Plastic Surgery

Plastic Surgery
is a medical Specialty concerned with the correction or restoration of from and function. Though cosmetic or aesthetic surgery is the best known king of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand surgery, microsurgery, and the treatment of burns.

History

Walter Yeo, a British soldier, is often cited as the first known person to have benefited from Plastic surgery. The photograph shows him before the procedure(left)and after(right) receiving a skin graft performed by Sir Harold Gillies in 1917.

Reconstructive surgery techniques were being carried out in India by 800 BC. Sushruta, the father of Surgery, made important contributions to the field of Plastic and cataract surgery in 6th century BC. The medical works of  both Sushruta and Charak originally in Sanskrit were translated into Arabic language during the Abbasid Caliphate in 7550 AD. The Arabic translations made their way into Europe via intermediaries. In Italy the Branca family of Sicily and Gaspare Tagliacozzi (Bologan) became familiar with the techniques of Sushruta.

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

Aulus Cornelius Celsus, Who lived in the first century AD, described  plastic surgery of the face, using skin from other pasts of the body.

The ancient Egyptian and Romans also performed plastic cosmetic surgery. The Romans were able to perform 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, some of which- for instance, his studies on the genitalia and the skeleton- are of special interest to plastic surgery.

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. 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 20the centuries that such surgery became common.

Up until the techniques of anesthesia became established, surgeries involving healthy tissues involved great pain. Infection from surgery was reduced by the introduction of sterile techniques and disinfectants. The invention and use of antibiotics, begining with sulfa drugs and penicillin, was another step in making elective surgery possible.

In 1792, Chopart performed operative procedure on a lip using a flap from the neck. In 1814, Joseph Carpue successfully performed 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, entitled Operative Chinurgie, 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 whome he reduced a dorsal nasal hump for cosmetic indications. In 1892, Robert Weir experimented unsuccessfully with xenorgafts (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.

20th Century

In World War 1, a  New Zealand otolaryngologist working in London, Harold Gillies, developed many of the techniques of modern plastic surgery in caring for soldiers suffering from disfiguring facial injuries. Gillies was from England but volunteered in France with the Red Cross. During that time, he learned about plastic surgery. he became particularly successful in the field and was well known for his work. Kazanjian and Blair, two men hired for plastic surgery by the United States army, learned from Gillies in England. His work was expanded upon during World War II by his cousin and former student Archibald McIndoe's radical, experimental treatments, led to the formation of the Guinea Pig Club. In 1946, Gillies carried out the first female-to-male sex reassignment surgery.

Plastic surgery, as a specialty, evolved remarkably during the 20th century in the United States. One of the founders of the specialty, 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.

Techniques And Procedures
In Plastic surgery, the transfer of skin tissue (skin grafting) is a very common procedure. Skin grafts can be taken 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 differents species.

Usually, good results are expected from plastic surgery that emphasizes careful planning of incisions so that they fall in the line of natural skin folds or lines, appropriate choice of sutures so that the wound is held closed by buries sutures.
Reconstructive Surgery
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. Reconstructive plastic surgery is usually performed to improve furntion, but it may be done to approximate a normal appearance.
The most commone reconstructive procedures are tumor removal, laceration repair, scar repair, hand surgery, and breast reduction. According to the American Society of Plastic Surgeons, the number of reconstructive breast reductions for women increased in 2007 by 2 percent from the year befor. Breast reduction in men also increased in 2007 by 7 percent. Some other common reconstructive surgical procedures include breast reconstruction after a mastectomy, 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 availablel. Free flaps of skin, muscle, bone, fat, or a combination maybe 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



Aesthetic plastic surgery involves techniques intended for the "enhancement" of appearance through surgical and medical techniques, and specifically concerned with maintaining normal appearance, restoring it, or enhancing it beyond the average level toward some aesthetic ideal.

In 2006, nearly 11 million cosmetic procedures were performed in the United States alone. The number of cosmetic porcedures performed in the United States has increased over 50 percent since the start of the century. Nearly 12 million cosmetic procedures were performed in 2007, with the five most common surgeries being breast augmentation, liposuction, nasal surgery, eyelid surgery and abdominoplasty. The American Society for Aesthetic Plastic Surgery looks at the statistics for thirty-four 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. They also found that large majority, 81% of the procedures were done on Caucasian people. The increased use of cosmetic procedures crosses racial and ethnic lines in the U.S, with increases seen among African-Americans and Hispanic Americans as well as Caucasian Americans. In Europe, the second largest market for cosmetic procedures, cosmetic surgery is a $2.2 billion business. Cosmetic surgery is now very common in countries such as the United Kingdom, France, and Germany. In Asia, cosmetic surgery has become an accepted practice; currently most widely prevalent and normal in China where it is currently Asia's biggest cosmetic surgery market. Children undergoing cosmetic eye surgery can be seen in Japan and South Korea.

The most prevalent aesthetic/ cosmetic procedures include;

• Abdominoplasty(tummy tuck): reshaping and firming of the abdomen.
• Blepharoplasty(eyelid surgery): reshaping of the eyelids or the application of permanent eyeliner, including Asian blepharoplasty
• Phalloplasty(penile liposuction): construction (or reconstruction) of a penis or, sometime 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 to 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 or for psychological benefit men with gynecomastia.
• Mastopesy(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.
• Buttock augmentation(butt implant) enhancement of the buttocks using silicone implants or fat gafting (Brazilian bull lift) and transfer from other areas of the body.
• Buttock lift: lifting, and tightening of the buttocks by excision of redundant skin
• Chemical peel: minimizing the appearance of acne, chicken pox, and other scars as well as wrinkles (depending on concentration and type of agent used, except for deep furrows), solar lentigines(age spots, freckles),and photodamage in general .Chemical peels commonly involve carbolic acid (Phenol), trichloroacetic acid (TCA), glycolic acid(AHA), or salicylic acid (BHA) as the active agent.
• Labiaplasty: surgical reduction and reshaping of the labia.
• Lip enhancement: surgical improvement of lips fullness throughenlargement
• Rhinoplasty(nose job): reshaping of the nose
• Otoplasty(ear surgery/ear pining): reshaping of the ear, most often done by pining the protruding ear closer to the head.
• Rhytidectomy(face lift): removal of wrinkles and signs of aging from the face
• Browplasty(brow lift or forehead lift): elevates eyebrows, smoths forehead skin
• Midface lift(cheek lift): tightening of the cheeks
• Suction-assisted lipectomy(liposuction): removal of fat from the body
• Chin augmentation(chin implant): augmentation of the chin with an implant, usually silicone, by sliding genioplasty of the jawbone or by surture of the soft tissue.
• Cheek augmentation(cheek implant): implants to the cheek
• Orthognathic Surgery: manipulation of the facial bones through controlled fracturing
• Fillers injections: collagen, fat, and other tissue filler injections, such as hyaluronic acid
• Laser skin resurfacing
• Liposuction: removel of fat deposits by traditional suction technique or ultrasonic energy to aid fat remova