Plastic Surgery: Where Science Meets Art

Today, plastic surgery is synonymous with Hollywood and its never ending quest to remain young and beautiful forever, through mammoplasty (breast reduction or augmentation), mastopexy (breast lift), rhinoplasty (nose lift), chin augmentations, cheek augmentations, tummy tucks, liposuction, and face lifts. These procedures are more commonly referred to as cosmetic surgery. However, the art and science of plastic surgery is not solely limited to improve the physical appearance of an aging Hollywood actor. In fact, this particular branch of surgery was developed to correct disfigurement and restore impaired function. This type of surgery became known as reconstructive surgery, which can be defined as the correction of a congenital or acquired deformity; as opposed to cosmetic surgery, which entails the correction of a perceived physical imperfection.
The use of the word plastic does does not refer to the synthetic polymer material, but is derived from the Greek word “plastikos,” meaning to mold or shape. This refers to the fact that plastic surgeons typically mold and reshape bone, cartilage, muscle, fat and skin to achieve the aesthetic results they desire. These body parts may be moved to fill, alter, or cover the appearance of a defect, or completely removed.

Although rudimentary plastic surgery methods were being practiced as early as 800BC, the techniques being used today are largely attributed to Sir Harold Delf Gillies, a Cambridge-educated surgeon from New Zealand. He is often referred to as the father of plastic surgery. Gillies joined the Red Cross during World War I and saw the need for a plastic surgery unit for the British troops after seeing the French surgery units in Paris. This war was particularly gruesome because it had the distinction of being the first fully mechanized war, and the advent of heavy artillery, shells and machine guns meant more devastating injuries than ever before could be inflicted. The War Office recognized the necessity for a specialized unit of surgery and subsequently sent Gillies to the Cambridge Military Hospital in Aldershot to set this up, thus becoming Britain's first plastic surgeon. Soon men began pouring in to the facility from the field hospitals, all with jaw and face injuries that required reconstruction.
Gillies was determined not only to restore the function of these wounded men but to also make the person look as normal as possible, if not more attractive than before. He called his brand of plastic surgery, “ a strange new art.” This melding of function and aesthetics underlined his entire body of work. Gillies pioneered many surgical techniques and developed instruments to use in his operations; many of them are still being used today. One of these techniques is the pedicle tube, in which a skin graft taken from an undamaged part of the patient's body is sewn into a tube and used to cover the damaged area. Not only was the blood supply maintained to the skin graft, but sewing the edges of skin together meant that the skin graft was less prone to infection, a constant hazard to patients.
He delighted in sharing his skills and insights with doctors from all over the world, helping many countries to establish their skill base for this emerging field of surgery. In addition to describing his work in written form, he was the first surgeon to make pictorial records of facial reconstruction cases, both before and after surgery. In 1920 he published a book called Plastic Surgery of the Face, which detailed his work and techniques.
As weapons of war become more and more destructive, the need for reconstructive surgery increases for its casualties. But because of men like Sir Harold Gillies, these men and women can get back the face that was stolen from them.