The many faces of plastic surgery

Posted: 05/11/2015


The term ‘plastic surgeon’ is widely used by the media and the general public alike but perhaps not always completely understood. In many people’s minds, plastic surgery is synonymous with cosmetic surgery, yet some plastic surgeons undertake no cosmetic surgery at all. This can strike people as peculiar. A plastic surgeon who doesn’t do cosmetic surgery sounds like an auto-mechanic who doesn’t fix cars or a teacher who doesn’t teach. 

So what do plastic surgeons do? Some undertake cosmetic treatment of course but many instead have a subspecialism in reconstructive surgery, either macro or micro. The truth is that while cosmetic surgery is probably the most visible and perhaps the most glamorous aspect of plastic surgery, it’s a relatively small part of the specialty. The breadth of the specialty is considerable to say the least. 

Some say that plastic surgeons are the last general surgeons. They don’t own a disease like cancer specialists (oncologists) do and they often don’t own a part of the body like heart surgeons (cardiologists) do. Plastic surgeons work all over the body on all kinds of diseases and frequently with other physicians in a multidisciplinary group. They can not only be misunderstood by the public but also even by their medical colleagues. 

As an example, we came across a story from several years ago when on Christmas Day a plastic surgeon finished an emergency case in the operating room. One of his cardiac surgery colleagues had performed a coronary artery bypass graft on a patient several days before. The sternotomy wound had become infected and the patient was gravely ill. The reconstructive plastic surgeon was called upon to remove the infected tissue and use muscle flaps to provide healthy cover for the patient’s exposed heart. As the plastic surgeon was leaving the hospital, he saw an intensive care colleague in the lobby, who called out: “Hey, what are you doing here on Christmas Day? Somebody drop their face?” The cardiac surgeon set him straight and told him that the plastic surgeon had just saved his patient’s life. 

The history of plastic surgery is one of innovation. Plastic surgeon Dr Joseph Murray performed the world’s first kidney transplant in Boston in 1954. Five years later he performed the world’s first successful allograft and, in 1962, the world’s first renal transplant on a cadaver. He received the Nobel Prize in 1990. 

So what was a plastic surgeon doing transplanting kidneys? His experience treating burn patients sent back from World War II gave him wide exposure to skin grafting and raised issues of immune rejection that he studied using the kidney as a single organ model. In recent years plastic surgeons are leading the way in hand and face transplantation, continuing Dr Murray’s tradition of innovation.


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