Plastic Surgery - General Questions:
What is plastic surgery?
Plastic surgery is a surgical specialty that reconstructs facial and body defects due to birth disorders, trauma, burns, and disease. The plastic surgery is also involved with the enhancement of the appearance of a person through such operations as rhinoplasty, breast augmentation, facelift and liposuction.
Plastic Surgery - Why the "Plastic"?
The word "plastic" comes from the Greek word plastikos, meaning "to mold or shape."
What is the history of Plastic Surgery?s
Plastic surgery as a medical specialty was born out of the horrors of World War I and the tremendous toll taken on mankind. Besides the thousands of soldiers who were killed, millions more were crippled or hideously deformed, requiring ingenious and specialized surgical treatment.
Surgeons at the time faced gaping skull wounds, severe facial burns, shattered jaws, and noses and lips that were shot off-injuries of a type and severity that had never been seen before.
As described by plastic surgeon James, H. Carraway, M.D., they could be attributed to modern weaponry: "When the engines of planes caught on fire, soldiers' faces would get severely burned, when planes crashed. Soldiers' heads would hit the control panels and they would sustain severe fractures. Sniper trench warfare also caused soldiers to sometimes have their jaws blown off." Ironically, steel helmets that soldiers wore saved lives, but when hit, these helmets could shatter into steel shards that injured soldiers' unprotected places.
Plastic surgery made its debut by the impetus of faciomaxillary injuries, so severe and new to surgeons, other technological advances moved the discipline of plastic surgery forward, such as improved anesthesia techniques, utilization of antiseptic surgical techniques and the availability of the electric light bulb to illuminate the surgical field and body cavities.
According to Bamji Andrew, M.D., curator of the Gillies Archives, Queens Hospital, Sidcup, "Prior to the 20th century, plastic surgery existed but was hamstrung by a lack of anesthetics and a failure to understand the problems of infection. Techniques developed in an inchoate and uncoordinated way, with little direct communication between surgeons. The first World War changed that by simply producing huge numbers of patients with facial injuries."
To help all these patients, pockets of collaborations formed between surgeons of various nationalities and disciplines. American, British, French, German, Russian, and Austro-Hungarian surgeons became rhinologists, oral surgeons, general surgeons, dental surgeons, ophthalmologists, and neurosurgeons. At this time the now-deemed fathers of plastic surgery rose to prominence.
Founding fathers included Sir Harold Gillies, born in New Zealand and trained as an otolaryngologist; Vilray Blair, an orthopedic surgeon from St. Louis; Robert Ivy, a general surgeon from Philadelphia; Lee Cohen, an American otolaryngologist who studied in Europe; and Varaztad Kazanjian, an American immigrant who studied dentistry at Harvard Dental School and worked on the staff at Massachusetts General Hospital.
Plastic surgery was needed by the many soldiers. In Britain, injuries of wounded soldiers were managed comprehensively, beginning with treatment on the battlefield, leading eventually to treatment at a rehabilitation hospital as necessary. Harold Delf Gillies, M.D., a young army doctor at the center at Shepherd's Bush, treated soldiers with severe skeletal injuries, nerve lesions and orthopedic problems.
As an otolaryngologist, he saw an urgent need to separate soldiers with facial and maxillary injuries from the rest, and offer them specialized treatment. Operating with dental specialist, Auguste Valadier, Dr. Gillies learned how to repair jaw defects by using tissue and bone from other parts of the body. He read about these injures and learned about them by meeting with other surgeons, such as plastic surgeon Hippolyte Morestin.
He thought that soldiers with facial injuries should be segregated and given special attention, so he successfully arranged for Cambridge Hospital to open. On European battlefields, injured soldiers were transferred to Cambridge Hospital if pinned with labels (that Dr. Gillies reportedly bought himself), that read "Faciomaxillary injury--Cambridge Hospital, Aldershot."
Plastic surgery was not used widely at then time. In 1916, 2,000 soldiers with faces or jaws shot away arrived from the Battle of Somme. Suffocation, sepsis, gangrene, and hemorrhage loomed, and they often arrived at the hospital crying, "Kill me, kill me." Operating on these soldiers, Dr. Gillies became proficient at creating skin flaps to reconstruct noses, mouths, eyelids, and ears. In 1915, Varaztad Kazanjian, a dentist at the time, became chief dental officer of the British Army's first Maxillofacial Treatment Center in France.
While soldiers were to be returned to England within three weeks, some chose to stay for further treatment. "The severely wounded and disfigured men were loath to be seen by member of their families," Dr. Kazanjian said. Surgeons would wire small fragments of jaw together, devise splints to hold the jaws of patients who had no teeth, and construct internal facial splints of vulcanized rubber to prevent the patient's face from contracting until more extensive bone grafting could be tried. For these feats, he was referred to as "Miracle Man of the Western Front."
In England, when Cambridge Hospital filled, the overflow went to Queen's Hospital in Sidcup, Kent, which opened in August 1917. There, Gillies made major strides in the field of reconstructive surgery, most notably developing the tubed pedicle graft, which allowed for skin from distant sites to be used to fill defects elsewhere. The method was also developed independently by Vladimir Petrovich Filatov, M.D., an ophthalmic surgeon in Odessa, Russia, in 1916. The tubed pedicle graft remained the most common method used by surgeons until 1974.
By the end of the war, 11,572 major facial operations had taken place at Queen's Hospital. When World War II threatened, in 1939, Gillies began organizing hospitals again. As a direct result of their experience performing reconstructive work during the war, surgeons of diverse backgrounds created a society that would eventually become the American Association of Plastic Surgeons (AAPS), founded in 1921. In 1931, Jacques Maliniak, M.D., organized the Society of Plastic and Reconstructive Surgery, which became the American Society of Plastic and Reconstructive Surgeons (ASPRS).
Plastic surgery started to grow after world war 1. Surgeon Max Thorek, M.D., called this budding hope a strange and sudden aftermath of the war. He said that people began to reason, "If soldiers whose faces had been torn away by bursting shells on the battlefield could come back into an almost normal life with new faces created by the wizardry of the new science of plastic surgery, why couldn't women whose faces had been ravaged by nothing more explosive than the hand of the years find again the firm clear contours of youth."
Interest in cosmetic work, however, didn't flower for several decades, and is still growing. By the 1960s, cosmetic procedures, including facelifts and breast implants, began gaining broader cultural acceptance.
Plastic surgery advances:
1827 America's first noteworthy plastic surgeon was Dr. John Peter Mettauer, who performed the first cleft-palate operation in New World with instruments he designed himself.
1845 Dr. Diffenbach of Germany published a text that described surgical procedures for nasal reduction through external incisions. However, it was not until 1887 that seminal publications and rhinoplasty presentations began taking place in the United States and Germany.
1876 The American Dermatologic Association (ADA) is established
1881 Robert Talbott Ely, M.D., a staff member of the Manhattan Eye, Ear, and Throat Hospital in New York performed an otoplasty for protruding ears on a 12 year old boy.
1885 Robert F. Weir, M.D., professor of surgery at the College of Physicians and Surgeons in New York City, claimed to have performed a four-stage total nose reduction.
1887 John Orlando Roe, M.D., an otolaryngologist who studied in New York and Europe performed the first intranasal rhinoplasty. He published "The Deformity Termed 'Pub Nose' and Its Correction by a Simple Operation," the first published report on an endonasal rhinoplasty.
1891 After performing endonasal hump removal on five patients and using spring wire for internal splinting of the nose, Dr. Roe published a second article, "The Correction or Angular Deformities of the Nose by Subcutaneous Operation." He spoke of the value of cosmetic surgery, of people seeking surgery as having "valuable talent ... buried from human eyes, lost to the world and society by reason of embarrassment, caused by ... the influence of some physical infirmity, or deformity or unsightly blemish."
1892 Robert F. Weir, M.D., a professor of surgery in New York City published an article "On Restoring Sunken Noses Without Scarring the Face," which described hump removal, nasal shortening, tip modification, and narrowing of the base through alar base wedge excisions, aptly named 'The Weir Incision.'
1898 Jacques Joseph, M.D., considered by some to be the father of modern rhinoplasty surgery, presented his endonasal techniques to the Medical Society of Berlin. An American doctor watching the presentation asked Joseph whether he knew that Roe had described a similar procedure. That same year, Joseph operated on the large, protruding ears of a young boy who refused to go to school because of them.
1914 During World War I (1914-1919), Dr. Joseph served as director of the Division of Facial Plastic Surgery of the Charity Hospital in Berlin, where he worked to repair the faces of countless German soldiers.
1915 Cambridge Hospital opens at Alershot to treat soldiers with faciomaxillary injuries. It soon became overcrowded.
1917 Queen's Hospital, a major center for maxillofacial and plastic surgery opened in Sidcup as Cambridge Hospital filled up. At first, there were 1,000 beds, but by 1921, the hospital admitted 5,000 servicemen.
1920 S. Noel, M.D., a French dermatologist, became world famous for her work in facelifting and blepharoplasty in the 1920s, and published a book on aesthetic surgery.
1921 Jacques Maliniak, M.D., a Polish surgeon who trained in France and served in the Russian army; Gustave Aufricht, M.D., a Hungarian surgeon who trained in Budapest and Berlin; and Joseph Safian, M.D., a general practitioner from New York studied with Dr. Joseph and all three eventually practiced in New York.
1930 In the 1930s, Samuel Foman, M.D., went to Europe to study with Dr. Joseph, and went on to organize a course around Dr. Joseph's methods. Among hundreds of otolaryngologists, Maurice H. Cottle, M.D., and Irving Goldman, M.D., studied with Dr. Foman and went on to develop their own courses. Those that followed these men formed societies, with Dr. Foman's and Dr. Goldman's groups merging into one to form the AAFPRS in 1964.
1931 ASPRS formed, and the American Board of Physicians recognized the progress of plastic surgery. Members created the first qualifying exam in the history of plastic surgery in the United States.
1937 The American Board of Plastic Surgery is founded, with Gillies representing otolaryngology.
1941 The American Academy of Plastic Surgery is founded. The United States enters World War II.
1942 The American Otorhinologic Society (later shortened to American Otorhinological Society for Plastic Surgery) was founded and was the largest otolarnygologic plastic society for 20 years.
Will I be able to cope with the pain after the procedure?
Each patient tolerates pain post-operatively in a different way. Some patients experience pain as an ache, others have greater discomfort. Pain medications are prescribed for post-operative patients, and these aid to minimize the discomfort.
Most facial cosmetic operations have minimal postoperative discomfort. Liposuction is slightly more uncomfortable, and operations that require elevation or tightening of the muscles, such as breast augmentation or abdominoplasty have discomfort equal to that experienced after a cesarean section.
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