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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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