Honestly, what’s the first thing that comes to your mind when you hear the words ‘Plastic Surgery’?
- Fancy, expensive surgeries- nose job, tummy tuck, b**b job;
- News of Hollywood and Bollywood actresses who underwent cosmetic surgeries;
- Character(s) from television series like Grey’s Anatomy, House M.D., Nip/Tuck, Botched, Swan- featuring plastic surgeons or movie(s) depicting identity theft in Hollywood like Face/Off (1997), Stolen Face (1952) or Bollywood like Yakeen (2005);
- [This one, if you are a medical professional] Someone doing cosmetic surgery and skin grafting slowly for hours. Huh, I can do skin grafting better!.
If the answer is “yes”, or you know someone who would say “yes”, then this post is for you.
Why should you bother?
Accidents, burns can happen to anyone and in such circumstances, a Plastic surgery intervention at the right time (golden period) can have a profound effect on the subsequent quality of life of the injured. [Example- See Plastic Surgery Video no. 2]
Unfortunately, the general public, even, many medical students, physicians and surgeons from other disciplines, hospital administrators and politicians making healthcare policies are NOT fully aware or misinformed about the scope of Plastic Surgery as a discipline.
This lack of awareness leads to inadequate/ absent plastic surgery facilities in many hospitals, and absent or delayed referral to plastic surgeons → resulting in suboptimal management of various ailments by unaware surgeons/physicians of other disciplines → leading to amputation of salvageable traumatic limbs, deformities, poor function and ultimately→ poor quality of life and sometimes death, as in major burns (all of which were avoidable).
What’s so special about Plastic Surgery?
Plastic surgery is a principle-based, problem-solving surgical specialty, the most versatile and innovative of all. It’s origin and evolution hinged on pushing limits to restore form and/or function of various parts of the body to improve Quality of life.
1) Sound (plastic surgical) principles, 2) Meticulous planning (attention to detail), 3) Fine surgical skill, and 4) Creativity– sets a Plastic Surgeon apart.
Don’t get me wrong, many good surgeons from all disciplines may have the above-mentioned qualities, but you will rarely find a plastic surgeon without all of these (along with good photographic skills).
Plastic surgery currently can be divided into three broad divisions:
1. Reconstructive or Reparative surgery (includes micro and super-micro surgery)- primarily focuses on reconstruction or repair of missing, deformed or damaged skin and tissues of various parts of the body to restore ‘function‘ of the body part [with preservation or restoration of ‘form‘/appearance as far as possible].
2. Cosmetic or Aesthetic surgery- aims to improve ‘form’/appearance and restore confidence by reshaping structures of the body using cutting-edge medical and surgical techniques.
3. Burns management- deals with not only the initial medical and surgical management of minor and major burns (of all types like- Thermal, Electrical, Chemical, etc.) but also its sequelae (like scars, deformities, contractures) with contributions from reconstructive & cosmetic surgery.
The overlap and relationship between these 3 divisions may be depicted as below:
There’s a way to do it better – find it.
Thomas A. Edison
☝️ The above quote is very much, the essence of this discipline.
The following video by a (former) American Plastic Surgery resident, Dr. Jubbal, gives a sneak peek into the scope of Plastic Surgery.
Residents, please note: The video below is meant for residents in the USA- where Plastic surgery is the most sought-after/ competitive surgical specialty whereas it’s not so in India, yet! The rest of the information is quite accurate.
How is Cosmetic Surgery different from Plastic Surgery?
Cosmetic surgery is a part of the entire spectrum of Plastic surgery, that deals mainly with the appearance (form) of some part of the body. It can help improve function too- not just psychological, but also physical (for eg. a traumatic nose deformity with partial nose block when corrected using ‘nose job’/ rhinoplasty- relieves the blockage too. [The overlap between reconstructive and cosmetic surgery will be discussed in another post].
To put things in perspective, take a look at the following infographic depicting the scope of Plastic Surgery (currently).
Note→ The scope of Plastic Surgery is rapidly expanding and evolving. Just a decade back, some sub-specialties mentioned below, like- Brachial plexus reconstruction, Lymphatic surgery, Diabetic foot management, Hand transplantation– have emerged or have been significantly transformed by Plastic surgeons and their armamentarium- like micro, supermicro-surgery.
Emerging sub-specialties:
- Migraine Surgery (Surgical Management of Chronic Headache)
- Regenerative Medicine
- Tissue Engineering in Plastic Surgery
- Robotics in Plastic Surgery
Professor Karthikeyan Gomathinayagam MS, MCh(Plastic) has comprehensively presented in this LGS webinar→ Scope of Plastic Surgery.
Reasons for Misconceptions and Neglect
Why is that Plastic Reconstructive surgery one of the least understood specialties, such that even surgeons from other disciplines don’t get it right? Sometimes Plastic residents are pleasantly surprised to discover the full scope of Plastic Surgery a few months after joining it.
As we saw in the video above- yes, the name is derived from the Greek word ‘plastikos’ meaning ‘mould’ and is non-specific. But is that the only reason? We have discussed it here: 8 Reasons Why Plastic Surgery is a Poorly Understood discipline.
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References (for further reading):
- Fraser SJ, Al youha S, Rasmussen PJ, Williams JG. Medical Student Perception of Plastic Surgery and the Impact of Mainstream Media. Plast Surg (Oakv). 2017;25(1):48-53.
- C.S. Dunkin, J.M. Pleat, S.A. Jones, T.E. Goodacre Perception and reality-a study of public and professional perceptions of plastic surgery Br J Plast Surg, 56 (2003), pp. 437-443
- Scope of Plastic Surgery– by APSI (Association of Plastic Surgeons of India)
- The overview of Plastic Surgery by United Kingdom National Health Service (NHS)
Tutorials & tips in Plastic Surgery
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