Plastic Surgery - What is it?

definition

Plastic surgery is a branch of surgery that deals with shape-changing or restorative interventions on the human body. Reasons for this can either be of an aesthetic nature (classic "cosmetic surgery" or aesthetic surgery) or of a restorative nature (reconstructive surgery, e.g. after accidents or breast augmentation after breast cancer).

Another main branch of plastic surgery is burn surgery, where burn injuries are helped in specialized centers. A final specialty of plastic surgery is hand surgery, which requires cooperation with the specialist areas of orthopedics and trauma surgery and deals with injuries, malformations and other diseases of the hand and forearm.

Cosmetic surgery in the narrower sense (so-called aesthetic plastic surgery) also developed in the 20th century due to increasingly finer operating techniques and anti-aging surgery became popular. At the beginning of the 20th century, the first face lifts, eyelid lifts, lip injections and breast and abdominal wall lifts were carried out. Nowadays, plastic surgery and its sub-areas have become an indispensable part of a hospital with maximum care and fixed standards and surgical techniques have been established.

Areas of application

Plastic surgery is divided into four major pillars, which differ fundamentally in their areas of application.

The first pillar, reconstructive plastic surgery, creates the restoration of body tissue after tumor operations, accidents or in the case of congenital malformations. Common clinical pictures are, for example, the removal of tumors (e.g. skin cancer or soft tissue tumors) with the subsequent covering of defects. Breast reconstruction after breast removal (mastectomy) for breast cancer is also one of the frequent indications. Similar plastics are also used after accidents. Frequent congenital malformations in children such as a cleft lip and palate (so-called "harelip") or a funnel chest are treated by reconstructive plastic surgery.

The second pillar of plastic surgery, burn surgery, can also be viewed as a sub-branch of reconstructive surgery as it deals with the treatment of burn victims. The main tasks here include e.g. scar correction by means of skin grafts or special plastics, as well as conservative procedures such as laser therapy or skin abrasion. Thanks to new treatment options such as growing the patient's own skin in the laboratory and microsurgical techniques, amputations of the extremities have now largely become avoidable.

The third branch of plastic surgery, hand surgery, deals with the complex functions of the human hand. With a multitude of bones, the smallest joints, tendons and ligaments, the hand is one of our most complex, but also one of the most vulnerable parts of the body. Hand surgery deals with age-related changes in the tissues of the hand as well as with the consequences of accidents and congenital malformations. The focus is always on maintaining the functionality of the hand as our most important tool, otherwise there is a risk of severe disability in everyday life and professional life.

The fourth pillar, aesthetic plastic surgery (cosmetic surgery) is the subfield that many people colloquially refer to as plastic surgery. This is not about restorative techniques (e.g. breast augmentation after breast cancer) or functionality (e.g. cleft lip and palate or hand surgery), but purely about the aesthetic, cosmetic result of the operation. There is no dedicated specialist in cosmetic surgery, nor is the definition of “cosmetic surgery” a protected term. In any case, patients should make sure that the attending physician has completed specialist training in the field of “plastic and aesthetic surgery”. The most common treatments include non-surgical wrinkle treatment using Botox injections or hyaluronic acid injections. But surgical procedures on the face such as eyelid tightening, nose corrections or the so-called facelift have increased significantly in recent years. Breast operations (mainly breast enlargements or breast lifts, but also breast reductions) are also an important part of cosmetic surgery. Tightening of the abdominal wall or thighs or liposuction of the abdomen, flanks or thighs are just as popular. In recent years, numerous new procedures have been developed, such as the labia correction for aesthetic reasons or the rejuvenation of the back of the hand is very popular. In principle, there are no limits to creativity, as almost every part of the body can now be changed cosmetically.

Operation costs

Plastic surgery in the sense of restorative, burn and hand surgery is covered by the health insurance companies in terms of the restoration of body parts and their functionality. The question always arises as to whether the functionality of the respective body part is restricted (e.g. if back pain or curvatures are caused by breasts that are too large, nasal breathing difficulties due to a crooked nasal septum or a functional problem due to oversized labia). In this case, the doctor can apply to the health insurance company to cover the costs. However, if it is a question of purely cosmetic problems such as a bumpy nose without hindrance to breathing or lip enlargement, the costs must be borne by the patient. The costs vary greatly depending on the complexity of the procedure and the respective clinic. The price range for non-surgical wrinkle treatment starts at a few hundred euros and can go into the 5-digit range for complex procedures with anesthesia and several days of inpatient hospitalization.

Risks of plastic surgery

Like any operation, plastic interventions involve certain risks, which the attending physician must explain. In the case of a purely aesthetic operation, the explanation must be particularly thorough, as the patient does not have any functional problem, but the operation sometimes involves serious risks.

The risk depends on the type and complexity of the operation, so a botox treatment is obviously less risky than a complex breast augmentation or difficult operations on the face. The risks of any operation include the risk of infection, the risk of anesthesia, the severing of blood vessels or nerves and thus loss of function. In addition, there is the risk that the result of the operation does not correspond to the wishes and ideas of the patient, so that the patient should be presented with an honest and realistic picture of the result in advance.The cost-benefit factor should therefore be carefully weighed, especially with purely cosmetic interventions. To this end, it is essential that the doctor conducts an honest educational discussion in which there is critical questioning and the patient does not have the feeling that something is being forced upon him.

History of Plastic Surgery

Plastic surgery, especially aesthetic surgery, has experienced a strong boom, especially in the last few decades, and is no longer a privilege of the super-rich and film stars and is therefore suitable for society.

Contrary to popular belief, the origins of plastic surgery can be found more than 1000 BC. Documents show that nose operations were performed regularly around 1200 BC. in India, where a flap of tissue was removed from the forehead and a nose was formed from it. In the background is that, according to old Indian law, criminals had their noses amputated as a sign of branding. Cosmetic surgical interventions such as sewn ears were also discovered in ancient Egyptian mummies.

The Greek physician and scholar Hippocrates (460-377 BC) already described procedures for correcting deformed noses and in the 1st century AD. the Roman scholar Celsus explained methods for the operation of "harelip" (cleft lip and palate).

In the dark Middle Ages, however, such arts and experiments were completely forgotten, so it was even frowned upon and punishable to want to presume to change the godly shape of man.

It was not until the Renaissance (French for rebirth) that sciences such as medicine and operative techniques flourished again. One of the best-known works “De curtorum chirurgica” (the restoration of the nose) by Gaspare Tagliacozzi (1546-1599) describes a further development of Indian nasal surgery, in which the skin comes from the upper arm through a pedicled distal flap. A common area of ​​application at this time is the restoration of tissue defects such as those on the nose or ears caused by the sexually transmitted disease syphilis, which was already widespread at the time.

Plastic surgery experienced a further boom in the 19th century, when groundbreaking findings in anatomy and natural science made new procedures possible. In German-speaking countries, the doctor Johann Friedrich Dieffenbach (1795-1847) should be mentioned here, who dealt with surgical techniques on the nose, tendons and transplants. After World War II, which naturally left many casualties, microsurgery enabled a new era in plastic surgery: it was now possible to join tiny blood vessels and nerves and sew tissue to new areas of the body by securing the blood supply . For example, the suturing of arms and legs or the free transfer of skin to non-closable wounds was made possible.