This information is intended to assist those who
have general questions about plastic surgery. It includes information
about how plastic surgery fits into medical care, how plastic surgeons
are trained, and the types of cases that plastic surgeons commonly
treat. For more detailed information about a particular surgical
procedure, look for articles related to those topics on the rest of
this site. Remember, each case is unique and a great deal depends upon
the patient's individual circumstances. Specific questions about
surgery can be best answered in a consultation with a board-certified
plastic surgeon.
What is plastic surgery?
Taken from the Greek word "plastikos,"
meaning to mold or give form, plastic surgery is the specialty of
medicine dedicated to restoring and reshaping the human body. It
encompasses both reconstructive surgery, which is performed on
abnormal structures of the body caused by birth defects, developmental
problems, injuries, infection, tumors or disease; and cosmetic
surgery, which is performed to reshape or restore normal structures of
the body to improve appearance and self-esteem. *
History suggests that the practice of plastic
surgery has ancient roots. However, plastic surgery as a defined
specialty became fully recognized during World War I. Today,
scientific advances in the field allow plastic surgeons to achieve
improvements in form and function thought to be impossible10 years
ago.
Who is a plastic surgeon?
A board-certified plastic surgeon is a doctor
trained to be a concerned care-giver, a wound-care expert, a
problem-solver, an artist-designer and a meticulous surgeon in the
operating room. It's important to realize that not every doctor who
has claimed the title "plastic surgeon" has the same
training. The truth is, anyone with a medical degree can call himself
or herself a plastic surgeon; there are no laws that require doctors
offering specialty care to meet certain qualifications.
In checking a plastic surgeon's credentials,
patients are advised to consider a doctor who has completed an
accredited residency training program specifically in plastic surgery.
Such a program includes two or three years of intensive training that
covers the full spectrum of reconstructive and cosmetic procedures.
*Definition as adopted by the American
Medical Association (AMA) and the American Society of Plastic Surgeons
(ASPS).
Patients are encouraged to consider a doctor
certified by the American Board of Plastic Surgery (ABPS). By choosing
a plastic surgeon who is certified by the ABPS, a patient can be
assured that the doctor has graduated from an accredited medical
school and completed at least five years of additional residency
training ? usually three years of general surgery (or its equivalent)
and two years of plastic surgery. To be certified by the ABPS, a
doctor must also practice plastic surgery for two years and pass
comprehensive written and oral exams.
Good credentials do not guarantee a
successful outcome, but they can guide you to select a surgeon whose
training and background will help you to meet your personal goals.
To locate a board-certified plastic
surgeon
Patients may call the Plastic Surgery
Information Service at 1-888-4-PLASTIC to receive the names of plastic
surgeons in their area who are certified by the ABPS. This service,
operated by the American Society of Plastic and Reconstructive
Surgeons, Inc. (ASPS), a national medical specialty society requiring
ABPS certification as a condition for membership, can verify if a
particular doctor is certified in plastic surgery, or has completed
required training and is working toward certification.
Cases that warrant a plastic surgeon's
care
Although much depends upon the patient's
unique circumstances, there are certain situations that almost always
warrant the specialized care that a plastic surgeon can provide. (See
Table I) Typically, a plastic surgeon is consulted when a child is
born with a defect that affects function and/or normal appearance or
when accident, injury, disease or aging causes a physical abnormality.
Plastic surgeons also are consulted in hand surgery, microsurgery, and
craniofacial and maxillofacial surgery.
Emergency cases, such as facial lacerations,
burns, trauma and bite wounds, are also commonly treated by plastic
surgeons. A patient who requests a plastic surgeon in the emergency
room ? rather than allowing the "on-duty" doctor to close a
significant wound ? is more likely to be satisfied with the end
result.
Insurance coverage
Reconstructive surgery is covered by most
health insurance policies, although the specifics of coverage may vary
greatly. Some carriers may fully cover reconstructive procedures,
others may pay only a portion of the cost.
Cosmetic surgery, however, is usually not
covered by health insurance because it is elective and not considered
a medical necessity. Some plastic surgeons accept major credit cards
or offer financing programs that allow patients to make manageable
monthly payments for cosmetic surgery.
Keep in mind that there are a number of
"gray areas" in plastic surgery that sometimes require
special consideration by an insurance carrier. (See Table II) For
example, eyelid surgery ? a procedure normally performed to achieve
cosmetic improvement ? may be covered if drooping eyelids obscure a
patient's vision. In assessing whether the procedure will be covered,
the carrier often looks at the primary reason the procedure is being
performed: Is it for relief of symptoms or for aesthetic improvement?
The other doctors involved
There are many cases in which a "team
approach" is needed to best treat specific cases. Plastic
surgeons commonly work in tandem with family practice physicians,
general surgeons, pediatricians, oncologists, orthopedic surgeons and
neurosurgeons. Sometimes, numerous specialists are needed for a single
case. For example, a child undergoing cleft-lip and palate repair
might be overseen by a surgical team that includes a plastic surgeon,
otolaryngologist, pedodontist, orthodontist and speech pathologist.
A consultation
A personal consultation with a plastic
surgeon allows a patient to find out if he or she feels comfortable
with the surgeon and his or her office staff. Typically, a
consultation may take anywhere from 15 minutes to an hour. Some
plastic surgeons offer no-cost consultations, while others may charge.
During the consultation, the surgeon will
explain the procedure, the risks involved and the probability of
success. Patients are encouraged to bring a list of their own
questions, as well as a note pad to jot down any information not
included in take-home reading materials the surgeon may provide. The
plastic surgeon will review a patient's medical history to evaluate
any medical condition that might affect the surgical result. The
patient's expectations and goals are also discussed to make certain
the desired surgical outcome is realistic.
Predicting surgical results
A patient's age, skin type, general health,
genetic background and the nature of his or her condition can all
affect any final result. Patients who smoke may not heal as quickly as
non-smoking patients. Patients with sun-damaged skin may not achieve
the same degree of improvement as those without sun-damaged skin.
Though there is no way to exactly predict a
surgical outcome, the surgeon will examine the known patient variables
before surgery begins and can project an estimate of the surgical
result. Patients can take comfort in knowing that most of the
procedures performed today have been refined over several decades.
In recent years, some plastic surgeons have
begun using computer-imaging machines during consultations to show
patients an estimate of post-operative appearance. A photograph of the
patient is transferred to a computer screen and then altered by the
surgeon to approximate the post-operative result. Doctors who use
imaging find that computer-generated pictures can enhance
doctor-patient communication. It's important for the patient to
realize that a computer image may not match reality and represents no
guarantee of outcome. No computer can take into account a patient's
skin elasticity, bone structure, blood supply and healing ability.
Types of anesthesia used by plastic
surgeons
Three basic types of anesthesia are used for
plastic surgery procedures. A local injection, which numbs only the
immediate area to be operated on, is used mainly for less invasive
procedures. Local injection plus sedation allows the patient to remain
awake, yet relaxed through the entire procedure and is a common type
of anesthesia used for cosmetic surgery procedures. General
anesthesia, which allows a patient to sleep though the procedure, is
usually used when large areas of the body are involved or in children.
Where are most plastic surgery procedures
performed?
Whether a procedure is performed in an
in-office surgical facility, a hospital or a freestanding surgery
center usually depends upon the complexity of the operation and the
plastic surgeon's recommendation.
For cost-containment and convenience, an
increasing number of procedures ? especially cosmetic operations ? are
being performed in freestanding or office-based surgical facilities on
an outpatient basis. Patients planning to have surgery in this type of
facility should ensure that it is properly equipped and staffed, that
it has access to a nearby hospital, that the anesthesia will be
administered by a well-trained professional, and that the doctor has
privileges to perform the same procedure at an accredited hospital.
One additional sign of a quality facility is
accreditation by the American Association for Accreditation of
Ambulatory Plastic Surgery Facilities (AAAAPSF). This organization not
only inspects the facility itself, it requires that the practicing
physicians are certified in plastic surgery and have operating
privileges at a local accredited hospital. AAAAPSF re-inspects
facilities every three years. A patient can check if a plastic
surgeon's facility is accredited by calling the American Society of
Plastic Surgeons at 800/635-0635.
Problems Commonly Treated by Plastic
Surgeons*
Birth defects and developmental
abnormalities
- Birthmarks, including port-wine stains and
hemangiomas, congenital nevi
- Abnormal breast development
- Cleft-lip and palate deformities
- Hand deformities
- Skull and facial bone deformities
- Prominent and deformed ears
Acquired deformities, including those
resulting from trauma or disease
- Scars
- Wounds, soft tissue deformity from trauma
or disease
- Burn scars
- Growths and tissue defects, including
cancer treatment and mastectomy
- Poorly-healed wounds, scars that limit
movement
- Lacerations
- Severed limbs, fingers or toes
- Skull and jaw injuries
- Drooping brow and upper eyelids, which
impair vision
- Hand injuries and acquired problems
- Congenital and developmental breast
deformity
Cosmetic concerns
- Excess body fat
- Disproportionate or sagging breasts
- Skin problems: wrinkling, uneven
pigmentation, sun-damage, unwanted tattoos
- Sagging facial skin and muscles, loose
neck skin
- Hair loss
- Facial features to improve the appearance
of the nose, cheekbones, chin shapes
* This table represents a partial list.
Procedures That May be Covered by
Insurance*
Abdominal surgery, when it is performed
to:
- Alleviate health problems, such as back
pain, sores, rashes, hernia
- Restore the ability to walk normally
Breast surgery, when it is performed to:
- Correct congenital asymmetry
- Reduce overly-large breasts that are
causing health problems (shoulder grooving, neck and back pain,
etc.)
- Reconstruct a breast lost to disease
- Correct congenital absence of breast
- Reduce overdeveloped male breasts (gynecomastia)
Ear surgery, when it is performed to:
- Correct congenitally-deformed ears
- Reconstruct ears that are deformed by
disease or injury
Eyelid surgery, when it is performed to:
- Correct drooping upper eyelids that are
obscuring vision
- Correct out-turned or in-turned lower
eyelids
Facial surgery, when it is performed to:
- Correct an asymmetrical appearance caused
by facial paralysis
- Treat conditions affecting the facial
muscles, lips and cheeks
- Treat traumatic deformities
- Correct head and neck deformities
Hand surgery, when it is performed to:
- Treat carpal tunnel syndrome
- Correct Dupuytren's contracture, treat
tendon and nerve injuries
- Correct syndactyly (fused fingers) and
other congenital deformities
Nasal surgery, when it is performed to:
- Correct deformities resulting from birth
defects or disease;
- Treat injuries or nasal deformities that
may affect breathing.
* Numerous individual circumstances affect
whether a procedure is covered. Patients should obtain written
verification of coverage and prior authorization for the treatment
from their insurance carriers.
