Plastic Surgery Demystified

By Tammy Wu, MD

Plastic surgery is such a common term that when one hears it, one knows what someone is talking about. But more likely than not, people will equate the term “plastic surgery” with “cosmetic surgery”. Due to the recent popularity of media coverage as well as shows portraying lives of plastic surgeons and some plastic surgeries (ie. Nip Tuck, Dr. 90210, etc), and shows that “give away” plastic surgery, such as The Swan, plastic surgery is no longer “hush hush”, as it was in the past, but is in the very forefront of everyone’s television and/or internet.

But what IS Plastic Surgery? What does it entail? Who performs them? How is it different from Cosmetic Surgery, or is it?

These are the questions that I will address in this article.

The word “plastic” in plastic surgery came from the Greek word, “plastikos”, which means “to give form or to mold”. Hence the specialty of plastic surgery encompasses the field of Cosmetic Surgery, but also Reconstructive Surgery. As a plastic surgeon, I was trained on doing both reconstructive as well as cosmetic surgeries. In fact, if one were to read the history on cosmetic surgery, one will find that many cosmetic surgeries have their origins in reconstructive surgery. Many discoveries for either new ways or methods for cosmetic surgery came from the field of reconstructive surgery. Therefore, it makes sense then that a surgeon who is well versed in reconstructive surgery would also be well-trained in the field of cosmetic surgery.

What then is Reconstructive Surgery? How is it different from Cosmetic Surgery?

Reconstructive Surgery, in general, is surgery that is performed on abnormal structures to improve function or appearance. The abnormal structure may have been a structure that someone was born with, termed “congenital”, or due to acquired causes or external events, such as trauma, infection, tumor, or other disease processes.  Some examples of congenital structures that plastic surgeons perform to reconstruct, or correct the deformity, include cleft lip and palate, hemangioma formation or other blood vessel malformations, or limb abnormalities, such as absence of a thumb.

Some examples of trauma reconstruction would be soft tissue or bony injuries from car accidents or boating accidents, falls, dog bites, as well as burn care and burn reconstructions. Then there are also the reconstructive surgeries that are performed to restore a structure either deformed or taken away by cancer, such as breast reconstruction for breast cancer, facial reconstruction due to cancers of the head and neck, or limb reconstruction due to limb cancers such as sarcomas. Many of these reconstructive surgeries sometimes will involve microsurgery, which is the usage of a microscope, in order to perform very fine detailed work to optimize the outcome of the surgery.

As you can see, just the field of Reconstructive Surgery is quite extensive.

What is Cosmetic Surgery then?  Cosmetic surgery is surgery that is performed to reshape normal structures to improve appearance.  Therefore, most if not all cosmetic surgeries are elective in nature, meaning that one does not have to have the surgery, because the structure or body part that one does not like, is not necessarily abnormal or nonfunctional; but one wishes to improve upon its appearance. That is also why when a surgery is considered “cosmetic” in nature, insurance companies do not cover or pay for them. The range of cosmetic procedures is extensive as well. They include areas of non-invasive topical treatments to less invasive treatments such as Botox ®, fillers, medium-level chemical peels, to invasive procedures that require anesthesia in order for the procedure or surgery to be performed comfortably for the patient.  The cosmetic surgeries may involve any body part from head to toe. From the head (hair transplantation), to the face (eyelid lift and face/neck lifts), to the chest (breast augmentation /lift in women and gynecomastia treatment in men), to the abdomen (tummy tuck, liposuction), to the thighs (thigh lift, liposuction, etc.), and shaping of calves with contouring liposuction or other modalities of treatment. Thus, it does seem that the possibilities are almost endless.

So, is it true then, that when one starts down the road of plastic surgery, one can’t stop? This is an issue which shoulders the responsibility on both the patient and the surgeon, to ensure that  the patient does not become a cosmetic surgery “junkie”. However, there are certainly situations in which multiple surgeries are planned for the safety of the patient. For example, when one has lost a massive amount of weight (, ie, > 100 lbs), one may be left with a lot of loose skin all over. Due to the extensiveness of some of these body contouring procedures to remove the excess skin, it is necessary to divide up the surgeries and do them in multiple stages, so that we can minimize the perioperative risks and optimize the patient’s safety.

In the next article on Plastic Surgery, De-mystified, I will discuss in more detail some of these reconstructive and cosmetic surgeries.