- Category: knowledge base
- Published on Thursday, 11 November 2010 00:00
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The word 'plastic' comes from the greek 'plastikos' meaning to change the shape of. Today, plastic surgeons are known for performing cosmetic surgery, but their skills are used in many other areas.
Wars have always been a rich area for progress in plastic surgery and much of the acute workload of any plastic surgeon is treating trauma victims. Skin and soft tissue injury whether it be caused by machinery, motor vehicle or burns, as well as repair of tendons and microsurgery to damaged nerves and blood vessels are all performed by plastic surgeons.
Hand surgery is a major sub-specialty of plastic surgery and as well as the major trauma workload, conditions such as carpal tunnel syndrome and rheumatoid arthritis affecting the hand are treated by plastic surgeons.
Treatment of Burns
Burns surgery is another major sub-specialty of plastic surgery. Whilst only the secondary deformities caused by burns scars are treated by plastic surgeons in the USA, in the UK, burns patients are managed entirely by plastic surgeons. This ranges from the initial resuscitation, through the often intensive inpatient stay with skin grafting and other skin replacement techniques and on to the postoperative rehabilitation and secondary burn scar surgery.
Plastic surgeons play a major role in reconstruction following excision of cancers. They remove skin cancers from all areas of the body and often work alongside other surgical specialities performing head and neck and breast reconstructions.
Plastic surgeons also work to correct congenital abnormalities such as cleft lip and palate and other craniofacial deformities as well as congenital hand defects and congenital genitourinary anomalies such as hypospadias (abnormal opening of the male urethra).
Finally, there is cosmetic or aesthetic surgery. This is the area that the public most know plastic surgeons for. Whilst cosmetic surgery is a sub-specialty in its own right, attention to the cosmetic as well as the functional outcome is a common theme throughout all of the areas in which plastic surgeons are involved. Meticulous operative technique and attention to detail is a trait that plastic surgeons are known for across all the sub-specialties.
The areas covered by cosmetic surgery can be broadly split up into facial procedures and body contouring. Facial procedures involve surgery for the ageing face such as brow lifting, upper and lower blepharoplasty (eyelid surgery) and rejuvenation of the face and neck (face-lifting). Other procedures include augmentation of the chin or cheeks, surgery to reshape the nose (rhinoplasty) or to correct prominent ears.
Body contouring procedures are commonly performed on the breast, abdomen, thighs and buttocks.
Botox® has become synonymous with plastic surgery. Botox®, or botulinum toxin, paralyses muscles and is used to eliminate skin wrinkles caused by hyperactivity of the underlying muscles. After several months, the effect of the toxin wears off and the procedure can be repeated.
Soft tissue fillers are increasing in popularity. There are many different types but they can be broadly divided into temporary and permanent or autologous (part of the patient's body) and synthetic.
Autologous fillers can contain fat or fat and dermis (part of the skin). The harvesting and injection of these fillers involves a surgical procedure (and so strictly should not be in this section). If fat alone is used, then the Coleman fat transfer technique is popular.
The fat is harvested with liposuction from a place of excess, usually the lower abdomen, through a small stab incision near the belly-button. The fat is then spun down (centrifuged) and any excess fluid (blood, local anaesthetic, ruptured fat cells) is removed. The fat is then injected into the area of soft tissue deficit through multiple stab incisions with a view to overcorrection as some of the fat will atrophy.
Synthetic fillers are increasing in popularity particularly in the cosmetic field where skin lines and wrinkles can be filled