modelling" of malleable flesh.[3] This meaning in English is seen as early as 1598.[4] The surgical definition of "plastic" first appeared in 1839, preceding the modern "engineering material made from petroleum" sense by 70 years.[5]

A statue of Sushruta, at the Royal Australasian College of Surgeons in Melbourne, Australia.

Plates vi & vii of the Edwin Smith Papyrus at the Rare Book Room, New York Academy of Medicine[6]

Treatments for the plastic repair of a broken nose are first mentioned in the c. 1600 BCE Egyptian medical text called the Edwin Smith papyrus.[7][8] The early trauma surgery textbook was named after the American Egyptologist, Edwin Smith.[8] Reconstructive surgery techniques were being carried out in India by 800 BC.[9] Sushruta Samhita talks about nose surgery and cataract surgery in the 6th century BC.[10]

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. 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 surprisingly accurate anatomical descriptions,[11] some of which — for instance, his studies on the genitalia and the skeleton — are of special interest to plastic surgery.[12]

The Indian medical works of both Sushruta and Charaka, originally in Sanskrit, were translated into the Arabic language during the Abbasid Caliphate in 750 AD.[13]

Illustration of an 18th-century nose reconstruction method from Poona performed by an Indian potter, from The Gentleman's Magazine, 1794

British physicians travelled to India to see rhinoplasties being performed by Indian methods.[14] Reports on Indian rhinoplasty performed by a Kumhar vaidya were published in the Gentleman's Magazine by 1794.[14] Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods.[14] Carpue was able to perform the first major surgery in the Western world in the year 1815.[15] Instruments described in the Sushruta Samhita were further modified in the Western world.[15]

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. In 1845, Johann Friedrich 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. Another case of plastic surgery for nose reconstruction from 1884 at Bellevue Hospital was described in Scientific American.[16]

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.[17]

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 Sir Harold 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.[18]

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 surgeon Hippolyte Morestin on skin graft, 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). 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 burn, and serious facial disfigurement, such as loss of eyelids, typical of those caused to aircrew by burning fuel.

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."

His other important work included 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.

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.[19] Subdisciplines of plastic surgery may include:

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 cells in 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.
• 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.,[23]

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 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 and/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.[24] 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.[25] 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.[26] 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).[27]

In 1949, 15,000 Americans underwent cosmetic surgery procedures and by 1969.[28] This number rose to almost half a million people.[29] 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.[28][30] 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.[31] 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.[32] South Korea is also rising in popularity due to their expertise in facial bone surgeries.

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."[33] 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;[34] cited estimates include a 10% increase in the United States and a 20% increase in France.[35]

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.[36] The SAM technique involves invaginating and tacking the tissues first, in order to previsualize the result, before making any surgical incisions to the breast.[37]
• 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[38]
  • 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.[39]
• 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[38]
• Jaw reduction: reduction of the mandible angle to smooth out an angular jaw and creating a slim jaw[38]
• 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[40]) once it has been stretched past capacity and is unable to recoil back to its standard position against the body and also with age.[41]
• Sclerotherapy: removing visible 'spider veins' (Telangiectasia), which appear on the surface of the skin.[42]
• 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.[43]
• 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.[44] 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).[45]

All surgery has risks. Common complications of cosmetic surgery includes hematoma, nerve damage, infection, scarring, implant failure and organ damage.[46][47][48] 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.[49] In 2011 FDA stated that one in five patients who received implants for breast augmentation will need them removed within 10 years of implantation.[50]

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,[51] researchers believe that plastic surgery obsession is linked to psychological disorders like body dysmorphic disorder.[52] 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.[53]

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.[53] 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.[54] 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.[55] As a protest to the detrimental trend, Instagram banned all augmented reality (AR) filters that depict or promote cosmetic surgery.[56]

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.[57]

• Biomaterial
• Body modification
• Cosmetic surgery in Australia
• Dental trauma
• Ethnic plastic surgery
• List of plastic surgery flaps
• Plastic and Reconstructive Surgery
• Scalp reconstruction
• Serdev suture
• Rejuvenation

• Atkinson M (2008). "Exploring Male Femininity in the 'Crisis': Men and Cosmetic Surgery". Body & Society. 14: 67–87. doi:10.1177/1357034X07087531. S2CID 143604536.
• Fraser S (2003). Cosmetic surgery, gender and culture. Palgrave. ISBN 978-1-4039-1299-2.
• Gilman S (2005). Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery. Duke University Press. ISBN 978-0-8223-2144-6.
• Haiken E (1997). Venus Envy: A History of Cosmetic Surgery. Johns Hopkins University Press. ISBN 978-0-8018-5763-8.
• Santoni-Rugiu P (2007). A History of Plastic Surgery. Springer. ISBN 978-3-540-46240-8.

Wikimedia Commons has media related to Plastic surgery.

• Countries with the largest total number of cosmetic procedures, Statista, 2019