Frequently Asked Questions
What is Plastic Surgery?
Plastic Surgery Defined: Plastic Surgery is defined by Merriam-Webster’s Dictionary as: “plastic surgery Function: noun: surgery concerned with the repair, restoration, or improvement of lost, injured, defective, or misshapen body parts.” Encyclopedia Britannica defined Plastic Surgery as: “to correct disfigurement, restore function, or improve appearance. Plastic Surgery may involve reshaping or moving tissues to fill a depression, cover a wound, or improve appearance. Cosmetic Surgery solely to improve appearance is not the main focus of plastic surgery. It is utilized after disfigurement by burns or tumor removal or for reconstructive work, and it may involve hiding incisions in skin folds or using buried sutures to hold wounds closed. Reconstructive plastic surgery corrects severe functional impairments, fixes physical abnormalities, and compensates for tissue lost to trauma or surgery.” Still others have slightly different definitions of Plastic Surgery: “Plastic surgery: The field of surgery concerned with reducing scarring or disfigurement that may occur as a result of accidents, birth defects, or treatment for diseases, such as melanoma. Many plastic surgeons also perform cosmetic surgery that is unrelated to medical conditions, such as rhinoplasty to change the shape of the nose.”
With all these different meanings to the words Plastic Surgery is there any wonder that there may be some confusion when we hear and use the term Plastic Surgery? Plastic Surgery is derived from the Greek word Plastikos which means to bend or mold. The term Plastic Surgery became popular during the World War II, the Korean War and Vietnam when Plastic Surgery was used to repair traumatic war injuries. Many of the Plastic Surgery Procedures, at that time, entailed the bending or molding of existing tissues (flaps) used to repair tissue defects from war injuries. So the term Plastic Surgery stayed with that particular type of surgical procedures. In subsequent decades, after those conflicts, the term Plastic Surgery began to take on additional meaning and include the surgical treatment on non-traumatic injuries and conditions. Plastic Surgery Procedures then expanded to also mean the repair of damaged tissues from birth defects, disease conditions, surgical defects to remove disease and tumors as well as Procedures to improve the appearance. It is amazing that the latter aspect of Plastic Surgery is perhaps the most common perception of Plastic Surgery today.
Plastic Surgery is often used by people in the media, medicine and lay people when speaking about Procedures that are performed on perfectly healthy individuals for the sole purpose of improving their appearance. We may think that Plastic Surgery is new, but in reality Plastic Surgery has been around since ancient times. People attempting to achieve beauty have left scattered details of their endeavors throughout recorded history. There is evidence that Ancient Egyptians practiced many beauty rituals including Plastic Surgery. They practiced Facelifts, Blepharoplasty and Rhinoplasties and may be considered the forefathers of modern-day Plastic Surgery Procedures. The ancient Greeks and Romans however are generally credited with discovering many of the ideal beauty standards (ideal angles and proportions) that remain in existence today. From this point, the history of Plastic Surgery becomes vague.
It is clear, that mankind has been driven to achieve beauty and has looked to Plastic Surgery as a means of achieving this goal. This desire to improve one’s looks through Plastic Surgery has never faltered, nor has the reverence with which beauty has been recognized. Reports as early as the 1800s indicate that Plastic Surgery Procedures were being performed on an almost routine manner. However these Plastic Surgery Procedures were not widely accepted and having Plastic Surgery was considered taboo. This negative attitude, towards Plastic Surgery, prevailed well into the 1900s when Plastic Surgery was being performed secretly. Plastic Surgery was something that reputable surgeons did not do and if you were caught performing Plastic Surgery Procedures for the frivolous nature of improving someone’s appearance, the surgeon risked being scorned and ridiculed by the surgical societies of the time. Still there were some that braved this new world of Plastic Surgery Procedures.
One such surgeon, Harold Delf Gillies (1882-1960) is credited with developing Plastic Surgery as a field of medicine. In 1918 he became the first physician to specialize in plastic surgery. Born in New Zealand, Gillies studied and stayed in England. At the beginning of World War II he was one of only 4 qualified Plastic Surgeons in England. Dr. Gillies once confessed, “Often while lifting a face I have a feeling of guilt that I am merely making money,” adding, “Yet, is it not justified if it brings even a little extra happiness to a soul who needs it?” Such was the prevailing attitude towards Plastic Surgery and Plastic Surgeons. It wasn’t until the 1950s that Plastic Surgery began to enjoy some of the popularity that we see today. Ever so slowly, Plastic Surgery became more of a medical discipline and more surgeons were being trained in the various aspects of Plastic Surgery and Plastic Surgery Procedures. Plastic Surgery came to it’s current day meaning of an all inclusive medical surgical specialty that includes: Reconstructive Plastic Surgery to repair congenital, traumatic or defects caused by disease states and the treatment of the disease; Cosmetic or Aesthetic Plastic Surgery to improve one’s appearance; Hand Surgery Microvascular.
Plastic Surgery Training: So that we do not get ahead of ourselves, I must digress before we go into the different types of Plastic Surgery training. Because there are different meanings to the term Plastic Surgery, we must identify what Plastic Surgery and Cosmetic Surgery groups are in existence today and look at their specific training in Plastic Surgery and Cosmetic Surgery. It turns out that there are three groups of MD’s that are involved in Plastic Surgery and Cosmetic Surgery. Some groups train Plastic and Cosmetic Surgeons that perform only the Aesthetic aspect of Plastic and Cosmetic Surgery and other groups training both reconstructive Plastic Surgeons as well as Plastic and Cosmetic Surgeons that do Aesthetic Plastic and Cosmetic Surgery. For the sake of clarity and to remain unbiased, I prefer to refer to the aesthetic aspect of Plastic and Cosmetic Surgery as just that…Plastic and Cosmetic Surgery. This allows all of the three surgical groups to lay equal claim to this area of Plastic and Cosmetic Surgery. Since all three groups specialize in Plastic and Cosmetic Surgery it is untrue that any one group can lay claim to some superiority in what we are calling Plastic and Cosmetic Surgery. Be wary of such claims.
The first group that specializes in what we refer to as Plastic and Cosmetic Surgery Procedures is the American Academy of Facial Plastic and Reconstructive Surgery. This is a group of Plastic and Cosmetic Surgeons that specialize in Plastic and Cosmetic Surgery of the face, head, neck and the associated structures lying therein. Their Plastic and Cosmetic Surgery Board is called the American Board of Facial Plastic and Reconstructive Surgery. The next organization is called the American Academy of Cosmetic Surgery with their Plastic and Cosmetic Surgery Board called the American Board of Cosmetic Surgery. This Plastic and Cosmetic Surgery group trains surgeons in the specialty of Plastic and Cosmetic Surgery of the entire body unlike the Facial Plastic and Cosmetic Surgery Group. The third group is called the American Society of Plastic Surgeons and trains specialists in Plastic and Cosmetic Surgery of the entire body as well as all facets of Plastic Surgery Procedures for reconstruction. These three groups represent the Plastic and Cosmetic Surgeons in the US and the rest of the world. Obviously, the organizations of Plastic and Cosmetic Surgeons in other countries use the name of the specific country but they are associated with the specific Plastic and Cosmetic Surgery group. For example, the European Society of Cosmetic Surgery is similar to the American Academy of Cosmetic Surgery. The specific Plastic Surgery training that a Plastic and Cosmetic Surgeon would undergo varies with each of these Plastic and Cosmetic Surgery organizations.
In general terms the training required to become a Plastic and Cosmetic Surgeon is as follows:
First the Plastic and Cosmetic Surgery training requires that medical school be completed for 4 years.
Second in the Plastic and Cosmetic Surgery training is Internship for 1 year following medical school.
Third in the Plastic and Cosmetic Surgery training is residency. Here the different programs that train surgeons in Plastic and Cosmetic Surgery use variations of years required and types of training to complete their programs in Plastic and Cosmetic Surgery. There are many Plastic and Cosmetic Surgery training programs and as such there is no way we can list the exact training requirements in all of these Plastic and Cosmetic Surgery programs however, what follows is an example of each of the training programs for the three Plastic and Cosmetic Surgery groups: The American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Cosmetic Surgery and the American Society of Plastic Surgery. We will look at each of these Plastic and Cosmetic Surgery training programs separately.
A. Facial Plastic and Reconstructive Surgery Training Programs in Plastic and Cosmetic Surgery: These programs are offered after surgeons have completed a 4 or 5 year residency program in Otolaryngology Head/Neck Surgery. The fellowships are 1 year in duration. Fellowships in Plastic and Cosmetic Surgery are taken after residency has been completed. Facial Plastic and Cosmetic Surgery therefore is 4 or 5 years residency and 1 year fellowship. The residency covers Facial Plastic and Cosmetic Surgery, accounting for 25% of the training on average. Facial Plastic, Cosmetic Surgery and Reconstructive Surgery is 100% of the 1 year Fellowship that follows. Upon completion of the residency, surgeons are allowed to join the American Academy of Facial Plastic and Reconstructive Surgery. To become board eligible and board certified by the American Board of Facial Plastic and Reconstructive Surgery, the 1 year fellowship in Facial Plastic and Cosmetic Surgery is required. Upon completion of training, surgeons have been trained in Facial Plastic, Cosmetic and Reconstructive Surgery Procedures.
B. Cosmetic Surgery Training Programs in Plastic and Cosmetic Surgery: Like the Facial Plastic programs, surgeons first complete various residencies in Otolaryngology Head/Neck Surgery (4-5 years), General Surgery (4-6 years), Dermatology (3-4 years), Opthalmology (3-4 years) and Facial Plastic Surgery (4-5 year residency and 1 year fellowship). Many different types of surgeons may train in these Plastic and Cosmetic Surgery Programs that are 1-2 years long. This Plastic and Cosmetic Surgery program trains surgeons in Plastic and Cosmetic Surgery Procedures of the Face and Body. Once the Cosmetic Surgery Program is completed, the surgeons are eligible to become board certified with the American Board of Cosmetic Surgery. Surgeons of different specialties may join the American Academy of Cosmetic Surgery but may not become board certified by the American Academy of Cosmetic Surgery until the 1-2 year fellowship in Cosmetic and Plastic Surgery of the Face and Body has been completed.
C. Plastic Surgery Training Programs of the American Society of Plastic Surgery: This Plastic and Cosmetic Surgery program trains surgeons that have completed: an internship of 1 year and then a Plastic Surgery residency of 5-6 years, a general surgery residency of 3-6 years with 2-3 years in an additional Plastic Surgery residency or Otolaryngology Head/Neck Surgery residency with 2-3 years Plastic Surgery Residency. Other combinations may exist as pre-requisites for Plastic Surgery residency. This Plastic and Cosmetic Surgery training program trains Plastic and Cosmetic Surgeons in Plastic and Cosmetic Surgery of the face and body as well as reconstructive Plastic Surgery Procedures. Upon completion of the Plastic and Cosmetic Surgery Residency, surgeons are eligible to join the American Society of Plastic Surgeons and are board eligible for the American Board of Plastic Surgery.
Many years of training in Plastic and Cosmetic Surgery Procedures go into each of the three Plastic and Cosmetic Surgery training programs and each training program may have slightly different requirements and focus on Plastic and Cosmetic Surgery Procedures. In addition each Plastic and Cosmetic Surgery organization and Plastic and Cosmetic Surgery Board will have slightly different criteria for membership. As a consumer seeking Plastic and Cosmetic Surgery Procedures it is wise to focus on the Plastic and Cosmetic Surgery experience of an individual surgeon over claims made by any one Plastic and Cosmetic Surgery organization over another Plastic and Cosmetic Surgery organization. The Plastic and Cosmetic Surgeon, as an individual, will be performing your Plastic and Cosmetic Surgery Procedureâ€¦not the Plastic and Cosmetic Surgery organization. Plastic and Cosmetic Surgery has become a highly competitive market and this sometimes motivates statements and claims that you as a consumer seeking Plastic and Cosmetic Surgery Procedures must have the knowledge to evaluate. Hopefully, the explanation of the different Plastic and Cosmetic Surgery organizations and their training in Plastic and Cosmetic Surgery Procedures will assist you in this evaluation. Dr. Francis Palmer, a world-renowned Beverly Hills Plastic and Cosmetic Surgeon has written a method for “Choosing your Plastic and Cosmetic Surgeon“.
What is Facial Plastic Surgery?
Facial plastic surgery represents a group of surgical procedures that are used to make the face appear more youthful and attractive.These procedures include:
- Blepharoplasty (Eyelifts)
- Rhinoplasty (Nasal Refinement)
- Facial Liposuction
- Facial Sculpting Implants (Cheek and Chin)
- Skin Rejuvenation (Laser/Chemical Peels)
- Lip Augmentation
- Line/Wrinkle Elimination (Botox)
- Line/Wrinkle Elimination (Collagen)
- Otoplasty (Ear Reshaping)
This also refers to a group of surgeons that specialize in these procedures. They are Board Certified by The American Board of Facial Plastic and Reconstructive Surgery and represented by The American Academy of Facial Plastic and Reconstructive Surgery.
“ABOUT THE ABFPRS”
To be eligible for certification, a surgeon must:
american board Have completed a residency program approved by the Accreditation Council for Graduate Medical Education or the Royal College of Physicians and Surgeons of Canada in one of the two medical specialties containing identifiable training in facial plastic and reconstructive surgery: otolaryngology/head-and-neck surgery or plastic surgery.
Have earned prior certification by the American Board of Otolaryngology, the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada in otolaryngology/head-and-neck surgery or plastic surgery.
Have been in practice for a minimum of two years. Have 100 operative reports accepted by a peer-review committee. Successfully pass an 8-hour written and oral examination.
Hold the appropriate licensure and adhere to the ABFPRS Code of Ethics.
The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) represents 2,800 facial plastic and reconstructive surgeons throughout the world. The AAFPRS is a National Medical Specialty Society of the American Medical Association (AMA), and holds an official seat in both the AMA House of Delegates and the American College of Surgeons board of governors. The AAFPRS was founded in 1964 as an autonomous professional society representing the specialty of facial plastic surgery. The mission of the AAFPRS is: ” To promote the highest quality facial plastic surgery through education, dissemination of professional information, and the establishment of professional standards;”· To achieve understanding and recognition of the specialty of facial plastic surgery by the medical profession, hospitals, and other medical care entities, legislative and regulatory bodies, and the public at large. “· To define facial plastic surgery as a specialty that requires intensive training and competence, embodies high ethical standards, artistic ideals, commitment to humanitarian service, and a desire to enhance the quality of human life. “· To serve as the public’s information source on facial plastic surgery “· To assist members in the practice of facial plastic and reconstructive surgery, guiding them in the delivery of high quality, cost-effective medicine.
Why Should I consider Plastic Surgery?
This may be a 30 year-old woman with excess fat around her eyes, a 17 year old boy with a large nose or a 55 year old woman with all the signs of facial aging. There is no easy or accurate formula that can be applied to every individual. Each person must be analyzed and evaluated separately and what’s right for one may not be acceptable for another. The following is a brief excerpt from my upcoming book on beauty and plastic surgery. Please enjoy.
To Pursue or not to Pursue
The age-old debate surrounding whether or not one should be content with the beauty that God gave them continues today. This debate is perhaps as old as man himself and has been a question left unanswered for all of recorded time. For this reason alone, it should be apparent that there is no singularly acceptable answer for all individuals. There are those that believe we should leave ourselves alone-leave yourself the way that you were borne. They may believe that God obviously intended you to look that way so what right do you have to muck around with it. As harsh a stance as this may seem, some people truly feel this way. This of course is a valid argument, and those individuals are clearly not candidates for any type of aesthetic plastic surgery.
I have, several times throughout my career, had discussions with individuals who express these sentiments. It has been my general impression that most of these people were young with above average looks. I could not help but feel that perhaps their attitude would have been different had they been less blessed, or were they beginning to see their former beauty wane-lost to the ravages of time and gravity. But, that is best left for the psychologists and philosophers to debate.
Today plastic surgery enjoys an acceptance unparalleled throughout time. Last year in the United States alone approximately 3 million plastic surgical procedures were performed. And this is, most likely, a very conservative estimate. The most common procedures are listed in descending order of magnitude.
1.Rhinoplasty or nasal refinement. ( 500,00 )
2.Skin resurfacing ( peels ) using laser, chemicals, or dermabrasion. ( 475,000 )
3.Blepharoplasty or eyelift. ( 350,000 )
4.Liposuction or body sculpting. ( 300,000 )
5.Rhytidectomy or facelift. ( 200,000 )
6.Breast Augmentation/Reduction. ( 150,000 )
7.Hair Replacement ( 140,000 )
8.Implant Augmentation of the face/body ( 130,000 )
9.Browlift or forehead lift. ( 60,000 )
10.Otoplasty or ear pinning. ( 45,000 )
11.Abdominoplasty or tummy tuck. ( 30,000 )
There is no question that people are seeking plastic surgery in record numbers. The figures can easily double or triple in the next decade, yet many individuals still don’t understand exactly what plastic surgery is. What it does and what it can or can not accomplish. Plastic surgery, or more aptly put aesthetic surgery, is the improvement and/or replacement of existing features. This may be a simple chemical peel of the face, total body liposuction, a facelift or something in between. The fact of the matter is that people are constantly looking for ways to improve themselves and their appearance is certainly no exception. While the reason and degree of acceptance may have changed throughout time the driving desire to improve ones looks has remained constant.
Plastic surgery has, in recent years become increasingly more commonplace. This is due in part to a few celebrities that have “come out of the closet”, so to speak, admitting to some nips and tucks of their own. Phyllis Diller was, most likely, one of the first celebrities to stand up and support plastic surgery as a reasonable alternative to growing old gracefully. Since then numerous others have in one way or another admitted to having gone under the knife. Dolly Parton has discussed her surgery openly. So has Joan Rivers and Roxanne. Many other celebâ€™s have reluctantly spoken about their plastic surgery and many more rumors abound about celebrities and what plastic surgeries they may have had.
When celebrities admit to having had aesthetic surgery it sends a very powerful message to others that hold them in such high regard. I believe that once the average person discovered that their favorite celebrity had a little help in their quest for beauty, they felt that-if it’s good enough for them it must be ok for me. And that is the prevailing attitude about plastic surgery today.
Most would agree with an individual’s right to pursue beauty through plastic surgery as long as it is performed with the proper aesthetics in mind. Although beauty is being sought at an ever-increasing pace few have ever asked why? What is it that we find so attractive? What are the ideal features and even more importantly can we have the same or similar looking ones? These are the questions that must be answered.
The field of plastic surgery continues to evolve with exciting advances for the future especially in the areas of artistic representation and post operative healing. What once only artists could envision, plastic surgeons will someday create. What once took weeks to heal following surgery may take only hours.
Advances in the field of retarding the aging process will occur. With the recent discovery of the gene that controls aging, and the so-called immortal cells that are being grown in a scientist’s lab, these issues are rapidly moving from the realm of science fiction to the forefront of modern medicine. These discoveries may some day allow us to live longer and healthier lives. More and more emphasis will be placed on not only feeling good but also looking good.
Things that seem incredible today will become commonplace. One example is the ability of a surgeon to perform remote surgery with the aid of virtual reality. Just think about having the expertise of the world’s top surgeons at your instant beck and call without leaving your own city. In virtual reality, the surgeon will perform your surgery with the aid of an on site robotic device that instantly relays sensations of touch and pressure. This will be done without the surgeon ever leaving his hometown.
Computers will play an even greater role in the initial evaluation of individuals thereby enhancing the aesthetic ability of the surgeon-however it is doubtful that the surgeon will be replaced by automation anytime in the near future. For it is the human imprint that recognizes beauty-and without the ability to recognize beauty and its component parts -there is a zero chance of it being successfully recreated.