Plastic Surgery : More Than Just Beauty & Vanity
Updated: Apr 1
When people find out that I'm a plastic surgeon, the first question they ask is usually, "What kind of plastic surgery do you do?" I'm always surprised by how many people don't know that plastic surgery encompasses a wide range of procedures beyond just cosmetic surgery. In fact, plastic surgery is the specialty that deals with the repair, reconstruction, or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk, external genitalia, or cosmetic enhancement of these areas of the body.
I am certain that many people, even some professionals I met, do not know the vast scope that is covered under plastic surgery. Let me break it down to you here.
PLASTIC SURGERY
As the above shown photo, plastic surgery is the main speciality that covers both areas of interests (reconstructive and aesthetic surgery). Plastic surgery is defined as “ the repair, reconstruction, or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk, external genitalia or cosmetic enhancement of these areas of the body.”
RECONSTRUCTIVE SURGERY
This area is focused in restoring abnormal form and function of the body as well as enhancement procedures to improve body function. The keyword is “function”. The body’s abnormal form and function could be due to trauma or illness, or congenital defect.
AESTHETIC / COSMETIC SURGERY
This area, despite being the most famous for being related to the term “plastic surgery”, actually constitutes probably 20% from the whole field of plastic surgery. The term is defined as “a procedure that is entirely focused on enhancing a patient’s appearance”. Improving symmetry, proportion and aesthetic appeal are the primary goals.
Sometimes, a procedure may serve both reconstructive and cosmetic surgery. For example, a blepharoplasty (eyelid surgery) - when its done for a person with limited vision due to excessive eyelid ptosis, it is considered as a reconstructive procedure as we want to improve his/her eyesights. When it's done for a person who has no functional problem, but rather to look more beautiful, it is considered as aesthetic. Same procedure, different purpose.
What does a true plastic, reconstructive & aesthetic surgeon cover? I mention "true", as some plastic / cosmetic surgeon out there in some part of the world calls themselves that even after just going for plastic surgery courses for few months (sometimes weeks), and presented themselves as plastic surgeon as compared to plastic surgeons that underwent rigorous years of training of plastic surgery as a whole.
Below is the syllabus of my postgraduate program in plastic surgery in Malaysia. Take a look (click each of them to expand into further details).
PLASTIC, RECONSTRUCTIVE & AESTHETIC SURGERY COVERS:
(Click the arrows " >" to expand)
1. BASIC PRINCIPLES AND FUNDAMENTAL TECHNIQUES OF PLASTIC SURGERY
1.1 Biology of Tissue Injury and Repair
1.2 Normal and Pathological Wound Healing
1.3 Basic Principles of Surgical Techniques
1.4 Skin Grafting
1.5 Dermal Grafting
1.6 Basic Principles of Skin Flaps
1.7 Types of Flaps and Their Design
1.8 Composite Grafts
1.9 Principles of Bone Transplantation
1.10 Basic Principles of Tendon Grafting
1.11 Principles of Cartilage Grafting
1.12 Basic Principles of Nerve Grafting
1.13 Skin Expansion
1.14 Biomaterials in Plastic Surgery
1.15 Scar Revision
1.16 Psychological Understanding and Management of the Plastic surgery patient.
1.17 Basic Medico-legal Principles In Plastic Surgery
1.18 Commonly used Drugs and Their Interactions
2. SKIN AND SOFT TISSUES
2.1 Cutaneous Carcinoma
2.2 Benign Skin Tumours
2.3 Melanoma
2.4 Soft Tissue Sarcoma
2.5 Vascular Anomalies
2.6 Laser therapy
3. HEAD AND NECK CANCER
3.1 Benign and Malignant Primary Salivary Gland Tumours
3.2 Benign and Malignant Tumours of the Oral Cavities
3.3 Solid and Cystic Tumours of the Jaws
3.4 Craniofacial Tumours
3.5 Basic Principles of Reconstruction of the Lip, Oral Commissure and Cheek
3.6 Reconstruction of the Nose
3.7 Reconstruction of Eyelid Deformities
3.8 Cervical Masses
3.9 Neck Dissection
3.10 Head and Neck Reconstruction
3.11 Chemotherapy
3.12 Basic Principle of Radiation Therapy (including its complications)
4. FACIAL AESTHETIC SURGERY (Including Rhinoplasty and Blepharoplasty)
4.1 Basic Principles of Aesthetic Surgery of the Face, Neck and Brow
4.2 Blepharoplasties
4.3 Rhytidectomy
4.4 Ancillary Procedures for Facial Rejuvenation
4.5 Complications and Its Management
4.6 Dermabrasion, Chemical Peel and Collagen Injection
4.7 Rhinoplasty
4.8 Aesthetic Surgery of the Ears
4.9 Hair Transplantation
4.10 Laser surgery
5. HAND SURGERY (Trauma/Peripheral Nerve/ Congenital/ Dupuytren/ Rheumatoid)
5.1 Embryology of the Upper Extremity
5.2 Congenital Defect of the Hand
5.3 Management of Injuries to Upper Extremity (Hands/Digits)
5.4 Tendons Injuries of the Hand
5.5 Peripheral Nerve Injuries
5.6 Rheumatoid Hand
5.7 Dupuytren
5.8 Tumour of the Hand
5.9 Thumb Reconstruction
5.10 Replantation
6. CRANIO FACIAL/FACIAL TRAUMA/FACIAL PALSY
6.1 Repair of Traumatic Injuries Involving Skin and Soft Tissue
6.2 Basic Principles and Management of Facial Injuries
6.3 Management of Midfacial Fractures
6.4 Management of Fractures of the Mandible
6.5 Ear Reconstruction
6.6 Reanimation of Paralysed Face
7. CLEFT LIP AND PALATE AND CRANIOFACIAL ANOMALIES
7.1 Embryology of the Head and Neck
7.2 The Unilateral Cleft Lip
7.3 Bilateral Cleft Lip
7.4 Cleft Palate
7.5 Secondary Deformities of Cleft Lip and Palate
7.6 Orthodontics and Cephalometrics
7.7 Principles of Speech Pathology in the Cleft Lip and Palate Child
7.8 The Cleft Palate Team – Its Organization and Function
7.9 An Outline of Craniofacial Anomalies and Principles of Their Correction
7.10 Facial Osteotomies
8. TRUNK /LIMB TRAUMA
8.1 Pressure Sore
8.2 Lymphedema of the Extremities
8.3 Principles of the Extremities
8.4 Principles and Management of Leg Ulcers
8.5 Basic Principles Involving the Management if Tissue Loss in the Lower Extremity Including Muscle and Musculocutaneous Flaps
9. BREAST AND BODY CONTOURING
9.1 Congenital and Development Breast Anomalies
9.2 Augmentation Mammaplasty
9.3 Basic Principles in the Management of Complications Following Augmentation Mammaplasty
9.4 Hypermastia , Ptosis
9.5 Management of Patients with High-Risk Diseases of the Breast
9.6 Breasts Reconstruction After Mastectomy
9.7 Gynecomastia
9.8 Total Body Contouring – the Abdomen and Hips, Buttocks, Thighs 9.9 Aspirative Lipoplasty
10. BURNS
10.1 Current Concepts and Controversies
10.2 Resuscitation
10.3 Early and Late Surgery for Burn
10.4 Burns Reconstruction
10.5 Reconstruction of Special Areas - Eyelid , Ear, Genitalia and Hand
10.6 Principles and Management of Injuries from Physical and Chemical Agents
11. GENITALIA
11.1 Embryology of Genitalia
11.2 Anomalies of the Male Genitalia
11.3 Congenital Deformities of the Female Genitalia
11.4 Penoscrotal Trauma and Reconstruction
11.5 Penoscrotal Lymphedema
12. MICROSURGERY
12.1 Basic Principles of Microsurgery
12.2 Cutaneous Free Flaps
12.3 Free Muscle and Musculocutaneous Flaps
12.4 Free Vascularized Bone Grafts and Osteocutaneous Flaps
12.5 The Use of Omentum and Jejunum in Head and Neck Reconstruction
12.6 Principles of Microneurosurgery
12.7 Replantation of Amputated Parts
12.8 Microsurgery Complications
After 4 years of plastic surgery training (on top of the surgical experience years required prior entering the program), some of us even took a step further and do one or more optional fellowships to pursue which area that interests us most, to gain deeper skills and experience in certain niche. For example, I did my plastic, reconstructive and microsurgery fellowship that focuses on post bariatric body contouring, facial palsy, lymphedema microsurgery and supermicrosurgery in Vienna, Austria. I also did a fellowship in breast plastic, reconstructive & microsurgery in Gent, Belgium. Continuous learning is essential in the medical field for us doctors to stay up to date with the latest knowledge, techniques and innovations all for our patient's best interest. On top of that, we also our knowledges and experiences with our colleagues around the world, to ensure the benefits expands and continues for everyone.
I hope you understand what plastic surgery is all about after reading this.