Episode 14: Why is Plastic Surgery Called Plastic Surgery?
Why is plastic surgery called plastic surgery? It really doesn't have anything to do with the synthetic material plastic. In fact, the term plastic surgery goes back to the ancient Greek word plastikos, which essentially means the ability to be molded. We can start to understand why plastic surgery is called plastic surgery deriving from the term plastikos if we look as far back as the sixth century BC to a physician in India named Sushruta.
What was the first plastic surgery procedure?
Sushruta is widely credited with performing one of the first true plastic surgery procedures, which was reconstruction of the nose with the forehead flap. In this operation, tissue from the forehead was used to reconstruct severe nasal defects. This operation was so successful that it's often used to this day. The person widely thought of as the father of plastic surgery is Gaspare Tagliacozzi. He lived in Italy in the 1500s. Tagliacozzi became quite famous for his answer to the question, what do plastic surgeons do? He said that we restore, rebuild and make whole those parts which nature have given, but which fortune has taken away, not so much that it may delight the eye, but that it might buoy up the spirit and help the mind of the afflicted.
All of this conversation around what plastic surgery actually is and what plastic surgeons do happened well before the world's first fully synthetic plastic was even created. This material what is called Bakelite, which was invented in New York in 1907 by Leo Baekeland. He's the individual who actually coined the term plastics.
How has plastic surgery evolved over time?
Tagliacozzi's definition of plastic surgery rings true to this day. However, it only tells part of the story of modern plastic surgery. Tagliacozzi was really describing reconstructive plastic surgery. That is the discipline in which we are in fact charged with restoring the form and function of the human body from head to toe, and reconstructive plastic surgery has further subspecialties, including microsurgery, which is essentially the transplantation of tissue from one part of the body to another. It's called microsurgery because a microscope is used to connect extremely small blood vessels down to one to two millimeters in diameter from the donor tissue to the recipient site. A common example of this is use of abdominal soft tissue to reconstruct the breasts after mastectomy, surgery of the bones and soft tissue of the hand can also be considered a form of reconstructive surgery, and finally craniofacial surgery or surgery of the soft tissue and bones of the face to address congenital problems such as cleft lip and cleft palate or malformations of the skull like craniosynostosis.
Just for background, a cleft lip or cleft palate occurs when a child is born in such a way that the two sides of the lip or the top of the mouth didn't fuse during development. Craniosynostosis occurs when the growth plates of the skull fuse too early leading to abnormal skull shapes and sometimes even increased pressure inside the skull, which could lead to developmental and neurological problems.
Now, we've taken what we've learned from reconstructive surgery and Tagliacozzi's definition and extended into the realm of aesthetic surgery, where we are performing procedures to improve upon already normal body parts and body shapes to make them more pleasing in appearance. What's interesting is there's often a very strong relationship between the principles of reconstructive surgery and the principles of aesthetic surgery. This is something that I've studied a great deal as I've done subspecialty fellowship training in both craniofacial surgery and aesthetic surgery. A wonderful example of this is rhinoplasty or nose job surgery.
Some of the most difficult rhinoplasties or nose jobs that we ever perform in plastic surgery are those that we need to do in the context of a cleft lip. These procedures are so difficult because when the upper lip does not form completely during development, the entire structure of the nose is affected as well. When I do an aesthetic rhinoplasty, I take many of the principles and techniques that I've learned from performing many very difficult cleft rhinoplasties and I apply them to aesthetic procedures.
What is plastic surgery?
So, to ask a question related to why is plastic surgery called plastic surgery, I'll go ahead and also ask, what is plastic surgery? The answer isn't as straightforward as for example the answer to the question, what is cardiac surgery? Well, that's surgery of the heart. What is pulmonary surgery? Well, that's surgery of the lungs. What is orthopedic surgery? Well, that's surgery of the bones, but in plastic surgery, we operate on almost every tissue of the body. We operate on skin. We operate on bones. We operate on muscle. This led to what I think is a very clever answer to the question, what is plastic surgery? Plastic surgery is surgery of the skin and its contents. Those procedures today are performed both for reconstructive surgery as Tagliacozzi conceived it and for aesthetic surgery as well.