Plastic Surgery

Plastic surgery is a medical specialty that uses a number of surgical and nonsurgical techniques to change the appearance and function of a person's body. Plastic surgery procedures include both cosmetic enhancements as well as functionally reconstructive operations. In the former case, where aesthetics are considered more important than functionality, plastic surgery is sometimes referred to as cosmetic surgery. Most procedures involve both aesthetic and functional elements.

The word "plastic" derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with the synthetic polymer material known as plastic. Plastic surgeons typically mold and reshape the following tissues of the body: bone, cartilage, muscle, fat, and skin.The history of plastic surgery reaches back to the 700s BCE. Physicians in ancient India including Sushruta were utilizing skin grafts for reconstructive work as early as the 8th century BC. In his work Sushruta Samhita describes rhinoplasty and otoplasty.

This knowledge of plastic surgery existed in India up to the late 18th century as can be seen from the reports published in Gentleman's Magazine (October 1794). The Romans were able to perform simple techniques such as repairing damaged ears from around the 1st century BC. 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 20th centuries that such surgery became commonplace. Up until the techniques of anesthesia became established, all surgery on healthy tissues involved great pain. Infection from surgery was reduced once sterile technique and disinfectants were introduced.

The invention and use of antibiotics beginning with sulfa drugs and penicillin was another step in making elective surgery possible. Chopart in 1791 performed operative procedure of a lip using a flap from the neck. Joseph Carpue in 1814 successfully performed operative procedure in a British military officer who had lost his nose to the toxic effects of mercury treatments. Carl Von Graefe the German surgeon in 1818 published his major work entitled "Rhinoplastik." Carl Von Graefe modified the Italian method using a free skin graft from the arm instead of the original delayed pedicle flap. In 1845 Dieffenbach wrote a comprehensive text on rhinoplasty, entitled "Operative Chirurgie." He introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose.

In 1891 John Roe, an American otorhinolaryngologist 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 1989 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.

The U.S.'s first plastic surgeon was Dr. John Peter Mettauer. He performed the first cleft palate operation in 1827 with instruments that he designed himself. The New Zealander Sir Harold Gillies developed many of the techniques of modern plastic surgery in caring for those who suffered facial injuries in World War I; he is considered to be the father of modern plastic surgery. His work was expanded upon during World War II by one of his former students and cousin, Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns. McIndoe's radical, experimental treatments, lead to the formation of the Guinea Pig Club.

Plastic surgery as a specialty evolved tremendously during the 20th Century in the United States. One of the founders of the specialty – Dr. Vilray Blair – served as the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis. 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. He was also one of the first non-oral surgeons elected to the American Association of Oral and Plastic Surgery (later renamed the American Association of Plastic Surgeons) and taught many surgeons who became leaders in the field of plastic surgery.