Whenever we, as Plastic surgeons have to explain what Plastic surgery means, to the layperson, we have to always first clarify that it does not mean the use of any material made of Plastic in the operations that we do!!. The word Plastic derives from the Greek word “Plastikos”, which means “to mould” or “that which is mouldable”. As our Indian philosophy tells us, we are of the earth and to the earth, we shall return. Earth is clay and clay as we all know is mouldable. So our bodies can be moulded similarly and hence the use of Plastic surgery to do so.
Ancient Plastic surgery originated from India with the work of Sushruta, an Indian sage and surgeon several hundred years before the birth of Christ (BC). Sushruta wrote the “Sushruta Samhita”, a brilliantly detailed compendium of how to successfully perform many surgical procedures in different parts of the body. He also designed many instruments to perform these surgeries. We can be very proud of this heritage – of the origin of a major surgical branch in our own country so many centuries ago.
Modern Plastic surgery has its roots in the First World War where techniques were desperately required to reconstruct the mutilating and horrendous injuries in soldiers in that war. Dr. Harold Delf Gillies, a British surgeon is regarded as the father of modern Plastic surgery. Many other pioneers across the world, including Indian Plastic surgeons, then contributed to its tremendous development to the present date.
It is a commonly held myth among the public that Plastic Surgery is only for beautification. This is certainly not true. Beautification surgery or Cosmetic / Aesthetic Surgery is only one part of a huge spectrum of surgeries and sub-specialities that comprises the whole gamut of our surgical branch. Plastic surgery is a speciality that is involved in procedures literally from head to toe. Plastic surgeons do work FROM Hair transplantation and Scalp reconstruction following injuries TO reconstructive work on post-Burn contractures or injuries in the toes and ALL body parts in between.
Plastic surgery can broadly be divided into Reconstructive and Aesthetic. Reconstructive Surgery is in turn divided into several types: Cleft lip and palate surgery, Maxillofacial surgery, Craniofacial surgery, Hand Surgery, Reconstructive Microsurgery in all parts of the body for Post-trauma and post-cancer Reconstruction, Genitourinary reconstructive surgery, and Burns management. Aesthetic Surgery relates to beautification, reshaping, recontouring, and refinement of all parts of the body.
All of us have seen children born with Cleft lips and Cleft palates. The correction and repair of these congenital (from birth) deformities with the restoration of both appearance and function are one of the fundamental parts of this speciality. These children are operated on at a very young age between 3 months to 1 ½ year so that by the time they go to school, the external appearance, as well as the function of near-normal speech, is restored with the help of plastic surgery so that these children can grow normally without being teased or differentiated.
Facial fractures and injuries comprise the field of Maxillofacial surgery. Following road traffic accidents, falls, sports injuries or fights, fractures involving the facial bones are common. They are disfiguring and compromise function in terms of how the teeth of the upper jaws and lower jaws meet with each other for biting and chewing food and support to the eyeball and vision. Hence proper realignment and fixation of these fractures are very critical for both form and function. Once again, this is part of our Plastic Surgery training and expertise to help patients in this regard to restoring normalcy.
Craniofacial surgery is a complex subspecialty of Plastic Surgery, involving the treatment of deformities of the skull bones and upper facial bones present from birth in children, which can have a very serious effect on their brain development and sometimes vision, if left uncorrected. Plastic surgeons trained in this field can reshape and remould the skull and facial bones and reposition them in such a manner that the brain can expand with age thus allowing for normal growth and development of these children.
Hand surgery is a large and important part of our speciality. The treatment of congenital hand deformities, hand injuries, peripheral nerve injuries, injuries to tendons (which move the fingers and thumb) and restoration of useful hand function after burns is one of the most gratifying aspects of Plastic surgical work. The ability to perform successful reimplantation of amputated parts at the level of the fingers, thumb, hands/wrist, forearm, or even arm within a few hours of the accident/injury in a precise and meticulous manner to restore near normalcy of function is one of the most revolutionary advances in Plastic surgery in the last few decades and is a part of hand surgery.
Reconstructive Microsurgery is an exciting field wherein complicated tissue reconstructions in the limbs following severe mutilating trauma or in the face and neck following cancer surgery are done by Plastic surgeons all over the country. Large masses of tissues with skin, skin and fat, skin and muscle, muscle alone, bone alone, or even skin and bone can be harvested from one of many donor areas in a patient’s body along with their blood supply (arteries and veins) and transferred to another distant site on the body where the blood supply to these tissues is restored by joining their blood vessels to arteries and veins in the recipient area, thereby allowing reconstruction of complex 3-dimensional tissue defects. This ability of Plastic surgeons has transformed the ability of cancer surgeons to confidently completely and often curatively remove even large cancerous tumours from any area of the body, because they are now aware that the Plastic surgeon will be able to successfully reconstruct the huge functional and cosmetic defects created by complete removal of cancer, thereby improving the patient’s future quality of life significantly.
Several areas of Genitourinary surgery are also done by Plastic surgeons such as treatment of congenital hypospadias (urinary opening by birth not being at the tip of the penis but at different points along the shaft), vaginal reconstruction (congenitally absent vaginal canal), and gender reassignment surgeries for male-to-female and female-to-male transformation.
Treatment of Burns has been one of the traditional bulwarks of Plastic surgery. Intensive and dedicated management of burn injuries to a large area of the body by Plastic surgeons saves thousands upon thousands of burn victims in our country. Early removal of the burnt skin and replacement with skin grafts restores and heals these unfortunate patients and rehabilitates them back into society. Plastic surgeons also corrected the treatment of contracture bands and functional deformities of the joints following burn injuries that often severely limit function. Acid burn victims also turn to Plastic surgeons for treatment and restoration of appearance and function.
So to summarize, as seen above, Reconstructive surgery encompasses a very wide spectrum of procedures in multiple subspecialties treating patients from head to toe.
Aesthetic surgery is the other part of Plastic Surgery. Once again, starting from the head and face, the Aesthetic Plastic surgeon is trained to do restorative hair transplants for hair fall and baldness, to do facelifts and neck lifts to reverse the ageing process, to rejuvenate eyelids surgery for baggy tired-looking eyelids, and to do cosmetic rhinoplasties for reshaping noses in all possible ways. Moving lower down, Aesthetic surgery of the Breasts can augment/increase the size of the breasts with implants or the patient’s own fat; reduce the size of abnormally large breasts as well as reshape them; and lift sagging breasts that have drooped after breastfeeding or with advancing age or weight loss, to a pleasing shape and youthful position. Excess fat in the arms, chest, tummy, back, thighs, hips, and buttocks can be safely removed and the areas recontoured with liposuction or excess loose skin in all these areas can also be removed and reshaped by tightening procedures such as tummy tucks, arm lifts, thigh lifts and upper /lower body lifts in the case of laxity after massive weight loss. It is easy to see that Aesthetic surgery also involves the entire body from head to toe.
By now, we hope and pray that it is clear to the reader that Plastic surgery is a vast spectrum of different sub-specialities which together significantly change the patient’s form and function for the better. We wish to bring this awareness before the public, so the common man understands how varied and widely expanded this speciality really is.
On the occasion of National Plastic surgery day which is observed every year on July 15th, if this message of awareness of the vast potential of Plastic surgery and what it can do, is spread among our fellow citizens, we are sure it will help us to serve them better in the future.
– Dr Milind Wagh