Plastic surgery is a procedure performed to change an external part of the body or its appearance. It may be performed to address problems that result from disease, trauma or congenital defects, or may be completed solely to improve the appearance of the body or skin.

Plastic surgery may be divided into two types. Reconstructive surgery addresses problems that are the result of birth defects, injury, disease or infection. Cosmetic surgery focuses on reshaping normal structures to improve the external appearance of the body. Most plastic surgeries are reconstructive, with many of them related to tumor removals. However, cosmetic surgeries are more often associated with the term “plastic surgery” and include body contouring procedures such as liposuction and facial surgeries. Most facial surgeries, such as facelifts and browlifts, are designed to remove wrinkles and fight the effects of aging on the skin.

In addition to these invasive surgeries, many plastic surgeons perform less invasive cosmetic procedures such as chemical peels and dermabrasion, which produce similar results to facelifts. Newer methods of laser surgery, which are less invasive than plastic surgery, are also performed for many conditions, including some formerly treated with plastic surgery. A number of these cosmetic and noninvasive procedures can also be performed by well trained dermatologists.

For all plastic surgeries, especially those for cosmetic reasons, patients should research the procedures and potential results. Some patients may have unrealistic expectations about the results of surgery and may be disappointed in the time and money devoted to a procedure. Patient self-knowledge and study of the potential outcomes increase the likelihood of a positive response to the surgery. Research should also include careful surgeon selection and understanding of the procedure and its recovery period.

Some plastic surgery procedures are relatively simple and may be performed in a clinic or physician’s office with just a local anesthetic. Others are major surgeries that involve hospitalization, general anesthesia and lengthy recovery times. All procedures can involve normal surgical outcomes such as pain, swelling, bruising and limitations on activity during recovery.

Plastic surgery refers to any surgical procedure performed to change or mold the skin or other body parts. The term plastic surgery is derived from the Greek word “plastikos,” which means to mold or give form. Many plastic surgeries involve repositioning or moving the skin and some underlying tissues to change the form or appearance of the face or other parts of the body.

Plastic surgery can generally be divided into two categories: cosmetic and reconstructive.

• Cosmetic surgery is performed on generally healthy body structures, reshaping them to improve appearance. Most cosmetic surgeries are elective procedures, meaning they are not considered necessary for health. Many changes occur in the body and on the skin as a natural result of aging. The skin sags, wrinkles and responds to changes in weight and exposure to the environment. Cosmetic surgeries that focus on wrinkles or related conditions of aging skin may improve appearance, but cannot stop the aging process.
  
  
• Reconstructive surgery usually involves improvement of function, but it may improve appearance as well. Some reconstructive surgeries include those to correct a cleft palate (a birth defect that occurs when the tissues of the roof of the mouth do not properly fuse during fetal development) or to reconstruct breasts after mastectomy to treat breast cancer. Other reconstructive procedures treat skin damaged by wounds such as deep lacerations or burns.

Both types of plastic surgery can be a part of treating a patient to achieve overall wellness. Diseases may be cured or controlled with medications, but may still produce body changes that require surgical repair. Traumatic injuries may require initial life-saving treatment and at a later stage involve plastic surgery to restore appearance.

Some plastic surgery procedures are relatively simple and may be performed in a clinic or physician’s office with just a local anesthetic. These include hair restoration procedures and blepharoplasties (eyelid lifts). Others are major surgeries that involve hospitalization, general anesthesia and lengthy recovery times. These may include some tumor removals, abdominoplasties (tummy tucks) or facial implants. Many procedures can be performed in either manner, depending on patient preference and cost.

According to the American Society of Plastic Surgeons, more than 10.2 million cosmetic surgery procedures were performed in 2005. In addition, more than 5.4 million reconstructive procedures were performed, the vast majority of them involving tumor removal.

Liposuction (the removal of body fat with surgical equipment) was the most commonly performed surgical procedure. Plastic surgeons also performed nearly 8.5 million non–surgical, minimally invasive procedures such as Botox injection and chemical peels.

Some cosmetic procedures now achieve similar results through the use of laser surgery, which uses intense light beams to treat conditions.

Many types of plastic surgery are cosmetic surgery, which reshapes normal structures to improve their appearance. Some of the most common cosmetic surgical procedures include:

• Liposuction. Procedure where a surgical tube is used to remove excess fat from various areas of the body.
  
  
• Rhinoplasty. Surgery to resize or change the shape of the nose. It may be merely cosmetic or may improve the function of the nose for breathing.
  
  
• Blepharoplasty. Surgery on the eyelids to correct sagging lids or remove fatty deposits, although it does not affect “crow’s feet” wrinkles on the temples. Blepharoplasty may be performed with other facial procedures, including a facelift or browlift.
  
  
• Facelift (rhytidectomy). Surgery to lessen wrinkles and minimize some signs of aging. A surgeon makes incisions near the hairline to pull back the skin, remove fat and tighten facial muscles. Facelifts are frequently performed with other facial surgeries.
  
  
• Abdominoplasty (tummy tuck). Procedure to tighten muscles and remove skin from the abdomen.
  
  
• browlift (forehead lift). Surgery to remove forehead lines and elevate the eyebrows. An incision is made near the hairline to lift the skin of the forehead and either remove tissue or move muscles that cause forehead furrows. The eyebrows may also be elevated on the forehead and any excess skin is trimmed. Forehead lifts are frequently performed with other procedures, including hair transplants or facelifts.
  
  

  

• Hair restoration. Surgery to fill balding areas with a patient’s own hair. Several procedures are used. They include reducing the size of the bald portion of the scalp or moving sections with hair from the back or sides of the head to the top. Some hair restorations surgeries may be permanent, although they may require additional grafts to blend the areas with hair.
  
  
• Otoplasty. Surgery to reshape or reduce the prominence of the ears. Cartilage inside the ear may be removed or reshaped to keep the ears closer to the head. The ears stop growing before adulthood, so this procedure may be safely performed on both children and adults. Most otoplasties are performed on children younger than 14.
  
  
• Facial implants. Materials such as silicone or soft tissues may be implanted to reshape the lips, chin or cheeks.

Cosmetic surgery may also be used to lift and tighten skin and muscles in the breasts, thighs, buttocks or upper arms.  Cosmetic surgery may be performed after extreme weight loss, such as the type that occurs following gastric bypass surgery. When a person loses weight, the skin usually retains some flexibility and shrinks to fit the smaller size. Patients who lose large amounts of weight may have excess skin that has lost its elasticity and is too large for the smaller body. Surgery can remove sections of this excess skin.  

In addition, plastic surgeons and well trained dermatologists perform numerous cosmetic procedures that may be much less invasive than traditional surgery and in some cases, have replaced traditional surgical procedures. Some of these procedures involve the use of laser surgery, where an intense beam of light is used to treat skin conditions. Some of the common less invasive cosmetic surgery procedures include:

• Botox injections. Type of botulinum toxin injected into facial muscles to reduce lines. It is most often used on the forehead area, around the eyes and between the eyebrows.
  
  
• Facial skin rejuvenation. General term for chemical and laser therapies that focus on removing wrinkles and lines on the face. It is also used to treat pigmented areas.
  
  
• Chemical peels. Use of various chemical applications to refresh the skin and remove pigmented lesions.
  
  
• Dermabrasion. Surgical use of a high-speed brush to remove facial scars from acne or other disorders.

Reconstructive plastic surgery can change the shape, appearance and function of various body parts. Most reconstructive plastic surgeries involve removal of tumors in areas such as the breasts and eventual reconstruction of the breast. Reconstructive surgery on the hand can correct webbing of the fingers.

Other common reconstructive surgical procedures include:

• Wound or laceration repair. Treatment of cuts or open wounds. Large lacerations can affect all layers of the skin and underlying tissue. Inadequate care or repair may leave the body susceptible to infection or re-injury. Many lacerations can be repaired with stitches but the repair may leave a scar. In more serious cases, inner layers of tissue or muscle may require stitches before the wound is closed on the surface.  Skin that is too damaged to stitch together may require a skin graft.
  
  
• Scar revision. Surgical procedures to minimize the appearance of scars. Scars may be the result of previous injuries that collect extra collagen and form keloids or hypertrophic scars. Other scars may form as contractures, where injured skin puckered as it healed. Some scars can be minimized by surgery to align them with naturally occurring skin tension lines. Others respond to nonsurgical techniques such as dermabrasion or laser resurfacing. In severe cases where large areas of skin are scarred, skin grafts may be needed.
  
  
• Skin grafts. Sections of healthy skin are transplanted from one area of the body to another, frequently to treat serious burns. Healthy skin is selected from an inconspicuous area, such as the buttocks or thighs, and moved to the damaged area. A split-thickness graft takes the top layer of skin (epidermis) and part of the middle layer (dermis). A split-thickness graft survives in the new location well, but may not have normal skin pigmentation or hair growth. A full-thickness graft takes both epidermis and dermis and part of the subcutaneous layer of skin. It may look more like normal skin and may be better for more visible areas. Full-thickness grafts require areas with many blood vessels to nourish the grafted skin.
  
  Surgeons have two other options when considering skin grafts. Skin flap surgery moves a section of skin, but maintains all or part of its original blood vessels, either permanently or until the skin attaches to blood vessels in the new area. Another related option is tissue expanders. A surgeon inserts a balloon-like device under the skin and over a period of time fills it with saline. This causes a bulge and forces skin in this area to grow. When the new skin area is large enough, the balloon is removed and the new excess skin can be used as either a graft or flap for an injured area.

Plastic surgery is an area of medicine where part of a successful outcome can be attributed to the patient’s research before the procedure. For purely cosmetic procedures, patients should consider their reasons for the surgery and expectations of results. Most surgeries will improve a patient’s appearance, but the appearance may not meet expectations or be a permanent solution. Reconstructive procedures can improve the appearance of the skin, but may not make an area look “like new.” Patients may have unrealistic ideas about the change and how it will improve other aspects of their lives.

Research into the growing number of plastic surgery procedures may also help a patient. Some newer, less invasive procedures provide results similar to invasive surgery. For example, some facial skin rejuvenation techniques may remove enough wrinkles to please a patient, rather than a surgical facelift. Many newer laser surgery techniques provide satisfactory results for treatment of some scars and birthmarks. Patients can educate themselves through discussions with the surgeon about available techniques, their expected results and potential complications.

The choice of a plastic surgeon is especially important. Patients should research a surgeon’s qualifications and history of performing the desired procedure. Physicians and surgeons may indicate that they are “board certified.” Most medical specialties have certifying boards that qualify physicians based on their education, years of residency and practice, oral and written examinations and procedures completed in a given field. Patients should identify which medical board has certified a surgeon and what criteria that board uses for certification.

Many surgeons provide visual examples, such as photographs or videos, of their work. Patients should ask to view these items to be sure they are satisfied with the results of the surgery.

Although it is impossible for physicians to predict the exact outcome of a plastic surgery procedure, they can estimate the results by evaluating certain factors. These variables include the patient’s age, skin type, general health, genetic background and the nature of their condition.

Some physicians use computer-imaging technology to show patients an estimate of their post-operative appearance. These machines enable surgeons to alter actual photographs of a patient to generate an image of the projected outcome. Patients should understand that results cannot be guaranteed, especially since a computer cannot account for a patient’s skin elasticity, bone structure, blood supply and healing ability.

After selecting a surgeon and scheduling a procedure, a patient should follow all pre-operative instructions from the surgeon. Depending on the complexity of the surgery, they may involve changes to diet, drinking, smoking and use of medications. The physician or nurse will obtain a medical history of the patient, which should include medications or supplements that the patient is currently taking, prior or existing medical conditions, as well as any allergies or reactions to medications or substances (such as anesthesia).

Plastic surgery procedures vary greatly in complexity. Some procedures may be performed in a physician’s office, clinic or hospital on an outpatient basis. Many procedures may use only a local anesthetic, which numbs just a specific area of the body. In these cases, the patient remains conscious, although they may receive a sedative to keep them calm during the surgery. Other times the surgeon uses a general anesthetic so the patient is unconscious for the surgery. The length of time required for the actual surgery depends on the type of procedure.

For most procedures, the surgeon makes one or more incisions and moves the skin and modifies or removes tissue, often fat. Implants are positioned under the skin where desired. Incisions are made in less conspicuous areas, especially for facial surgeries. For facelifts, incisions may be made above the hairline and behind the ears. For some nose surgeries (rhinoplasties), the incision may be made inside the nose. Some surgeries involve multiple areas, such as moving skin with hair from the back of the head to the top. Skin graft surgeries may involve removing skin from a donor site and moving it to the repair site. Surgeons carefully suture the incisions to minimize scarring and follow natural lines of the skin when possible.

After surgery, patients will have a recovery period, which may involve swelling, bruising, pain, itching and numbness. The length of recovery time varies by procedure and by patient. Plastic surgery procedures have many of the same postoperative restrictions as other surgeries, which may limit a patient’s diet, and ability to drive, lift objects or walk stairs. The amount of missed work or school can range anywhere from one day to over a month. Some facial surgery patients may need to limit their sun exposure for several months.

The benefits of plastic surgery include improved function for reconstructive procedures and better appearance (and, consequently, increased self-confidence) for cosmetic surgery. Both types of surgery have the same risks inherent with all surgery. These include life-threatening complications such as blood clots and infection. Individuals with certain conditions (e.g., cardiovascular disease, lung disease, obesity) are at increased risk for blood clots, as well as surgery-related stroke and heart attack.

Pain, scarring and lengthy recovery times are also common with any surgery. The level of pain experienced by the patient will depend on the procedure performed and the individual's personal tolerance for pain. Procedures performed on the face are typically less painful, while procedures involving elevation or tightening of the muscles (e.g., abdominoplasty) are often associated with a higher degree of pain during recovery. Patients experiencing extreme pain, nausea or dizziness following a plastic surgery procedure should notify their physician.

Some patients may experience numbness from nerve damage near their incisions. In some cases, the numbness is permanent. Seroma (an accumulation of fluid beneath the wound), hematoma (a collection of blood beneath the wound) and substantial bleeding may also occur. Complications from plastic surgery may require additional surgery or other procedures (e.g., blood transfusion) to treat the problem.

Skin graft patients face risks of infection at the graft site and the possibility that multiple surgeries may be needed to replace all areas of injured skin. Some skin grafts may not connect well to the blood supply at the new site and must be repeated. In addition, skin pigmentation may not match in grafted areas and may appear unnatural.

Because patients choose cosmetic surgery to improve their appearance, this type of procedure has the risk of falling short of expectations, in addition to a genuinely poor surgical outcome. For instance, surgery on dual body parts (e.g., ears, nostrils) may not produce symmetrical results.

In addition, the results of some procedures (e.g., facelifts) may only be temporary. Wrinkles may be removed but the aging process will eventually cause them to reappear. Patients should consider all these risks and their expectations when deciding on plastic surgery, and they should discuss their expectations and goals in detail with their physician.

Patients can lower their risk for plastic surgery-related complications by seeking out a qualified and experienced surgeon and following the physician's instructions for self-care before and after the procedure.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following plastic surgery-related questions:

1. What type of procedure will best suit my needs?
   
   
2. How many times have you performed this surgery and with what results?
   
   
3. What board has certified you?
   
   
4. In what facilities (e.g., clinics, hospitals) do you have privileges to perform surgery?
   
   
5. Do you have photographs or videos of your work?
   
   
6. What results can I expect from this procedure and how long will they last?
   
   
7. Can the procedure be performed on an outpatient basis?
   
   
8. What risks are associated with the procedure?
   
   
9. What will my recovery be like?
   
   
10. Will I need to make any lifestyle changes after the procedure?