Plastic, Reconstructive, and Cosmetic Surgery

Definition

Plastic, reconstructive, and cosmetic surgery refers to a variety of operations performed in order to repair or restore body parts to look normal, or to change a body part to look better. These types of surgery are highly specialized. They are characterized by careful preparation of a person's skin and tissues, by precise cutting and suturing techniques, and by care taken to minimize scarring. Recent advances in the development of miniaturized instruments, new materials for artificial limbs and body parts, and improved surgical techniques have expanded the range of plastic surgery procedures that can be performed

Purpose

Although these three types of surgery share some common techniques and approaches, they have somewhat different emphases. Plastic surgery is usually performed to treat birth defects and to remove skin blemishes such as warts, acne scars, or birthmarks. Cosmetic surgery procedures are performed to make persons look younger or enhance their appearance in other ways. Reconstructive surgery is used to reattach body parts severed in combat or accidents, to perform skin grafts after severe burns, or to reconstruct parts of person's body that were missing at birth or removed by surgery. Reconstructive surgery is the oldest form of plastic surgery, having developed out of the need to treat wounded soldiers in wartime.

Demographics

The top 10 most commonly performed elective cosmetic surgeries in the United States include the following:
liposuction
breast augmentation
eyelid surgery
face lift
tummy tuck
collagen injections
chemical peel
laser skin resurfacing
rhinoplasty
forehead lift

There were approximately 29 million surgical procedures performed in the United States in 2001. Because many plastic and reconstructive surgical procedures are performed in private professional offices or as outpatient procedures, accurate statistics concerning the number of procedures performed are not available.

General Preparation

Preparation for nonemergency plastic or reconstructive surgery includes individual education, as well as medical considerations. Some operations, such as nose reshaping or the removal of warts, small birthmarks, and tattoos can be done as outpatient procedures under local anesthesia. Most plastic and reconstructive surgery, however, involves a stay in the hospital and general anesthesia.

Medical Preparation

Preparation for plastic surgery includes the surgeon's detailed assessment of the parts of an individual's body that will be involved. Skin grafts require evaluating suitable areas of skin for the right color and texture to match the skin at the graft site. Face lifts and cosmetic surgery in the eye area require very close attention to the texture of the skin and the placement of surgical cuts (incisions).

Preparation for plastic surgery includes the surgeon's detailed assessment of the parts of an individual's body that will be involved. Skin grafts require evaluating suitable areas of skin for the right color and to match the skin at the graft site. Face lifts and cosmetic surgery in the eye area require very close attention to the texture of the skin and the placement of surgical cuts (incisions).

Persons scheduled for plastic surgery under general anesthesia will be given a physical examination, blood and urine tests, and other tests to make sure that they do not have any previously undetected health problems or blood clotting disorders. The surgeon will check the list of prescription medications that the prospective patient may be taking to make sure that none of them will interfere with normal blood clotting or interact with the anesthetic.

Individuals are asked to avoid using aspirin or medications containing aspirin for a week to two weeks before surgery, because these drugs lengthen the time of blood clotting. Smokers are asked to stop smoking two weeks before surgery because smoking interferes with the healing process. For some types of plastic surgery, individuals may be asked to donate several units of their own blood before the procedure, in case a transfusion is needed during the operation. The prospective patient will be asked to sign a consent form before the operation.

Medical Considerations

Some people should not have plastic surgery because of certain medical risks. These groups include:

• persons recovering from a heart attack, severe infection (for example, pneumonia), or other serious illnesses
• people with infectious hepatitis or HIV infections
• individuals with cancer whose cancer might spread (metastasize)
• people who are extremely overweight (Individuals who are more than 30% overweight should not have liposuction.)
• persons with blood clotting disorders

Psychological

Plastic, cosmetic, and reconstructive surgeries have an important psychological dimension because of the high value placed on outward appearance in Western society. Many people who are born with visible deformities or disfigured by accidents later in life develop emotional problems related to social rejection. Other people work in fields such as acting, modeling, media journalism, and even politics, where their employment depends on how they look. Some people have unrealistic expectations of cosmetic surgery and think that it will solve all their life problems. It is important for anyone considering nonemergency plastic or cosmetic surgery to be realistic about its results. One type of psychiatric disorder, called body dysmorphic disorder, is characterized by an excessive preoccupation with imaginary or minor flaws in appearance. Persons with this disorder frequently seek unnecessary plastic surgery.

Risks

The risks associated with plastic, cosmetic, and reconstructive surgery include the postoperative complications that can occur with any surgical operation under anesthesia. These complications include wound infection, internal bleeding, pneumonia, and reactions to the anesthesia.

In addition to these general risks, some plastic, cosmetic, and reconstructive surgical procedures carry specific risks:

• formation of undesirable scar tissue
• development of persistent pain, redness, or swelling in the area of the surgery
• infection inside the body related to inserting a prosthesis (These infections can result from contamination at the time of surgery or from bacteria migrating into the area around the prosthesis at a later time.)
• anemia or fat embolisms from liposuction
• rejection of skin grafts or tissue transplants
• loss of normal feeling or function in the area of the operation (For example, it is not unusual for women who have had mammoplasties to lose sensation in their nipples.)
• complications resulting from unforeseen technological problems (The best-known example of this problem was the discovery in the mid-1990s that breast implants made with silicone gel could leak into the recipient's body.)

Morbidity and Mortality Rates

Morbidity and mortality rates vary with the complexity and severity of different procedures. Mortality is similar to that associated with all surgical procedures. Morbidity is influenced by personal expectations. From a surgical perspective, most morbidity is due to errors associated with anesthesia, procedure, pain medications, and after care. From an individual's perspective, morbidity involves the degree to which actual results compared to expected outcomes. The latter distinction is very subjective.