Plastic surgery is a branch of medicine and surgery specialising in repairing, reconstructing and restoring appearance and function. When one refers to plastic surgery, many often have a misconception of the term relating to aesthetic procedures. This is partly due to the misunderstanding of the word "plastic" referring to man-made materials such as silicon or other materials used to achieve reconstructive goals. As a result, many often assume a virtual synonym between plastic surgery and aesthetic surgery.
"The general public is under the perception that most of what we do is for cosmetic reasons which is not true. We do a lot of surgical reconstruction," says Dr Joannis Constantinides, consultant plastic surgeon at the London Bridge Hospital.
"Plastic surgery is a very broad speciality. We operate on different parts of the body so there is no unique anatomy that we operate on," he adds.
In fact, plastic surgery is divided into two main components: reconstructive plastic surgery and aesthetic (interchangeable with “cosmetic”) plastic surgery.
Reconstructive plastic surgery aims to repair or restore missing or damaged tissue in a patient who suffers from physical trauma. On the other hand, aesthetic plastic surgery is performed on a healthy person solely to change the appearance and achieve a more desirable facial and body function.
But what is the difference between a plastic surgeon and a cosmetic surgeon?
Dr Lydia Badia, consultant facial plastic surgeon at The London Clinic explains: "Plastic surgeons have the training to perform plastic surgeries but cosmetic surgeons may or may not have the necessary training."
This means that any medical practitioner trained in other specialities such as internal medicine, ophthalmology or dermatology can perform cosmetic procedures even without qualified training in plastic surgery.
Many aesthetic procedures performed today were first developed and used for medical reasons. For example, breast implants were initially created for women who had undergone a mastectomy due to cancer or tumor but are now used for breast augmentation.
According to Roger Green, archivist for the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS), plastic surgery started off with nose reconstruction primarily to restore the appearance of people who had their nose amputated as a punishment.
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Background picture credit: MS051311/1/1/ID1941, Spreckley
From the Archives of the Royal College of Surgeons of England
In the UK, plastic surgery emerged during the First World War to repair soldiers’ faces. Many British soldiers were vulnerable to enemy fire as they were exposed to all manner of weapons, resulting them to return from the war with injuries to the head and face that left them permanently disfigured. Shrapnel was the biggest cause of many facial injuries as the twisted metal shards could easily rip a face off.
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Harold Gillies who is widely considered as the 'father of plastic surgery' joined the Royal Army Medical Corps at the outset of the war and took an interest in plastic surgery after witnessing surgeons experimenting and performing reconstructive procedures. He later persuaded the army’s chief surgeon to establish a facial injury ward at the Cambridge Military Hospital in Aldershot which later led to the opening of Queen Mary’s Hospital in Sidcup, Kent.
Mr Green explained: “Gillies’ primary aim was to treat wounds to restore function, to allow the patient to eat, speak and breathe properly.”
Mr Green also emphasised that plastic surgery is not just about the skin, as the main aim is to create and rebuild form and function. The technique is also applied to muscle and bones. Due to the broad field of the surgical speciality, plastic surgery is further divided into subspecialities, including aesthetic surgery, burns surgery, craniofacial surgery, hand surgery and microsurgery.
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In 2013, the Department of Plastic and Reconstructive Surgery at the University College Hospital Galway conducted a questionnaire to assess the general public’s perception of plastic surgery. Almost 900 public members were asked to match eight surgical specialities with 30 operative procedures.
The results showed more than half of the respondents correctly identified aesthetic plastic procedures such as breast augmentation and facelift to be performed by a plastic surgeon. However, the percentage fell to less than 50 percent when it came to reconstructive plastic procedures such as burns surgery and hand surgery. Only 43 percent of respondents correctly identified burns surgery as a primary speciality under plastic surgery and 4.7 percent identified hand surgery. Besides that, the respondents also ranked plastic surgery as the lowest of 30 specialities in terms of importance in providing care for patients within hospitals.
This reflects how unaware the general public is towards the role a plastic surgeon plays in reconstructing and saving the lives of trauma patients.
Background picture credit: MS0513/1/1/ID54, Ashworth
From the Archives of the Royal College of Surgeons of England
As knowledge on manipulating tissues to restore a “normal” appearance improved and developments in anesthesia and antisepsis increased, more attention was focused on using the techniques to “perfect” a “normal” appearance, therefore giving birth to aesthetic surgery. It is believed that a deeper understanding of the anatomy of facial structure also led to the application of plastic surgery techniques for aesthetic purposes. The first modern cosmetic surgery was rhinoplasty (nose surgery) performed in the United States in 1923, followed by the first public facelift procedure in 1931.
Today, the demand for aesthetic surgery worldwide continues to skyrocket since 2010, according to statistics published by the International Society of Aesthetic Plastic Surgery (ISAPS). This shows how far the concept of beauty has changed over the past few decades, as well as highlights the strong desire for people to opt for surgical procedures to improve their looks.