Surgeons reveal plastic surgery misconceptions

Consider the following medical scenario:

An aging man alarmed by the appearance of fissures of flesh on his forehead seeks medical attention. The surgeon performs a rhytidectomy, more commonly known a face lift. Incisions are made behind the hair line to remove excess facial skin, and then the facial skin on the forehead is pulled up like a drape. The result? A forehead free of wrinkles and the restoration of a youthful-looking face. Classic plastic surgery, one would say.

Now consider another scenario:

A child sustains a third degree burn on his left hand after being splashed by the boiling contents of a spilling pot of soup. The surgeon operates to remove an entire layer of burnt skin, removes a piece of healthy skin from the child’s leg and uses it to cover the burn site. The “skin patch” is held in place with tiny stitches or surgical staples, and the visible scar is minimal.

Skin surgery? Or perhaps transplant surgery? Not exactly. It’s also plastic surgery.

Confused? Here’s a third scenario:

A man notices a discrete, solid lump on his right leg, slightly wider than the tip of his finger. Over time, instead of going away, the lump grows bigger and bigger, to the size of a baseball. A tumor. The man then undergoes surgical intervention, which completely removes the tumor, but at the same time leaves a huge, gaping hole in his right leg. This huge hole is not only aesthetically unpleasant but also causes skeletal instability that gives the man a hard time standing.

To solve this problem, the surgeon brings in a flap of tissue along with skin, fat, muscle and even bone to reconstruct the defect. With biocompatible screws and metal plates, the surgeon fixes the bone in place. Then, using microsurgical techniques, the surgeon sews the transplanted nerves, blood vessels, muscle fibers and skin together with the rest of his leg. And yes, this is considered a plastic surgery procedure.

For many, it may be difficult to make the connection between all three scenarios. It is apparent that the first is a plastic surgery — but the rest?

The underlying cause of this misunderstanding is the incorrect belief that the term “plastic surgery” simply means “cosmetic surgery.”

It is important to recognize that cosmetic surgery, which refers to procedures such as breast implants, facial lifts and other operations performed for aesthetic purposes, is merely a subset of plastic surgery.

In fact, cosmetic surgery accounts for “just five percent” of all the plastic surgeries performed, according Jaime Shores, a plastic surgeon at the Johns Hopkins Hospital.

In fact, most plastic surgery procedures performed are considered reconstructive surgery. Oftentimes, after a patient undergoes physically destructive traumatic injuries or surgical procedures, plastic surgeries are performed to restore not only the appearance but also the functionality of impaired body parts.

In one famous case, plastic and orthopedic surgeons trained in hand surgery from Johns Hopkins Hospital transplanted two donated arms onto a war veteran whose arms were amputated during the Iraqi War.

Aided by microscopes and adroit hands skilled in microsurgery, the surgeons connected the bones, linked the nerves, sewed together the blood vessels and finally closed the skin tissues to connect the donated arms to the stump of the patient. This entire surgery was performed within the Department of Plastic and Reconstructive Surgery.

Other sub-specialties in plastic surgery include hand and upper extremity surgery, craniofacial surgery (treatment of cleft lips or facial fractures), breast reconstruction, microsurgical reconstruction, pediatric plastic surgery, and the treatment of burns. All of these extend far beyond the scope of cosmetic surgery.

Or to put it simply, “We don’t just operate on things that sag,” quipped Dr. Shores.