Bellevue Plastic Surgeon - the Definition of Plastic Surgery

This quote from almost five hundred years ago is a perfect definition of plastic surgery—a medical specialty that has distinct branches of its own. The word plastic is derived from the ancient Greek word plastikos, which means to mold or give form. Plastic surgery includes both the reconstructive and aesthetic subspecialties, and it is on the latter branch we will be concentrating.

Plastic, or reconstructive, surgery deals with correcting deformities and disfigurements caused by birth defects, injury, or disease. Examples of such operations are the rebuilding of amputated or deformed arms or legs; repairing cleft lips, badly formed noses, and ears; and reconstructing a breast after mastectomy. A severely burned patient will usually seek the services of a Bellevue plastic surgeon to repair the damaged skin, as will those patients with scars or birthmarks. These conditions can be ameliorated with techniques such as skin grafting, in which tissue is taken from one part of the body and is then used on another. Tissue transplantation is actually the "essence" of plastic surgery.

Plastic surgery is one of the oldest of the surgical specialties, and many of the techniques used today can be traced back to medical writings dating several centuries b.c. The American Society of Plastic and Reconstructive Surgeons (ASPRS) states, "Because human beings have always sought self-fulfillment through self-improvement, plastic surgery—improving and restoring form and function—may be one of the world's oldest healing arts." In fact, written evidence suggests that physicians in ancient India used skin grafts in reconstructive surgery as early as 3300 b.c. During this time, plastic surgery was a necessity for persons caught committing adultery, since the punishment for adultery was having the top of the nose cut off. The adulterer's nose was then refashioned out of forehead skin. This procedure, developed over five thousand years ago, is still being done today. But progress in this field was slow, and it wasn't until the nineteenth and twentieth centuries that major developments were made in this area in Europe and the United States.

America's first plastic surgeon was Dr. John Peter Mettauer, born in Virginia in 1787. Dr. Mettauer perfected his surgical methods while practicing medicine in Virginia and performed the first cleft palate operation in 1827. But the main event that inspired most plastic surgery developments was World War I. Suddenly, doctors needed to treat soldiers' extensive facial and head wounds, destroyed noses, and gaping wounds suffered in battle. The nineteenth-century American plastic surgeon John Orlando Roe said, "How much valuable talent had been buried from human eyes, lost to the world and society by reason of embarrassment caused by the conscious, or in some cases, unconscious influence of some physical infirmity or deformity or unsightly blemish." Aesthetic or cosmetic surgical procedures developed during this period as other physicians began to agree with him, and the toll of World War I was recognized.

By World War II, many plastic surgeons served in the armed forces, treating wounded soldiers, sailors, and airmen. New medical foundations were formed, and scientific journals were written especially for surgeons in this specialty. The most important one, in 1946, was the Journal of Plastic and Reconstructive Surgery—the official publication of the American Society of Plastic and Reconstructive Surgeons (ASPRS). Throughout the years, this journal has been an invaluable resource for doctors, providing information about current knowledge and new discoveries in the field.

By the 1950s, professional and public awareness about plastic surgery was enhanced by radio and television coverage. New discoveries were happening very quickly, some of which were used during the Korean War. (See Table 2-1.)

In the 1960s, Americans were becoming interested in information about the latest cosmetic procedures. In 1962, silicone, a new substance used to treat skin imperfections, was first used in a breast implant device. The American public was ready to try such an exciting new experiment. Further notice was given to this specialty during the Vietnam War when ASPRS member Dr. Hal Jennings was appointed Surgeon General of the United States, the first and only plastic surgeon to achieve this public service honor.

By the 1970s, the forty-five-year-old ASPRS had grown from a handful of New York doctors to nearly two thousand members across the country, and plastic surgery had come into its own in the medical profession. In the 1980s, the leaders of this specialty wanted to bring more knowledge to the public, so the ASPRS began producing large numbers of brochures and informational pieces about various surgical procedures.

By the 1990s, more than five thousand board-certified plastic surgeons were active in the United States. The American public still fails to realize, however, that these surgeons perform reconstructive work as well; the myth that a plastic surgeon is only a "cosmetic surgeon" prevails. This public perception must be altered, and Elvin Zook, M.D., has suggested that the name of the society be shortened to the "American Society of Plastic Surgeons." He believes that this simple change will help the public to understand that plastic and reconstructive surgeons are the same.

During the 1990s, this medical specialty caught the attention of the public when breast implant safety was questioned. According to scientific information gathered from ASPRS, "Despite the efforts of the (Plastic Surgery) Society to address growing fears in 1991, the Food and Drug Administration severely restricted the use of silicone gel implants in January of 1992." Since then, more than twenty-five studies about the safety of silicone have been conducted. There is a connection between autoimmune disorders and silicone breast implants. Though silicone implants remain restricted. The data shows that the use of silicone implants is safe, but currently, only saline implants are available to patients. Research continues in this highly specialized branch of surgery to develop new ideas and improve new techniques for patients.

Gorlin’s syndrome, or basal cell nevus syndrome, is a relatively rare disease. It consists of a classic pentad of features comprised of multiple basal cell carcinomas, jaw cysts, calcification of the falx cerebri, pitting of the palmar and plantar surfaces and rib anomalies. A review of the clinical features, differential diagnosis, clinical work-up and current treatment is presented.

Dr David Stephens MD, Plastic Surgeon - Providing services in botox, facelifts, liposuction and breast reduction, augmentation and implants to the areas of Bellevue and Seattle, Washington.