What is Plastic Surgery?

Plastic surgery is a broad surgical subspecialty that, unlike other specialties, isn't confined to a single organ system. As a result, it is a technically demanding and naturally creative field that is constantly changing and reinventing itself. Plastic surgeons treat pathologies that range from congenital anomalies to cancer, trauma and degenerative conditions. Additionally, plastic surgeons are inherent team players since they work alongside other specialties like general surgery, gynecology, neurosurgery, ophthalmology, oral surgery, orthopedic surgery, otolaryngology and urology to reconstruct any anomaly or defect in the body to restore both form and function.

Very few specialties in medicine offer the opportunity to be so creative and innovative. This is why we love plastic surgery!

On this page, we provide a broad overview of the "scope of practice" in plastic surgery. As you can imagine, it is not all-encompassing, however, it offers a glimpse of what plastic surgeons do!

Cosmetic

Aesthetic (Cosmetic) Surgery

Cosmetic or aesthetic surgery includes various rejuvenating procedures encompassing the entire body. For example, aesthetic surgery includes facelifts for age-related changes, rhinoplasty for nasal correction and blepharoplasty for excess eyelid skin. Breast and body surgeries are very common procedures and include breast augmentation, mastopexy, abdominoplasty and body contouring procedures after weight loss. The field also includes the use of various injectables, such as fillers and neurotoxins, to address asymmetries and age-related changes. Trainees can pursue further fellowship training if they desire.

Image: Sieber DA, Rohrich RJ. Finesse in Nasal Tip Refinement. Plast Reconstr Surg. Aug;140(2):277e-286e.

Hand/Peripheral Nerve

Hand/Upper Extremity

Plastic surgeons may care for both pediatric and adult patients with hand/upper extremity deformities related to traumatic, oncologic, degenerative and congenital/syndromic etiologies. Traumatic cases may necessitate bony fixation, soft tissue repair and reconstruction and even replantation of all or part of the hand and upper extremity after amputation. In addition, nerve and tendon repairs and transfers are important techniques for the restoration of sensation and function to the upper extremity. Trainees may pursue additional fellowship training in this field.

Image: Courtesy of Saïd Azoury, MD.

Nerve Surgery

Plastic surgeons perform nerve surgeries to treat a variety of conditions such as nerve decompression (i.e. for carpal tunnel syndrome), brachial plexus injury, facial reanimation, repair following traumatic injury, targeted muscle reinnervation after amputation and nerve transfers to treat injury. These various modalities aim to improve the quality of life in patients with either congenital, acquired or traumatic nerve pathologies.

Image: Terzis JK, Konofaos P. Radial nerve injuries and outcomes: our experience. Plast Reconstr Surg. 2011 Feb;127(2):739-751. doi: 10.1097/PRS.0b013e3181fed7de. PMID: 20966815.

Reconstruction

Microsurgery

Microsurgery is a field of plastic surgery that involves the use of loupe or microscope magnification to anastomose small blood vessels (arteries and veins), nerves and lymphatics. Such techniques may be used in cases of free tissue transfer for reconstruction following cancer or trauma. As you can see below, plastic surgeons perform reconstructive surgery all over the body and often work with other surgical disciplines. Trainees have the option of pursuing additional fellowship training in this field.

Image: Hsieh et al. Chang's Technique of Sequential End-toS-Side Microvascular Anastomosis. International Microsurgery Journal. 2017;1(1):4.

Breast Reconstruction

Plastic surgeons play a critical role in the multidisciplinary care of patients with breast cancer. Reconstructive options after breast cancer surgery include implant-based or autologous reconstruction after mastectomy. Autologous reconstruction uses a patient's own tissue to create a breast and typically utilizes free tissue transfer from the abdomen, buttocks or thighs.

Images: Implant Insertion. In: Cohen M, Thaller S, ed. The Unfavorable Result in Plastic Surgery: Avoidance and Treatment. 4th Edition. Thieme; 2018. doi:10.1055/b-005-143642
Sultan SM, et al. Bipedicle-Conjoined Deep Inferior Epigastric Perforator Flaps for Unilateral Breast Reconstruction in Overweight and Obese Patients: Do the Benefits Outweigh the Risks? J Reconstr Microsurg. 2020; 36(05): 346-352. doi:10.1055/s-0040-1701209

Head/Neck and Dermatologic Surgical Oncology

Plastic surgeons care for cancers of the head/neck region including melanoma, squamous cell carcinoma and osteosarcomas. As one of the oldest subspecialties in plastic surgery, head/neck surgical oncology includes the management of cancer and the reconstruction of tumor defects. Plastic surgeons also partner with dermatologists for reconstruction of defects from Mohs surgery for skin cancer, particularly those in cosmetically sensitive areas such as the face or hands. Reconstructive techniques range from local rotational, transposition and advancement flaps to pedicled and free flaps. Plastic surgeons have the unique training to be able to problem-solve the reconstruction of defects from anywhere on the body.

Image: Free Flaps. In: Cheney M, Hadlock T, ed. Facial Surgery. Plastic and Reconstructive. 1st Edition. Thieme; 2014. doi:10.1055/b-006-161012.

Chest/Abdominal Wall Reconstruction

Complex reconstructive surgeries of the chest and abdomen are a common aspect of plastic surgery practice. Plastic surgeons restore the chest wall following tumor resection using mesh or rigid fixation for skeletal reconstruction, as well as pedicled or free tissue coverage. For the abdominal wall, plastic surgeons utilize an understanding of abdominal wall anatomy to manage complex and recurrent defects.

Image: Azoury SC et al. Chest Wall Reconstruction: Evolution Over a Decade and Experience with a Novel Technique for Complex Defects. Annals of Plastic Surgery. 2016;76:231-237.

Lower Extremity Reconstruction

Orthopedic surgeons often partner with plastic surgeons for reconstruction and salvage of the lower extremity after trauma, tumor resection or chronic wounds. This requires an understanding of principles shared with orthopedic surgery, such as wound management and fracture fixation, as well as reconstructive principles to provide locoregional flaps and microvascular techniques for soft tissue coverage.

Image: Courtesy of Saïd Azoury, MD.

Lymphedema Treatment

Lymphedema affects nearly 250 million people worldwide. It can present as the primary pathology or can result from filariasis or, more commonly in the United States, lymph node dissection for cancer surgery. Modern surgical techniques for lymphedema range from direct excision or liposuction to more complex procedures such as lymphovenous anastomosis and lymph node microvascular transfer. The goals of these treatment options are to lessen long-term disability and functional impairment while improving quality of life.

Image: Schaverien, Mark V. M.B.Ch.B., M.Sc., M.Ed., M.D., P.G.Cert.(F.L.M.); Coroneos, Christopher J. M.D., M.Sc. Surgical Treatment of Lymphedema, Plastic and Reconstructive Surgery: September 2019 - Volume 144 - Issue 3 - p 738-758 doi: 10.1097/PRS.0000000000005993.

Burn Reconstruction

Plastic surgeons are integral to the care of both pediatric and adult patients suffering from burn injuries. Reconstructive techniques include skin grafting, the use of various biologic matrices, allografts, flaps and free tissue transfer.

Image: Glat PM, Davenport T. Current Techniques for Burn Reconstruction: Using Dehydrated Human Amnion/Chorion Membrane Allografts as an Adjunctive Treatment Along the Reconstructive Ladder. Ann Plast Surg. 2017 Feb;78(2 Suppl 1):S14-S18. doi: 10.1097/SAP.0000000000000980. PMID: 28079551.

Pediatric/Craniofacial

Cleft Lip/Palate Surgery

It is estimated that one in seven hundred children will be born with a cleft lip or palate and plastic surgeons are a critical component of the multidisciplinary care of these patients. Plastic surgery procedures include not only cleft lip and palate surgery but also primary and revisional rhinoplasties. Some surgeons may also have the opportunity to participate in missions around the world treating underserved patients and communities. Fellowships are available to further specialize in treating these patients.

Image: Courtesy of Saïd Azoury, MD.

Craniofacial Surgery

Craniofacial surgeons partake in the care of both pediatric and adult patients with craniofacial deformities related to various congenital, oncologic or traumatic etiologies. Techniques include ear and nose reconstruction, fracture fixation for maxillofacial fractures, skeletal reconstruction and cranial vault remodeling. Trainees may elect to pursue further training in this field.

Image: Swanson JW et al. An Algorithm for Managing Syndromic Craniosynostosis Using Posterior Vault Distraction Osteogenesis. Plast Reconstr Surg. 2016;137(5):829e-41e.

Orthognathic Surgery

Orthognathic surgery corrects dentofacial anomalies of the upper and lower jaw. Correcting these irregularities realigns the jaws and teeth to improve not only a patient's bite but also their breathing and facial appearance. Patients with cleft lip and palate often have orthognathic surgery during their longitudinal care. Surgeons who perform orthognathic surgery work closely with orthodontists and oral surgeons.

Image: Management of Developmental Dentofacial Deformities. In: Bentz M, Bauer B, Zuker R, ed. Principles & Practice of Pediatric Plastic Surgery. 2nd Edition. Thieme; 2016. doi:10.1055/b-006-161029.

Gender-Affirming Surgery

Gender-affirming surgery is a field where a transgender person's physical appearance and function are altered to resemble their identified gender. This includes facial feminization or masculinization, breast augmentation or mastectomy, vaginoplasties and phalloplasties. Several fellowships in this field have recently become available to trainees seeking additional training.

Images: Chen K, et al. Facial Recognition Neural Networks Confirm Success of Facial Feminization Surgery. Plast Reconstr Surg. 2020 Jan;145(1):203-209. doi: 10.1097/PRS.0000000000006342.
Van Boerum MS et al. Chest and Facial Surgery for the Transgender patient. Transl Androl Urol. 2019;8(3):219-227.
Chen ML, Safa B. Single-Stage Phalloplasty. Urol Clin North Am 2019;46(4):567-580.