Plastic surgery: An ancient art with modern order and contemporary vistas

Plastic Surgery is not only a ‘beautification surgery’ but a ‘problem-solving specialty’
Plastic surgery: An ancient art with modern order and contemporary vistas
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Today, 15th of July, is World Plastic Surgery Day. It is for the first time that this day is being observed globally as a Plastic Surgery event. Otherwise, for the last decade, we have been celebrating it as National Plastic Surgery Day in India only. It is the unrelenting efforts of the senior members of our Association, especially Dr S Raja Sabapathy and our incumbent President, Dr Rakesh Khazanchi that we were able to convey the significance of observing such an occasion to our overseas colleagues which was duly acknowledged and given due recognition so much that from this year onwards, this day will be commemorated as the World Plastic Surgery Day throughout the world. It is a triumph in itself for the plastic surgeons of this land. To append a little further, there is now a need to add a ‘theme’ to commemorate this day every year. This may further augment the purpose of celebrating the day. The ‘theme’ may be focused on some distinct facet of the specialty which may highlight some core issues of soaring merit and gravity.

I think this is high time that we ponder upon certain points regarding this specialty, and make our people aware of what Plastic Surgery actually means, what is its scope and what are the various misunderstandings and misconceptions prevailing about this specialty in the minds of people.

Basically, Plastic Surgery is a broad surgical specialty involving the restoration, reconstruction, or alteration of the human body. Plastic Surgery has been given the eponym ‘the problem-solving specialty’ as the role of plastic surgeon can be called for in any specialty, be medical or surgical, at any point in time. We can hardly come across any surgical discipline wherein plastic surgery does not contribute either as the first or the second line support. So, some folks even don’t hesitate to address plastic surgeons as ‘finishers’ as they are the final call takers in several procedures and clinical dilemmas; when many have accomplished their part, they are sought for the final stroke to furnish final, finer brushings by their ‘finishing touches’.

On a lighter note, adding here a witticism that goes as: the dictators Mussolini and Adolf Hitler used plastic surgery to create a more “perfect soldier”- supposed to fix the drooping eyelids of the army men and anything that enact troops appear feeble. This speaks of the strength of plastic surgery recognized, though in an adverse sense. Leaving aside this, it is a charming branch trying to render people more functional and looking more elegant and beautiful.

Although people consider Plastic Surgery as a relatively newer specialty; in fact, it is one of the oldest disciplines of surgery, having its roots more than 4000 years old in India. Sushruta (600 B.C.) is credited with describing plastic surgical principles in his famous ancient treatise 'Sushruta Samhita’ more than 2500 years ago. He was probably the first person to perform plastic surgical operations. All the basic principles of plastic surgery find an important place in his writings. His knowledge was so profound that he believed that medicine was as essential for a surgeon as his surgical know-how, otherwise he would be what he dubbed as a “bird with a single wing’’!

To start with, the name ‘Plastic’ in itself is quite incomplete and confusing. The name has not been taken from the synthetic substance but the Greek word ‘plastikos’. The word itself means ‘modeling or sculpting’, reiterating the fact that it is a moldable branch. Being one of the oldest disciplines of surgery, as already stated; but to date, still, there has been no consensus on the name of specialty which would fit into the diverse working areas touching all parts and regions of the human body. It is a distinctive specialty that doesn’t bear a name that defines it properly. The argument for defying definition is that the various specialties are acknowledged either by their anatomic territory (Ear, Nose, and Throat; Ophthalmology), the system involved (Urology, Nephrology, Neurology) or by age (as Pediatric Surgery/Geriatric Medicine) and so on. However, Plastic Surgery is a unique discipline that is not restricted to any particular region or system. It is rather established on certain basic surgical principles. These are the root level postulates for any surgery; however, are being observed by plastic surgeons in particular. These guiding principles can be translated into any procedure, on any body part/region, or organ system to accomplish a successful outcome. This principle-based nature of the specialty entitles it to qualify as, what is popularly referred to as, ‘problem-solving specialty’.

It caters to almost all parts of the body from top to toe, dealing with all body blocks from the skin to bones. So, the simplified argument of some citing plastic surgery as ‘surgery of skin’ is completely out. But still, the name does not symbolize much to a layman and the medical community at large. The diversity of plastic surgery can be made out by the variety of procedures it is involved in. Congenital defects (cleft lip/ palate, hand deformities, ear/nose deformities, moles and naevi, urogenital deformities), acute trauma, burns and burn reconstruction, cancer extirpations, and reconstructions, reattachment of amputated parts of the body, post-traumatic defects on any part of the body, numerous cosmetic procedures like liposuction/ lipofilling, facial rejuvenation, breast surgeries, gender reassignment procedures, hair transplantation, to name a few. Otherwise, the list seems unending. Important to mention here is only one thing that if anyone requires any plastic surgical consultation or procedure, he/she should seek a call from a board-certified person. This way we may avoid any mishap at the hands of inexperienced persons. It is also the duty of plastic surgeons as a community to make the common public aware of its scope and domain so that better services can be assured for needy people.

Nonetheless, many disciplines encounter more and more procedures that overlap with Plastic Surgery. So, in this age, Plastic Surgery is not invariably considered as a principal specialty for the procedures which were stereotyped as fundamental and time-honored to it. In such situations, we may call it sharing the care, rather than being antagonistic to one another.

However, there are circumstances wherein a multidisciplinary team approach is required for a more favorable result. Hence, in those areas, the engaged sister specialties cannot be viewed as competitors, but as organs of an alliance operating together in unison to accomplish the most favored end result. Picking up cleft lip/palate management as a reference, in which, along with a plastic surgeon other specialists like orthodontist, ENT specialist, orthognathic surgeon, audiologist, nutritionist and speech therapist and so on form an integral part of the team, and collaboration and coordination among them all is mandatory for a thriving functional and aesthetic outcome. Likewise, ‘Orthoplastic Surgery’ and ‘Oncoplastic Surgery’ had come into existence on a need basis partnership between the respective surgeons and a plastic surgeon. The principles and the practices of two specialties are being executed in unison on a clinical problem either by a single service provider or a team of operators working in harmony for the benefit of the patient. This idea has been extensively adopted with remarkable success for a long now.

Thirdly, Plastic Surgery is also known for its dynamicity and ever-evolving character. It has advanced to contribute in many complex areas previously managed by other specialists like general surgeons or orthopedicians. Management of diabetic foot is a glowing instance targeting salvage and reconstruction, thereby minimizing the amputation rates. Concurrently, the domain and scope of Plastic Surgery are growing day by day, with further sub-specialization/super specialization. The realm is increasing so much so that it can be confusing to those outside the specialty. Thus, it can be envisaged that although in some areas we are facing competitors, new vistas are opening for us. A lot more remains still unexplored!

More importantly, even today, the knowledge about the breadth and scope of plastic surgery remains hazy. Surveys have shown that about one-third of people relate Plastic Surgery to cosmetic surgery. Common masses are having the notion of Plastic Surgery as a ‘beautification surgery’ or, less than that, any surgery that leaves behind no marks or scars. But truth is that Plastic surgery is not completely scar-free. Like all surgeries, plastic surgery too leaves behind scars. However, plastic surgeons are skilled at not only minimizing but also hiding the scars effectively. Even media is projecting it as a specialty, giving people a new lease of life, and changing the ‘face of persons’, a concept especially popularized by our Bollywood movies additionally. The reconstructive part of Plastic Surgery (like post-traumatic/congenital deformity correction, burn surgery, cancer reconstruction) is not portrayed by the press and media. Though it has added glamour to the specialty and earned it a ‘darling status in media’, it has, however, led to/added a lot of confusion. So many people will look for a plastic surgeon only for some aesthetic procedure, and nevertheless, seek consultation from other disciplines for the procedures which are conventionally deemed as fundamental and time-honored to be a plastic surgical sphere.

Plastic surgeons as a community may be held accountable for this sorry state of affairs as we have not been able to make the people comprehend the span and width of plastic surgery. This objective can be procured through talks, symposia, meetings, or advertisements. So, this day will be high time that we gear up to help our community by making them more and more aware of the scope of plastic surgery, so that the services are best exploited for those who need them the most.

Again, one more myth connected to plastic surgery is regarding the aging process. Plastic surgery cannot pause or retard the aging process. After getting some plastic surgical procedure done, it cannot last forever; people will continue to age and he/she may require the procedure to be repeated or replicated or a brand-new stratagem.

Talking about aesthetics, technically speaking, in many instances there can be a very thin line between repair and cosmetic surgery. A reconstructive procedure may add to the cosmesis too. If the basic philosophy of ‘function taking precedence over cosmesis’ is to be followed, then one can say that the function of the face is to look good (appearance) or Breast Reconstruction (a patrimony of womanhood) can be considered as aesthetic reconstructive procedures too.

Lastly, in the wake of perpetually stretching the territory of plastic surgery, many amongst the medical fraternity are not cognizant of the variance and multiformity of Plastic Surgery. The enormous diversity in clinical competence and application can be the additional reason for the skepticism of those medical professionals outside it; the reason being that the basic education and principles of Plastic Surgery are not included in the curriculum of our medical schools. It is only after one chooses the specialty; one comes to know about the realms of the discipline. All this may culminate in the hesitancy of the referring physician. So, we are again duty-bound to make non-plastic surgical colleagues recognize the prerogative of Plastic Surgery through mutual discussions and informal talks.

With so much diversity with insubstantial comprehension about its performance, nonetheless, Plastic Surgery has established itself as a prestigious specialty that is capable of tracking down its role in any medical discipline at any part of the patient management. Having said all, last in the order, I conclude by wishing Happy Plastic Surgery Day to All!

Dr Umar Farooq is Associate Professor, Deptt. of Plastic and Reconstructive Surgery, SKIMS, Srinagar.

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