Plastic surgery is a surgical specialty involving 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, oral and maxillofacial surgery, hand surgery, microsurgery, and the treatment of burns. This kind of surgery focuses on restoring a body part or improving its function. In contrast, cosmetic surgery (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.
Etymology The word plastic in plastic surgery refers to the concept of "reshaping" and comes from the Greek πλαστική (τέχνη), plastikē (tekhnē), "the art of modelling" of malleable flesh.Oxford English Dictionary, s.v. 'plastic' This meaning in English is seen as early as 1598. In the surgical context, the word "plastic" first appeared in 1816 and was established in 1838 by Eduard Zeis, preceding the modern technical usage of the word for the synthetic polymer material by 70 years.
Research considerations Clinical research in plastic surgery requires careful consideration of factors that may influence surgical outcomes and the interpretation of evidence. Unlike many medical interventions, surgical results can be affected by variations in operative techniques, surgeon experience, patient selection, perioperative management, and differences in outcome assessment methods. Researchers should therefore consider these factors when designing studies and interpreting their findings.
Systematic reviews and meta-analyses in plastic surgery should address methodological issues such as study heterogeneity, publication bias, and differences in surgical techniques. Standardized reporting methods and well-designed prospective studies are important for improving the quality of evidence and supporting safe, evidence-based clinical practice.
History Ancient Period (3000 BC–500 AD)
Treatments for the repairing of a broken nose are first mentioned in the Egyptian medical text known as the Edwin Smith papyrus (c. 1600 BC).The early trauma surgery textbook was named after the American Egyptologist, Edwin Smith, one of the earliest known surgical texts focused on trauma care. Reconstructive surgery techniques were being carried out in India by 800 BC.MSN Encarta (2008). Plastic Surgery . Particularly as documented in Sushruta Samhita, which describes methods for nasal reconstruction using skin flaps. Sushrata, a physician of the 6th century BC,Dwivedi, Girish & Dwivedi, Shridhar (2007). History of Medicine: Sushruta – the Clinician – Teacher par Excellence . National Informatics Centre (Government of India). made significant contributions to early plastic and cataract surgery and is widely regarded as a foundational figure in reconstructive surgery. Roman physicians in the 1st century BCE also performed plastic reconstructive surgeries, using simple techniques, to repair damaged ears. 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,Wolfgang H. Vogel, Andreas Berke (2009). "Brief History of Vision and Ocular Medicine". Kugler Publications. p. 97. some of which—for instance, his studies on the genitalia and the skeleton—are of special interest to plastic surgery.P. Santoni-Rugiu, A History of Plastic Surgery (2007)
Middle Ages to early modern period (500–1800 CE)
Surgical practices continued to develop during the Abbasid Caliphate from 750 CE,Lock, Stephen etc. (200ĞďéĠĊ1). The Oxford Illustrated Companion to Medicine. US: Oxford University Press. . (page 607) where physicians preserved and expanded earlier medical knowledge through Arabic translations. The Arab physician, surgeon, and chemist Al-Zahrawi (936–1013) described the use of silk thread sutures in surgery to achieve good cosmesis, meaning an improved visual/bodily appearance, and documented 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. The Arabic translations made their way into Europe via intermediaries.
In Italy, the Branca family of Sicily and Gaspare Tagliacozzi of Bologna (1545–1599) became familiar with the techniques of Sushruta. Tagliacozzi was a Bolognese surgeon who popularized a rhinoplasty procedure involving the use of a skin flap from the patient's upper arm to reconstruct the nose. He wrote about this procedure in his book, "De curtorum chirurgia per insitionem" ('On the surgery of mutilations through grafting', (Venice, c.1597)).Earlier examples of a rhinoplastic procedure may be seen in the case of Federico da Montefeltro (1422–1482), Duke of Urbino, who sustained severe facial injuries during a jousting accident and whose nasal bridge was possibly surgically modified to improve his field of vision.
In 1465, Ottoman surgeon, Sabuncuoğlu Şerafeddin (1385–1468) provided detailed descriptions and classifications of certain congenital conditions such as hypospadias and ambiguous genitalia. Sabuncuoğlu's book, Cerrahiyyet'ul Haniye (Imperial Surgery), an illustrated surgical manual covering a range of medical and congenital conditions, provided an informative and up to date description of hypospadias, a congenital condition where the urethral opening is located on the underside of the penis. Localization of the urethral meatus was described in detail.
Modern Period (1800–present)
In the 18th century, British physicians travelled to India to observe rhinoplasties being performed by Indian methods.Lock, Stephen etc. (2001). The Oxford Illustrated Companion to Medicine. US: Oxford University Press. . (page 651) Reports on rhinoplasties performed by a Kumhar (potter) Vaidya were published in the Gentleman's Magazine by 1794, which brought wider attention to these techniques in Europe. Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods. Carpue later applied these methods in England, performing one of the first major rhinoplasty procedures in the Western world in the year 1815.Lock, Stephen etc. (2001). The Oxford Illustrated Companion to Medicine. US: Oxford University Press. . (page 652) Instruments described in the Sushruta Samhita were further modified in the Western world.
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".
Another case of plastic surgery for nose reconstruction from 1884 at Bellevue Hospital was described in Scientific American.
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. In 1928, Jacques Joseph published .
Nascency of maxillofacial surgery
The development of weapons such as machine guns and explosive shells during World War I led to a rapid increase in the number of mutilations to the faces and the heads of soldiers. Improved techniques for preventing and treating infections also meant that previously fatal injuries became survivable. This combination led to never-before seen rates of soldiers with facial injuries, alive but without noses, chins, cheekbones, or even eyes.
Battlefield surgeons had to quickly stabilize soldiers, often without the time to consider aesthetic results, further increasing the number of disfigured survivors. Harold Gillies, observing the number of new facial injuries and the lack of adequate surgical techniques to address them, dedicated an entire hospital to the study and reconstruction of facial injuries. Crucially, he recognized that facial disfigurement often resulted in psychological trauma, and sought to develop techniques that restored form as well as function in his patients.
Gillies developed a new technique using rotational and transposition flaps, as well as bone grafts from the ribs and tibia, to reconstruct facial defects. One of the most important advances developed at Gillies' hospital was the pedicle flap, which involved cutting a flap of skin from a donor site but leaving it connected at one end. The flap of skin, still connected to the donor site, would then be swung over the site of the wound, allowing the maintenance of physical connection and ensuring blood supply, lowering the risk of tissue rejection.
Development of modern techniques
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.
During World War I, he worked as a medical minder with the Royal Army Medical Corps. After working with the French oral and maxillofacial surgeon Hippolyte 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). After the war, Gillies developed a private practice with Rainsford Mowlem, including many famous patients, and travelled extensively to promote his advanced techniques worldwide.