Plastic surgery is a vast specialty that derives its name from the Greek term ‘plastikós’, meaning ‘to mould’. Thus, essentially in contrast to other surgical specialties, plastic surgery deals with the redistribution or transfer of tissues from one part of the body to the other and also from one person to another through tissue all transplantation. The sub-specialties are aesthetic surgery, hand surgery, trauma and cancer reconstruction, cleft and craniofacial surgery, and burn care.
The popularity of plastic surgery has largely been spurred by technological advancement, skill improvement, and overall economic development in society. This is evident from a large number of patients opting for aesthetic surgery these days. However, this by no means undermines the importance of reconstructive surgery in trauma and cancer patients, which not only restores anatomy but also initiates psychosocial and occupational rehabilitation. In a nutshell, it’s all about reconstructing, restoring, rejuvenating, and rehabilitating.
Aesthetic surgery deals with the improvement of appearance, which in turn translates into improved self-esteem and confidence, and also performance in professional life. However, it is important for patients seeking aesthetic surgery to have realistic expectations and understand the limitations of the procedures. Most of the aesthetic procedures are day-care surgery with aftercare at OPD.
Deals with the reshaping of the nose which can be an open or closed procedure. The open procedure is imperative for tip correction and for patients with cleft lip nose deformity. The closed approach suffices where there is no or minimal tip correction required. Rhinoplasty is a custom-made surgery. Quite naturally, it demands a unique plan for each patient with the need for extensive preoperative counseling.
Essentially constitutes tightening of the skin and supporting underlying soft tissues which have sagged owing to ageing and gravity with imperceptible scarring. Overnight hospital stay is generally required. Smokers and patients on anticoagulants (like aspirin, clopidogrel, and warfarin) have to stop consuming them for at least a week prior to surgery. Smoking is prohibited for three weeks during the post-operative period to facilitate healing. The common complications are bleeding and nerve injuries.
Fillers, botulin toxin, liposuction, and fat injection and implants help in facial contouring per the requirements and expectations of the patient. They may be office- or day-care procedures. While fillers and botulinum toxin injections are temporary (lasting six-nine months), others are permanent.
Surgical rejuvenation of baggy eyelids with minimal scarring. Post-operative swelling of the lids persists for a week. Facial scar revision, repair of split ear lobule, and excision of small moles and warts are performed as OPD procedures with local anaesthesia.
Liposuction is one of the most common and safe cosmetic procedures when performed by trained personnel. It is permanent at the site of suction. Most patients are counselled to discipline their diet, lifestyle, and exercise regime prior to undergoing liposuction to enable them to maintain the results obtained by the procedure. Approximately, 10% of body weight equivalent in volume can be safely removed in a single session of two to three hours. The sucked fat can be sedimented and injected in areas which are deficient to achieve better contouring. Results are usually visible after four to six weeks during which it is mandatory to use elastic compression garments. Body contouring has assumed greater application after the popularity of massive weight loss (bariatric) surgery. There is a need to contour the bodies of these patients once they have lost weight. Lower body and truncal lifts are common in these patients.
Abdominoplasty involves removal of excess, sagging of lower abdominal skin, and tightening of the abdominal muscles to create a narrow waistline. Liposuction is usually combined to achieve better contouring. The scars get easily be hidden within the underwear/bikini line. During abdominoplasty, the umbilicus is repositioned and reshaped too. Smoking reduces the chances of healing.
Contouring of the thighs and arms involve liposuction with/without lax skin excision to achieve desirable results. However, the patient has to accept long scars following skin excision. These scars tend to become less prominent with pressure therapy and time.
Unmarried girls with small breasts and post-childbirth mothers are usually the patients who avail of this procedure. The other indications are in sex change (gender reassignment) surgery and post-resection breast cancer patients. The newer-generation silicone gel implants are relatively safe, long lasting, and give the most natural feel. It is a day care procedure and the local discomfort is pronounced for the first 2-3 days. The dreaded complications related to implants are infection, capsular contracture, rupture, and leak. However, these are rare if proper intra-operative and postoperative care is taken. Fat grafting after liposuction is a new modality to augment breasts. However, results are unpredictable and further experience is required to satisfy patients. No heavy exercise, weight lifting or aerobics is recommended for at least 3 weeks postoperative.
Large breasts can be socially embarrassing and can cause neck and shoulder pain. Reduction of size and reshaping of the breasts and lifting the nipple-areola complex (NAC) to make them normal are the primary aims of this procedure. The procedure involves a single day hospital stay. The patient can resume showering from the next day. However, continuous breast support is mandatory for three to four weeks. Although nipple sensation and lactation cannot always be guaranteed after the procedure, the newer techniques ensure restoration of the same.
Usually, in puberty, the breast tissue regresses in males. Persistence of the same leads to the presence of female-type breasts with a variable amount of fat and breast tissue. Liposuction with or without breast disc excision (through imperceptible scars) as a day-care surgery is the treatment of choice, depending on the clinical assessment of each patient. A pressure garment is mandatory for one to three weeks during the post-operative period, depending on the size of the gynaecomastia removed.
Reconstructive surgery is, in its broadest sense, is the use of surgery to restore the form and function of the body. Reconstructive surgery is also performed by plastic surgeons on trauma and cancer patients. The operation attempts to restore the anatomy or the function of the body parts. Reconstructive plastic surgeons use the concept of a reconstructive ladder to manage complex wounds. This ranges from very simple techniques such as primary closure and dressings to more complex skin grafts, tissue expansion, and free flaps.
The human hand is a unique organ that functions as the messenger for the brain. Apart from the prehensile functions, hands express emotions and perform gestures which speak more than a thousand words. For good hand function, sensation, stability, skin cover, mobility, and strength are essential. Restoration of the same in injury, birth defects, and tumour patients is imperative for the rehabilitation of a patient. Microsurgery has made it possible to replant severed limbs and digits as well as reconstruct composite and complex tissue deficit. Already, face and hand transplants, akin to kidney and liver transplant are being performed in several centres.
Micro vascular tissue transfer has become the gold standard of reconstruction of bony and soft tissue defects following advanced cancer resection in the head and neck region. Skin, bone, muscle flaps, or a combination of these is harvested with its blood vessels and transferred to the defects by micro vascular anastomosis. This helps customize the reconstruction according to the size and nature of the defects. It also hastens healing and allows the early institution of chemo radiation.
Immediate or delayed breast reconstruction in cancer and burn patients is now gaining popularity. The procedure involves tissue transfer from the lower abdomen or buttock by microvascular technique to reconstruct the breast mound in the first stage. Nipple and areola reconstruction follow after three months. The abdomen and buttock donor sites are closed with minimal morbidity. This restores a feeling of femininity in patients and reduces their dependence on external breast prosthesis.
The main indications are loss of tissue due to trauma, tumour, and infection. Chest and abdominal wall defects can be reconstructed with muscle or skin flaps from the adjoining areas, if available, or from other body parts by micro vascular tissue transfer.
Pressure sores are common in bed-ridden, critical patients. These are often associated with neurological conditions. They need to be debrided (surgical removal of dead skin and soft tissue) and reconstructed with adjoining skin or muscle flaps.
Reconstruction of the external genitalia for birth defects, injury, and malignancy by local and distant flaps is very gratifying. Genital rejuvenation surgery is also becoming popular with the growing demand.
While deep burn ulcers are resurfaced in the acute stage, post-burn deformities (scar contracture) of the face, neck, hands, breasts, and limbs require corrective reconstructive procedures both for function as well as aesthetics. This is particularly a problem in the lesser developed areas, where no reconstruction of the deep burn ulcers is performed in the acute stage.
In India, maternal malnutrition is the main cause of cleft lip and palate. Hence, it is usually the poorest in society who are born with these defects. Repair of clefts along with speech therapy, orthodontic care, and corrective mid-face surgery constitute comprehensive treatment for these unfortunate children.