Plastic surgery

Plastic surgery is the branch of medicine concerned with the reconstruction and repair of defects in the body. Reconstructive plastic surgery repairs deformities or disfigurements caused by injuries, disease, or birth defects. It seeks not only to make a person look more normal but to function better as well. Cosmetic plastic surgery is performed solely for the purpose of improving the appearance of the body.

Origin of name

Many people have the mistaken belief that plastic surgery got its name because it involves the use of some sort of plastic or other manmade material. In fact, the term plastic surgery comes from the Greek word "plastikos," which means to mold or to shape. The first published use of that word was by German surgeon Karl Ferdinand von Graefe (1787–1840), one of the pioneers of plastic surgery. Von Graefe operated on the cleft palate (a birth defect in the roof of the mouth) and the eye and developed the first satisfactory procedure to correct the nose, called rhinoplasty (pronounced RYE-no-pla-stee), which he described in his 1818 book Rhinoplastik.

However, von Graefe was by no means the first or the earliest to perform such surgery. In fact, many believe that plastic surgery is one of the oldest forms of surgery. Some say that the earliest known surgery of any type dates back to the Peruvians of about 10,000 b.c., who performed craniotomies (pronounced kray-nee-AH-toh-meez) or surgery on the skull by burning holes in a person's head. Many of the healed skulls of these patients have been found, suggesting that they survived the operation.

Ancient surgery

Reconstructive plastic surgery is less old, although there is written evidence that surgeons in ancient India used skin grafts as early as 3300 b.c. to repair noses and ears lost in battle or to certain forms of punishment. Roman medical writer Aulus Cornelius Celsus, who is known to have lived during the reign of Tiberius (a.d. 14–37), mentioned the reconstructive surgery of the face in his book De re medicina. It is also known that during the Chin dynasty (a.d. 229–317), Chinese surgeons surgically repaired cleft lips.

Words to Know

Cosmetic plastic surgery: Surgery designed primarily to enhance or improve the looks of an individual who may not have a gross deformity or physical impairment.

Graft: Bone, skin, or other tissue taken from one place on the body (or from another body) and then transplanted to another place on that body where it begins to grow again.

Reconstructive plastic surgery: Surgery designed to restore the normal appearance and functioning of disfigured or impaired areas of the human body.

While surgical techniques developed slowly for many centuries up to the Renaissance (a period of vigorous artistic and intellectual activity that began in Italy in the fourteenth century and soon spread across Europe, lasting into the seventeenth century), the first textbook on plastic surgery was written by Italian surgeon Gasparo Tagliacozzi (1546–1599). His book De curatorum chirurgia contained illustrations as well as words on how to surgically repair or correct the nose. One famous image in that book shows how he placed his patients in a type of straight-jacket in which one of their hands was placed on the back of their head with their nose touching their shoulder or bicep. In this way he used the patient's own skin (on the arm) to graft new skin to the repaired nose.

Wartime advances

Surgical techniques continued to progress very slowly, yet in 1775, American surgeon John Jones (1729–1791) published the first surgical textbook in the American colonies, Plain, Concise, Practical Remarks on the Treatment of Wounds and Fractures. This book introduced plastic surgery techniques to the American colonies and became the military surgeon's bible when the Revolutionary War (1775–81) broke out. However, the first American plastic surgeon is considered to be Virginia surgeon John Peter Mettauer (1787–1875). By the time Mettauer had performed his first cleft palate operation in 1827, progress also was being made in Europe as surgeons in Italy and Germany performed skin graft experiments on animals. In the United States, the battles of the Civil War (1861–65) produced large numbers of injured and disfigured soldiers, and many surgical techniques were discovered or developed out of necessity.

Finally, it took another war, World War I (1914–18), to produce the father of modern plastic surgery, British surgeon Harold Delf Gillies (1882–1960). Since this war was conducted mostly in trenches, there were huge numbers of head and face injuries (since the rest of a soldier's body was usually below ground level and therefore protected). Gillies established the first hospital devoted to reconstructive surgery, and in 1917, he introduced the pedicle (pronounced PED-ih-kul) type of skin graft that uses the patient's own skin and the tissue below it to nourish the repaired site. Many of his discoveries and techniques formed the basics of modern plastic surgery. By World War II (1939–45), many of the armed forces had plastic surgeons as part of their medical teams, and following the war, microsurgical techniques had advanced to the point where the public became aware of cosmetic surgery as a way of enhancing their appearance.

Reconstructive plastic surgery

Today, plastic surgery has two components: reconstructive plastic surgery and cosmetic plastic surgery. Reconstructive surgery does just what it sounds like, since it reconstructs, repairs, or reshapes abnormal structures of the body. In other words, its goal is to fix things or to restore the function (as well as the appearance) of a body part that may have been injured, diseased, or suffered from some birth defect. Repairs of severe lacerations (deep cuts) and compound bone fractures are typical procedures, as are tissue grafts to repair severe burns. Removing cancerous skin growths and rebuilding lost or deformed parts, such as an ear or a nose, are other examples of reconstructive plastic surgery. The goal is always to restore damaged function by restoring normal form. It is this type of surgery that attempts to reattach severed fingers and limbs and to correct the damage done by the trauma of injury or disease.

Cosmetic plastic surgery

Cosmetic plastic surgery is the other type of plastic surgery. Also called aesthetic plastic surgery, it differs from reconstructive plastic surgery in that it is surgery performed on normal structures of the body. In other words, it is surgery performed solely for the purpose of improving the appearance of an otherwise healthy person. Examples of such operations would be "nose jobs," "face lifts," breast enlargement, and fat-suctioning procedures. This type of surgery is called "elective" because it is not necessary from a medical point of view. Rather, it is done to improve a person's self-image by fixing something that person finds objectionable about his or her body. Thus, while some choose to have their large ears put closer to their heads, others may elect to have the drooping skin around their eyes tightened or the wrinkles in their face removed. Hair transplants and chemical face peeling are also considered cosmetic plastic surgery.

Grafting

Whether reconstructive or cosmetic, plastic surgery is almost always about tissue transplantation. However, this is not surgery that

"transplants" a working donor organ like a kidney into someone who has lost theirs, but instead is the transplantation or grafting of healthy tissue from one part of the body to replace damaged tissue removed from another part. This tissue could be bone, skin, muscle, cartilage, tendons, or even nerves. Thus a surgeon can take cartilage from a patient's rib and "build" an ear or fix a nose. Baseball pitchers sometimes resume their throwing careers after having cartilage taken from their non-throwing arm surgically transplanted into their injured throwing elbow. Skin grafts used to cover a burned area are another common form of transplantation. A new version of this is called a xenograft (pronounced ZEE-no-graft), in which skin from a donor is used temporarily and grafted to a burned area that still has living cells. Although it is eventually rejected, the grafted skin often protects the damaged tissue just long enough, and gives the body time to heal itself. An even newer form of artificial or synthetic skin is being developed that will do the same thing.

Recent advances

Another essential part of all plastic surgery, whether reconstructive or cosmetic, is the planned and careful cutting of the skin in places where it follows or falls in the skin's natural lines or folds. At the end of surgery, an equally planned and careful way of suturing (pronounced SOO-churing) or sewing the wound closed is necessary. Today, plastic surgeons sometimes use lasers instead of scalpels, and often perform an entire operation at such a fine level of detail that they use a microscope the entire time. They can reattach the smallest of blood vessels using this technology. Even before they operate, they have access to such diagnostic technologies as magnetic resonance imaging and computed tomography that allow them to analyze and understand the problem better, and to plan how to repair it.

Despite the increased popularity of cosmetic plastic surgery (it is no longer a luxury only for the rich), reconstructive plastic surgery is still performed three times as often. Corrective eye surgery or blepharoplasty (pronounced BLEH-fer-oh-plas-tee)—in which bags under the eyes or skin on the upper eyelids are removed to give a person a younger, less tired look—is the most common type of cosmetic surgery. Hair transplants and eye surgery are the most popular procedures with men. Many adult women choose breast augmentation, now done with saline or salt water implants instead of the proven-dangerous silicone implants. Teenagers most often receive nose reshaping.

[See also Surgery ]

Plastic surgery

Plastic surgery is the specialized branch of surgery concerned with repairing deformities, correcting functional deficits, and enhancing appearance. Unlike most surgical specialties, plastic surgery is not confined to one specific anatomical or functional area of the body. Often, plastic surgery is classified as either reconstructive or aesthetic surgery. All plastic surgery procedures seek to restore or improve patients' appearances, however, reconstructive surgery focuses on patients with physical problems or deformities while aesthetic (or cosmetic) surgery often focuses on patients who want to improve their appearance even though they have no serious physical defect.

History of plastic surgery

Long before the word plastic was first applied in 1818 to denote surgery largely concerned with the pa tient's appearance, physicians performed a number of reconstructive procedures on the noses and ear lobes of soldiers who were injured during battle. As far back as 25 b.c. to a.d. 50, physicians were taking tissue from one part of the body and using it to correct physical defects in other areas. Much of the ancient pioneering efforts in plastic surgery took place in the ancient Arab and Hindu schools of medicine.

During the early part of the sixteenth century, the Branca family in Sicily began practicing plastic surgery procedures, including using flaps or masses of tissue from patient's arms to repair mutilated ears and lips. However, Gaspare Tagliacozzi of Bologna, Italy, is generally credited with initiating the modern era of plastic surgery during the latter half of the sixteenth century.

After Tagliacozzi's death in 1599, the art of plastic surgery languished for nearly two centuries, partly because many surgeons tried unsuccessfully to use donor flaps and skin from slaves and others. The transplantation of tissue between two individuals would not be successfully achieved until the second half of the twentieth century, when scientists learned more about differences in blood types and immune systems and the role these differences played in hindering transplantation of tissues between two people.

A resurgence of interest in plastic surgery began in the nineteenth century with renewed interest in reconstruction of the nose, lips, and other areas of the human body. During this time, a number of surgeons throughout Europe refined techniques for performing a variety of procedures. One of the most beneficial was the development of skin grafting on humans in 1817 to repair burnt or scarred skin.

The next major advances in plastic surgery would not take place until well into the next century, when various new flap techniques were developed in the 1960s and 1970s. The first successful reattachment of a severed arm was accomplished in 1970. And, in 1972, the advancement of microsurgical techniques that enabled surgeons to reattach minute nerves and blood vessels further enhanced this surgical field. It was during this time that cosmetic plastic surgery also began to bloom, as new techniques were refined to enhance physical appearances, including breast implants and face lifts.

Reconstructive plastic surgery

The primary aim of reconstructive plastic surgery is to restore the normal appearance and functioning of disfigured and/or impaired areas of the human body. Craniofacial reconstructive surgery, for example, focuses on face and skull defects. These defects may be congenital (birth ) or due to trauma (an injury or wound). Craniofacial surgeons also reconstruct parts of the face deformed by cancer and other diseases. The cleft palate, a split in the bony roof of the mouth that usually runs from the front of the mouth to the back, is one of the most common birth defects corrected by craniofacial plastic surgery.

Vascular, microvascular, and peripheral nerve surgery focuses on reestablishing the complex connections of nerve and blood vessels that may have been severed or otherwise damaged. Plastic surgeons also transplant muscles and tendons from one part of the body to another to restore common functions such as walking or other activities that incorporate these anatomical structures.

Skin grafting is a reconstructive surgical technique that transplants skin from one part of the body to another damaged area where the skin grows again. This technique is used to treat burned or otherwise damaged skin.

Flaps

In the realm of plastic surgery, flaps are large masses of tissue that may include fat and muscle. Flaps are taken from one place on the body and then attached to another area. These operations are much more complex than skin grafts because they involve the need to reestablish various vascular, or blood, connections.

A pedicle flap graft involves connecting the tissue and/or muscle to the new site while keeping part of it attached to the original site. This technique maintains the old blood vessel connections until the flap naturally creates new connections (revascularization) at the transplanted site. For example, a mass of tissue on an undamaged finger can be partially peeled back and connected to an adjacent finger until revascularization takes place. Then the flap can be totally severed from its original site.

A free flap is when tissue or muscles are completely severed from the body and then transplanted to the new site where the blood vessels are then reconnected surgically. An advantage of the free flap procedure is that the transplanted tissue can be taken from anywhere on the body and does not have to be in an area close to (or can be placed close to) the new site.

The advancement of microsurgical techniques have greatly improved the success of free flap surgical procedures. Using a microscope , tiny needles, and nearly invisible thread, the surgeon can painstakingly reconstruct the vascular web that supplies nourishment in the form of blood to the transplanted tissues.

Aesthetic plastic surgery

Aesthetic plastic surgery procedures are as varied as the many areas of the body they seek to enhance. They range from reshaping the nose and enlarging women's breasts to hair transplants for balding men and liposuction to remove unwanted fat from the body. For many years aesthetic plastic surgery, popularly known as cosmetic surgery, was held in low esteem by many within the plastic surgery field. This disdain was largely because aesthetic surgery was generally not a necessary procedure based on medical need or gross deformity, but rather on the patient's vanity or desire to have his or her looks surgically enhanced.

Today, hundreds of thousands of aesthetic plastic surgery procedures are conducted each year. Many of the operations are outpatient procedures, meaning they require no hospitalization overnight. However, the complexity of the procedures vary. Breast enlargements, for example, are made with a simple incision in the breast in which a bag-like structure filled with either silicone or saline is inserted and sewn into place. Facelifts, on the other hand, involve cutting the skin from the hairline to the back of the ear. The loosened skin can then be stretched upward from the neck and stitched together for a tighter, wrinkle free appearance. Another aesthetic surgery for facial skin is called skin peeling, which is used primarily on patients with scarred faces due to acne or some other disease . A surgical skin peel involves removal of the skin's surface layers with mechanical devices that scrape off the skin or grind it down.

If a person desires a new nose, they can undergo a procedure that involves making incisions inside the nose to reduce scarring and then breaking and reshaping the nasal bone. Another facial cosmetic surgery is the eyelid tuck, which removes fleshy bags under the eyes.

In recent years, a cosmetic surgery called liposuction has rapidly grown in popularity. Developed in France, this procedure involves removing fat from specific areas of the body by vacuuming it out through a long metal probe that is connected to a pump.

Drawbacks to aesthetic surgery

Although there is nothing wrong with wanting to look good, there are some troubling ethical issues associated with aesthetic plastic surgery. First and foremost, they are not 100% safe. Almost all surgical procedures are associated with the risk of infections, which can lead to death if not identified early and treated properly. In rare cases, liposuction has resulted in too much fluid loss and the formation of blood clots, which can also lead to death. Despite the lack of concrete scientific evidence, some concern has arisen over the possibility that silicone gel breast implants may cause a variety of diseases, including cancer. As a result, most implants are now filled with a saline solution similar to that naturally produced in the body.

Another important issue to consider is that not all aesthetic surgeries result in an improved appearance. Some surgeries, like facial reconstruction, have occasionally resulted in the patient being maimed and disfigured. Others, like the facelift, only last 3-10 years. Finally, some people may come to rely on these form of surgeries to improve their looks while ignoring the need to maintain the healthy lifestyles that not only promote looks but prolong life.

Resources

books

Aschheim, Kenneth W., and Barry G. Dale. Esthetic Dentistry:A Clinical Approach to Techniques and Materials. 2nd ed. St. Louis: Mosby, Inc., 2001.

Camp, John. Plastic Surgery: The Kindest Cut. New York: Henry Holt and Company, 1989.

Keller, Gregory, et al. Lasers in Aesthetic Surgery. New York: Thieme Medical Pub, 2001.

Smith, James W., and Sherrel J. Aston, eds. Grabb and Smith'sPlastic Surgery. Boston: Little, Brown, 1996.

periodicals

Becker, Daniel G. "A 3-Year Multi-institutional Experience With the Liposhaver." The Journal of the American Medical Association 282 (November 24, 1999): 1902.

Fu, Freddie H., et al. "Current Trends in Anterior Cruciate Ligament Reconstruction." The American Journal of Sports Medicine 28 (January 2000): 124.

Gokhan, Adanali. "A New, T-Shaped Adaptor For Easy, Quick And Efficient Fat Harvest." Aesthetic Plastic Surgery 26, no. 5 (2002): 340-344.

"The Manly Mammary." Discover (January 1, 2000).

Neimark, Jill. "Change of Face...Change of Fate." PsychologyToday (May/June 1994): 94.

Vreeland, Leslie N. "Cosmetic Surgery: Avoiding the Pitfalls." American Health (July/August 1992): 47-53.

David Petechuk

KEY TERMS

Aesthetic surgery

—Surgery designed primarily to enhance or improve the looks of an individual who may not have a gross deformity or physical impairment. This type of surgery is often referred to as cosmetic surgery.

Craniofacial

—Having to do with the face and skull.

Flap

—A mass of tissue used for transplantation.

Graft

—Bone, skin, or other tissue taken from one place on the body (or, in some cases, from another body), and then transplanted to another place where it begins to grow again.

Reconstructive surgery

—Surgery designed to restore the normal appearance and functioning of disfigured and/or impaired areas of the human body.

Transplantation

—Moving cells or tissues from their point of origin in one organism to a secondary site in the same or a different organism.

Plastic Surgery

History Of Plastic Surgery

Reconstructive Plastic Surgery

Aesthetic Plastic Surgery

Resources

Plastic surgery is the specialized branch of surgery concerned with repairing deformities, correcting functional deficits, and enhancing appearance. Unlike most surgical specialties, plastic surgery is not confined to one specific area of the body. Also, plastic surgery can be done to reconstruct a deformed or damaged region, or can be done by choice as an attempt to alter ones’ appearance in a way that is thought to be more beautiful than prior to the surgery.

History Of Plastic Surgery

The word plastic was first applied in 1818 to denote surgery largely concerned with the patient’s appearance. But, even before that time, physicians performed a number of reconstructive procedures on the noses and ear lobes of soldiers who were injured during battle. As far back as 25 BC to 50 AD, physicians were taking tissue from one part of the body and using it to correct physical defects in other areas. Much of the ancient pioneering efforts in plastic surgery took place in the ancient Arab and Hindu schools of medicine.

During the early part of the sixteenth century, the Branca family in Sicily began practicing plastic surgery procedures, including using flaps or masses of tissue from patient’s arms to repair mutilated ears and lips. However, Gaspare Tagliacozzi of Bologna, Italy, is generally credited with initiating the modern era of plastic surgery during the latter half of the sixteenth century.

After Tagliacozzi’s death in 1599, the art of plastic surgery languished for nearly two centuries, partly because many surgeons tried unsuccessfully to use donor flaps and skin from slaves and others. The transplantation of tissue between two individuals would not be successfully achieved until the second half of the twentieth century, when scientists learned more about differences in blood types and immune systems and the role these differences played in hindering transplantation of tissues between two people.

A resurgence of interest in plastic surgery began in the nineteenth century with renewed interest in reconstruction of the nose, lips, and other areas of the human body. During this time, a number of surgeons throughout Europe refined techniques for performing a variety of procedures. One of the most beneficial was the development of skin grafting on humans in 1817 to repair burnt or scarred skin.

The next major advances in plastic surgery would not take place until well into the next century, when various new flap techniques were developed in the 1960s and 1970s. The first successful reattachment of a severed arm was accomplished in 1970. During the 1970s, refinements in microsurgical techniques enabled surgeons to reattach minute nerves and blood vessels, which allowed plastic surgery to become more intricate. It was during this time that cosmetic plastic surgery also began to bloom, as new techniques were refined to enhance physical appearances, including breast implants and face lifts.

Reconstructive Plastic Surgery

The primary aim of reconstructive plastic surgery is to restore the normal appearance and functioning of disfigured and/or impaired areas of the human body. Craniofacial reconstructive surgery, for example, focuses on face and skull defects. These defects may be congenital (birth) or due to trauma (an injury or wound). Craniofacial surgeons also reconstruct parts of the face deformed by cancer and other diseases. The cleft palate, a split in the bony roof of the mouth that usually runs from the front of the mouth to the back, is one of the most common birth defects corrected by craniofacial plastic surgery.

Vascular, microvascular, and peripheral nerve surgery focuses on reestablishing the complex connections of nerve and blood vessels that may have been severed or otherwise damaged. Plastic surgeons also transplant muscles and tendons from one part of the body to another to restore common functions such as walking or other activities that incorporate these anatomical structures.

Skin grafting is a reconstructive surgical technique that transplants skin from one part of the body to another damaged area where the skin grows again. This technique is used to treat burned or otherwise damaged skin.

Flaps are large masses of tissue that may include fat and muscle. Flaps are taken from one place on the body and then attached to another area. These operations are much more complex than skin grafts because they involve the need to reestablish various vascular, or blood, connections.

A pedicle flap graft involves connecting the tissue and/or muscle to the new site while keeping part of it attached to the original site. This technique maintains the old blood vessel connections until the flap naturally creates new connections (revascularization) at the transplanted site. For example, a mass of tissue on an undamaged finger can be partially peeled back and connected to an adjacent finger until revascularization takes place. Then the flap can be totally severed from its original site.

A free flap is when tissue or muscles are completely severed from the body and then transplanted to the new site where the blood vessels are then reconnected surgically. An advantage of the free flap procedure is that the transplanted tissue can be taken from anywhere on the body and does not have to be in an area close to (or can be placed close to) the new site.

The advancement of microsurgical techniques have greatly improved the success of free flap surgical procedures. Using a microscope, tiny needles, and nearly invisible thread, the surgeon can painstakingly reconstruct the vascular web that supplies nourishment in the form of blood to the transplanted tissues.

Aesthetic Plastic Surgery

Aesthetic plastic surgery procedures are as varied as the many areas of the body they seek to enhance. They range from reshaping the nose and enlarging women’s breasts to hair transplants for balding men and liposuction to remove unwanted fat from the body. For many years aesthetic plastic surgery, popularly known as cosmetic surgery, was held in low esteem by many within the plastic surgery field. This disdain was largely because aesthetic surgery was generally not a necessary procedure based on medical need or gross deformity, but rather on the patient’s vanity or desire to have his or her looks surgically enhanced.

Today, hundreds of thousands of aesthetic plastic surgery procedures are conducted each year. Many of the operations are outpatient procedures, meaning they require no hospitalization overnight. However, the complexity of the procedures vary. Breast enlargements, for example, are made with a simple incision in the breast in which a bag like structure filled with either silicone or saline is inserted and sewn into place. Facelifts, on the other hand, involve cutting the skin from the hairline to the back of the ear. The loosened skin can then be stretched upward from the neck and stitched together for a tighter, wrinkle free appearance. Another aesthetic surgery for facial skin is called skin peeling, which is used primarily on patients with scarred faces due to acne or some other disease. A surgical skin peel involves removal of the skin’s surface layers with mechanical devices that scrape off the skin or grind it down.

If a person desires a new nose, they can undergo a procedure that involves making incisions inside the nose to reduce scarring and then breaking and reshaping the nasal bone. Another facial cosmetic surgery is the eyelid tuck, which removes fleshy bags under the eyes.

In recent years, a cosmetic surgery called liposuction has rapidly grown in popularity. Developed in France, this procedure involves removing fat from

KEY TERMS

Aesthetic surgery— Surgery designed primarily to enhance or improve the looks of an individual who may not have a gross deformity or physical impairment. This type of surgery is often referred to as cosmetic surgery.

Craniofacial— Having to do with the face and skull.

Flap— A mass of tissue used for transplantation.

Graft— Bone, skin, or other tissue taken from one place on the body (or, in some cases, from another body), and then transplanted to another place where it begins to grow again.

Reconstructive surgery— Surgery designed to restore the normal appearance and functioning of disfigured and/or impaired areas of the human body.

Transplantation— Moving cells or tissues from their point of origin in one organism to a secondary site in the same or a different organism.

specific areas of the body by vacuuming it out through a long metal probe that is connected to a pump.

Drawbacks to aesthetic surgery

There are some troubling ethical issues associated with aesthetic plastic surgery. Since all surgical procedures carry a risk of infections or death from some surgical malfunction, those who elect aesthetic surgery choose to risk their lives to look better. The use of defective silicone breast implants during the 1970s caused problems with the appearance of the breasts and, for some women, more serious complications due to the leakage of silicone. As a result, most implants are now filled with a saline solution similar to that naturally produced in the body. Despite this history, the use of silicone breast implants has again been approved in 2006.

Resources

BOOKS

Kuczynski, Alex. Beauty Junkies: Inside Our $15 Billion Obsession With Cosmetic Surgery. New York: Doubleday, 2006.

Lesesne, Cap. Confessions of a Park Avenue Plastic Surgeon.New York: Gotham, 2005.

McCarthy, Joseph G., Robert Galiano, and Sean Boutros.Current Therapy in Plastic Surgery. New York: Saunders, 2005.

David Petechuk

Plastic Surgery

Plastic surgery is the surgical repair of skin defects and deformities, the removal of skin tumors, and surgical reconstruction. Increasingly, however, this medical specialty includes other procedures such as fatty-tissue removal, wrinkle reduction, breast and penile enlargement or reduction, and even the permanent application of make-up. Technological advances and changing cultural mores have continually broadened the scope of plastic surgery such that it is now primarily equated with cosmetic or aesthetic surgery.

Surgery may well be the oldest branch of medicine, but many centuries passed before modern methods, including plastic surgery, were possible. It was not until precise knowledge of the body was available, anesthesia was understood, and methods of controlling hemorrhage and post-operative infection were devised that complex surgery could be undertaken. There is evidence to suggest, however, that surgery could have been an ancient practice. One Indian text dating from the fourth century B.C.E. includes an extended section on surgery, though it is unknown whether the procedures described were actually practiced. Direct accounts of a plastic surgery performed in Poona in 1793 do exist, and the British physicians who witnessed the procedure described the "Hindu method" as far superior to comparable Western techniques, which suggests that plastic surgery had been performed in India for perhaps centuries. Interestingly, the procedure was a rhinoplasty involving skin grafts and reconstruction for a man whose nose had been amputated as punishment for adultery. Because this method of punishment was common, it may have served as impetus for the development of early plastic surgery. Other records indicate that syphilis, which reached epidemic proportions during European colonial expansion, may have also facilitated advances in surgical techniques that attempted to repair the disease's grotesque manifestations.

Innovations in reconstructive surgery continued through the nineteenth century and, at least in America, interest in cosmetic surgery was already rising. Yet it is World War I which most medical historians designate as the dramatic beginning of modern plastic surgery. The war resulted in unprecedented devastation and death but also in thousands of mutilating facial injuries. The horror inspired one physician, Harold Gillies, to establish a plastic surgery unit in the south of England where he personally attended approximately 2,000 cases of facial trauma with equal sensitivity to the patient's medical needs and appearance. In America, three military hospitals were specifically designated as plastic surgery units to treat soldiers disfigured in battle. In the next 20 years, the American Board of Plastic Surgery was formed, and by 1941 it was certified as a primary specialty board by the American Medical Association.

By the 1960s, evolving attitudes about beauty began to change the course of plastic surgery, and cosmetic, rather than reconstructive, procedures began to dominate the field. In the intervening decades, many new techniques emerged to reduce or reverse the effects of aging, including dermabrasion to remove acne scarring; collagen injection to fill out the lips or sunken skin; and blepharoplasty to eliminate bags under the eye. One procedure on the wane at twentieth century's end is the rhinoplasty or "nose job," which reached its height of popularity in the 1960s and 1970s.

As plastic surgery has become a common cultural phenomenon, its critics have grown increasingly vocal. Some view it as radical conformity to artificial standards of beauty perpetuated by mass media, and its most strident opponents are particularly concerned that women have aesthetic operations more often than men and that even adolescent girls sometimes elect surgery. Nonetheless, each year more cosmetic procedures are performed than ever before, and many plastic surgery patients attest to the psychological benefits of feeling younger, thinner, and more attractive. Perhaps the most notable, if ambiguous, commentary on cosmetic surgery has been offered by the French performance artist Orlan, who explores standards of beauty by undergoing repeated plastic surgery.

—Michele S. Shauf

Further Reading:

Camp, John. Plastic Surgery: The Kindest Cut. New York, Henry Holt, 1989.

Haiken, Elizabeth. Venus Envy: A History of Cosmetic Surgery. Baltimore, Johns Hopkins University Press, 1997.

Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity. New York, W.W. Norton & Co., 1997.

Rutknow, Ira M. American Surgery: An Illustrated History. Philadelphia, Lippincott-Raven, 1998.

Wangensteen, Owen H., and Sarah D. Wangensteen. The Rise of Surgery: From Empiric Craft to Scientific Discipline. Minneapolis, University of Minnesota Press, 1978.

plas·tic sur·ger·y • n. the process of reconstructing or repairing parts of the body, esp. by the transfer of tissue, either in the treatment of injury or for cosmetic reasons.DERIVATIVES: plas·tic sur·geon n.