Putting the "Plastic" in Surgery

You've heard the terms plastic surgery, cosmetic surgery, and reconstructive surgery bandied about, and you're confused. No wonder. You'll see both medical and marketing uses of these terms and when you see them, you need to know what they mean.

When you hear the word plastic, you probably think of the modern material that's molded into myriad products — patio chairs, kids' toys, kitchen glasses, and airline knives and forks. The list goes on and on. This plastic isn't what we're talking about. Actually, the word comes from the Greek word "plastikos" or the later Latin word "plasticus," both of which mean "to shape or mold." Plastic surgeons shape or mold your body into new and more pleasing forms.

Another form of this word, the suffix -plasty, is used in the names of many plastic surgery procedures. In the mid-1800s, the medical term for nose reshaping came to be rhinoplasty — rhino (for nose) plus plasty (to describe the shaping technique). Other examples include abdominoplasty (reshaping of your abdomen), mammoplasty (changing the shape of your breasts), and blepharoplasty (reshaping of your eyelids).

As defined by the American Medical Association, the medical specialty of plastic surgery includes two subcategories of procedures:

• Cosmetic: Cosmetic surgery is performed to reshape normal structures of the body to improve the patient's appearance and self-esteem.

• Reconstructive: Reconstructive surgery is performed on abnormal features of the body (usually caused by congenital defects, developmental abnormalities, infection, tumors, or disease). It is generally done to improve function, but may also be done to approximate a normal appearance.

Cosmetic surgery improves form, whereas reconstructive surgery improves function.

Defining cosmetic surgery

The primary purpose of cosmetic surgery is to improve your form, or appearance. In cosmetic surgery (sometimes called aesthetic surgery), you take a normal or near-normal part of the body and alter it to make it look better. For example, a young man with a weak chin line seeks cosmetic surgery to alter his profile. Or a 60-year-old woman with a face that is normal for a 60-year-old decides to get a facelift to improve her appearance.

The most common cosmetic surgery procedures are the following:

• Liposuction

• Breast surgery

• Nose reshaping

• Eyelid lift

• Tummy tuck

• Facelift

The rate at which these procedures are performed has been growing exponentially for many years. From 1997 to 2003, the number of surgical and non-surgical cosmetic procedures grew from 2.1 million to 8.3 million, according to the American Society for Aesthetic Plastic Surgery. If this keeps up, you won't have a neighbor or coworker who hasn't has something lifted, tightened, augmented, or filled.

Cosmetic surgery and cosmetic surgeons are not synonymous. If you or a loved one is considering a cosmetic surgery procedure, you really need to know whether the surgeon you're consulting is trained in plastic surgery. Some doctors, even good ones in other fields, hoping to blur the boundaries of training and experience, run ads calling themselves cosmetic surgeons. This is perfectly legal in many places. They may be wonderful physicians, dermatologists or Ob-Gyns, for example, but they never had specialized training in plastic surgery, never did a residency, and so are not as qualified to give you the best result.

Ask, ask, and then ask again to verify that the person who will do the surgery you want is trained in the specialty of plastic surgery or a surgical specialty that includes training in the procedure you want.

Understanding reconstructive surgery

During reconstructive surgery, the surgeon works with a body part that is not within a range of normal appearance to make it look more normal. Generally disease, deformity, or trauma prompts patients to seek reconstructive surgery. The repair of a cleft lip or reconstruction of breasts after cancer is considered reconstructive surgery, not cosmetic surgery, because the body part that is being improved didn't start out in a range of normal appearance; rather, it's being brought back to a normal appearance or function.

Other common reconstructive procedures include facial reconstruction after serious accidents and hand surgery for work-related injuries or degenerative diseases such as arthritis.

Blending cosmetic and reconstructive techniques

Sometimes the cosmetic and reconstructive techniques are combined in one procedure that improves both appearance and function. An example is a rhino/septoplasty, in which the rhino portion of the surgery shapes the outer nose and the septo portion improves the breathing function of the inner nose.

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