Plastic Surgery: Superficial or Necessary?

Plastic surgery is a very necessary form of surgery. It is needed by millions of Americans every year, not only to improve life, but in some cases, to save it. There are two types of plastic surgery: cosmetic and reconstructive. Cosmetic surgery consists of certain procedures used to “improve” a person’s natural features, or give a more youthful appearance, while reconstructive surgery is used to restore a person’s natural form after an appearance-altering event, such as disease, infection, cancer, trauma, congenital abnormalities (birth defects), and burns.

Sometimes, however, the difference is not so black and white. A woman may feel she needs breast implants to look more attractive, while another may need breast reconstruction after an appearance-altering event, such as a mastectomy. The difference between these two, although they require the same procedure, is obvious. The first would be deemed “cosmetic” and the latter, “reconstructive. ” “The term ‘plastic surgery’ has nothing to do with plastic, as you might imagine it would, because plastic surgery predates plastic.

It comes form the Greek word plastique, which means ‘to shape or form’” (Larson Par. 3). Some other reconstructive surgeries commonly performed include operations to correct craniofacial abnormalities, mandibular and palatal reconstruction, and the correction of sleep apnea, burns, combat injuries and trauma. Besides major reconstructive surgery to repair physical defects, many standard cosmetic procedures are employed by plastic surgeons to help improve a patient’s self-esteem and self-image. Craniofacial abnormalities make up a fairly large percentage of reconstructive procedures performed each year.

Craniofacial abnormalities include physical deformities such as hemifacial microsomia (HFM), mandibulofacial dysostosis, Pierre Robin syndrome, Nager syndrome, and various other, rarer head-related defects. Nearly all of these syndromes and deformities are birth defects, some being related to genetics and others completely random. It is a plastic surgeon’s job to help remove the deformity so that the child may go about leading as normal a life as possible. Children with physical deformities or birth defects are statistically shown to be more likely to develop depression later in life (American Society of Plastic Surgeons).

This could be due to constant ridicule and harassment from their peers about something that the child has no control of whatsoever. This is an example of how plastic surgery can be used to better peoples’ lives. Reconstructive breast surgery is another procedure that is performed by plastic surgeons. Breast reconstruction is an option available to women who have undergone a mastectomy. A mastectomy is the removal of one or both breasts due to breast cancer. After a mastectomy is performed, a woman can choose whether to undergo reconstructive breast surgery.

Breast reconstruction is used to reconstruct a woman’s breast so that it looks very close to the same as it did before the mastectomy was performed. It can help to boost a woman’s self-esteem and return her natural appearance. Reconstructive breast surgery is usually done at the same time as a mastectomy, unless the patient had previously undergone radiation therapy. In these cases, the tissue would need to heal before breast reconstruction is performed (Spear, Scott L. ). Reduction mammaplasty, or breast reduction, is a common procedure undergone by women who have a physical problem due to the excessive weight and stress on their chest.

The physical problems that can be caused by having too large of breasts can include constant back and neck pain. A plastic surgeon will remove excessive fat, glandular, and skin tissue from the breast region, resulting in much lighter breasts, usually correcting any physical problems that a woman previously had. This form of plastic surgery is deemed necessary and is even covered by insurance companies because it helps to improve a woman’s life and health. Mandibular reconstruction surgeries are procedures that can be necessary for any number of reasons.

One of the leading and foremost reasons for undergoing mandibular reconstruction is carcinoma, or cancer, of the head and neck. Head and neck cancers can be caused from many things, although the leading cause is tobacco use. When a malignant tumor develops anywhere in the mandibular region (i. e. the area where the chin, jaw, neck, and mouth are located), a procedure to remove the tumor must be taken, if the patient has any hope of living. Usually, after the tumor is removed, a large portion of skin and bone is missing.

Plastic surgeons will attempt to reconstruct this and leave the patient with a normal appearance: “The goals of mandibular reconstruction include restoration of deglutition, speech, airway support and oral sphincter competence. In addition, reconstruction must provide adequate strength to support masticatory force and future dental implants. Reconstruction may be primary, being performed at the time of resection of the tumor, or secondary, being performed as a second procedure after the time of resection” (Danielson-Cohen, Wenig Par. 5). This quote shows how great of an impact mandibular reconstruction can have on patients who have suffered from diseases such as cancer.

Without mandibular reconstruction, a patient who had undergone a procedure to have neck or throat cancer removed would appear physically deformed. The patient would also be unable to speak, eat, and breathe properly, which could greatly affect his or her life. Palatal reconstruction is used to repair cleft lips and palates. A cleft lip, or harelip, is a birth defect in which the child is born with a gap in the upper lip, usually extending from the lip to the bottom of the nose. This can cause many problems, such as not being able to eat or speak correctly, not to mention the ridicule a child may have to endure by his or her peers.

A cleft palate is similar, but instead of a separation in the upper lip, it is located in the roof of the mouth. It is essential that a child with a cleft palate have it repaired. Many problems can come from not correcting a cleft palate, such as infections, not being able to speak, eat, and even having a higher risk for ear infections. A great amount of research has gone into the psychological development of children with cleft lips and palates, resulting in the knowledge that if left uncorrected, a child’s self-esteem, social skills, health, and behavior can be affected (Danielson-Cohen, Angelique, MD, Wenig, Barry L., MD).

Without plastic surgery, a child with a randomly occurring disorder may not be able to lead as full a life as a child born with no birth defect. Sleep apnea is another serious condition that can be permanently corrected with the use of plastic surgery. Sleep apnea is the intermittent stopping of breathing during sleep. This can occur anywhere from twenty to hundreds of times per night, depending on the severity. Patients suffering from sleep apnea may have symptoms of daytime drowsiness, insomnia, constant headache and body pain, resulting in leading a normal life.

A temporary solution to sleep apnea is a device called a CPAP, or Continuous Positive Airway Pressure machine. It consists of a small machine that forces the patient’s airways to remain open but does not actually force them to breathe. It has an attached mask that the patient wears during their entire time sleeping (Mayo Clinic Staff). An alternative to this, however, is a surgical procedure performed by skilled plastic surgeons. The plastic surgeon will enlarge the airway by removing excess tissue in the nasal passages, shortening the tongue and pulling it forward to remove any possible obstruction.

If necessary, a plastic surgeon may also move the upper and lower jaws forward to help enlarge the airway. It is believed that nearly 18 million people in the U. S. suffer from sleep apnea and that 90% may remain undiagnosed. Without the use of plastic surgery, a patient suffering from sleep apnea may have to wear a large and uncomfortable mask every night to simply fall asleep. People affected by serious burns may sometimes need plastic surgery to simply survive.

Many third-degree burns caused by anything from an explosive car accident to a firework-related mishap can cause life-threatening problems, unless the damaged tissue is removed and replaced. The removal of the dead skin is known as debriding and is a procedure that must be undergone before reconstructive surgery. Although some smaller burns, or burns in less conspicuous places, may be repaired by a general surgeon, a plastic surgeon is needed to repair any medium to large-sized burns, or any in noticeable places, such as the arms, legs, or head (Edlich, Richard F., MD, PhD).

There are several different ways the burned skin may be reconstructed, including skin grafts and tissue expansion. Tissue expansion is a medical procedure that allows a patient’s body to “grow” new skin by inserting a balloon shaped instrument that stretches nearby skin until it is large enough to be stitched over the area it is needed. Without a plastic surgeon, these procedures would be impossible. The grafting of skin is a surgical procedure primarily employed by plastic surgeons.

When a surgeon is applying a skin graft, he first selects an appropriate skin site to take skin from, called the donor site. He or she will then sew it onto the area where the skin is needed by using a special type of microsurgery to reconnect any muscles or nerves that may have been severed. Skin grafts are used to hide burns and scars and for very large wounds and other situations where stitches would not be appropriate. If a patient has sustained a serious burn in which the skin has died, either a skin graft would have to be used, or the arm would have to be amputated.

If a patient were to suffer a very large wound, a skin graft would have to be used in place of stitches, especially if the wound is not following a straight line, such as a knife wound. There are several different techniques used to graft skin that a plastic surgeon can use depending on the transplant area and type of injury. These include autografts (skin is transplanted from one place on the body to another), allografts (skin is transplanted from one patient to another), and xenografts (tissue transplanted from another species). In addition, an artificial skin has been approved by the FDA for use.

It is called Integra Dermal Regeneration Template and is composed of a layer of silicone to act as an epidermis and a porous matrix that acts as the body’s dermis. As the body’s own skin begins to grow back, the porous matrix biodegrades, and after the process is finished, the silicone outer layer is removed (University of Virginia). Without skin grafting techniques such as these, patients with serious burns or other accidents that result in large scarring would have to live with the scar for the remainder of their lives, a constant reminder of their tragic accident.

Plastic surgeons also serve an essential role in combat wounds, especially seen recently in Iraq. “As plastic surgeons, we use our general surgery training to help treat initial trauma in the field to save the patient’s life or limb. From there, they are transferred to Germany to help them stabilize, clear the infection and allow the wound to heal a bit. Back in the United States, however, we are using our plastic surgery training to reconstruct soldiers’ injuries, close the wounds and help them feel whole again” (Friedman Par.2).

Currently, in Iraq, plastic surgeons work with other types of surgeons in military hospitals to help repair the immediate needs of soldiers injured in combat. The immediate attention of war-related injuries is so important that plastic surgeons rarely actually perform plastic surgery in the field. They assist other surgeons and try to repair wounds as best aesthetically as possible. If more drastic plastic surgery is needed, the soldiers are flown back home to receive further operations.

Roadside bombs are one of the main reasons that plastic surgeons are so necessary to the soldiers in Iraq. Plastic surgeons handle microsurgery, which involves the repair of damaged or severed nerves, muscles, tendons, and limbs (Mousseau, Jessica). Without plastic surgeons in Iraq, many soldiers who have lost limbs would not be able to have them reattached. Plastic surgery also deals greatly with self-esteem issues and psychological problems, such as depression: Each of us has a ‘self-image,’ a perception of how we believe we look to others.

People who are happy with their self-image are more likely to be self-confident, effective in work and social situations, and comfortable in their relationships. Those who are dissatisfied tend to be self-conscious, inhibited, and less effective in activities. Plastic surgery, whether cosmetic or reconstructive, encourages and promotes a strong, positive self-image. Even a small change on the outside can create an extraordinary change on the inside, allowing an individual’s self-confidence to flourish. (American Society of Plastic Surgeons Par.1-2).

This quote shows how great an impact an individual’s self-image has on his or her mental health and well-being. Someone with a poor self-image may not lead as full a life because he or she may take fewer risks due to not being as confident as someone with a higher self-image is. Plastic surgery, whether cosmetic or reconstructive, can help to boost one’s self-image, helping him or her to have a better life. Plastic surgery has been shown repeatedly to be an essential form of surgery because not only does it only help people physically, but it also helps people mentally and emotionally.

Reconstructive plastic surgery is used to restore a person to his or her natural, physical appearance. It is unnecessary to live with anything less than this, physically speaking. Thus, reconstructive surgery is deemed “necessary. ” Cosmetic surgery may be considered necessary as well, because it has been shown to have a positive effect on one’s self-esteem. The unfortunate occurrences that one may encounter in life make plastic surgery not only a necessary part of medicine but of life as well. American Society of Plastic Surgeons. (2007). Cleft Lip and Palate.

ASPS . 17 November, 2007 from . American Society of Plastic Surgeons. “Psychological Aspects: Your Self-Image…” . Danielson-Cohen, Angelique, MD, Wenig, Barry L. , MD. “Mandibular and Palatal…” . Edlich, Richard F. , MD, PhD. (2007). Burns, Thermal. eMedicine. 14 November, 2007 from . Fischer, Joannie. “Facing the Future (Craniofacial Surgery Patients). ” U. S. News & World Report February 10 (2003): 70. Friedman, Andrew, LTC, MD. “Plastic Surgeons Play Pivotal Role…” . Jatoi, Ismail and Manfred Kaufmann, Jean Y. Petit. Atlas of Breast Surgery.

New York: Springer, December 1999. Larson, David L. , MD. “Plastic Surgery Has Many Faces”. . Mayo Clinic Staff. (2006). Sleep Apnea. MayoClinic. com . 12 November, 2007 from . Mousseau, Jessica. (2006). Positive Effects of War Time Plastic Surgery. AssociatedContent . 11 November, 2007 from . Spear, Scott L. Surgery of the Breast: Principles and Art. Philadelphia: Lippincott Williams & Wilkins, December 2005 University of Virginia. “Plastic Surgery Techniques. ” University of Virginia Health System. 2004. Rector and Visitors. 12 November, 2007. .

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