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What is plastic surgery? Is it Hollywood? Is it nose jobs? Is it silicone?

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Although many plastic surgeons perform cosmetic surgery on high-profile patients, this specialty involves much more than Hollywood movie stars and breast implants. The word plastic is derived from the Greek plastikos, meaning “to shape, change, or mould.” The goals of plastic surgery are threefold: (1) to alter surgically the form and function of anatomy—either normal or pathologic; (2) to improve quality of life; and (3) to preserve life itself.

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No other surgical specialist draws on a wider base of anatomic knowledge or operates in more regions of the body than does plastic surgeon. It has been said that plastic surgeons operate on “the skin and its contents,” alluding to the fact that on any given day, plastic surgeons might find themselves operating on the face, on the hand, inside the cranium, or inside the abdominal or thoracic cavities. The field has developed from the contributions of people from many different backgrounds, including general surgery, orthopedics, oral and maxillofacial surgery, dermatology, neurosurgery, and otolaryngology.

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Plastic surgery receives extensive media attention, yet remains poorly understood by the general public—and often by physicians as well. In some ways, it may seem to be a paradoxical specialty. Plastic surgery encompasses all of aesthetic surgery, yet it also deals with clinical problems that are often considered grotesque, including chronic wounds, limb replantation, and head and neck reconstruction. It is considered a surgical subspecialty, yet the fund of knowledge needed for even a basic understanding of the discipline requires a five- to eight-volume text. And although it is a relative newcomer as an organized specialty, some of the first recorded operations were plastic surgery procedures.

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Although most contemporary plastic surgical techniques were developed only within the last few decades, plastic surgery is actually one of the oldest surgical specialties. Historians believe that the Indian surgeon Sushruta, who took a flap of tissue from the forehead and covered a nasal tip defect, performed the first documented plastic surgery in 600 bc.1 In the fifteenth century, Western plastic surgeons began using surgical techniques to alter the form and function of the human body.2 Tagliacozzi, an Italian plastic surgeon, developed a technique to restore tissue to noses lost in traumatic amputations.

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Much of the history of contemporary plastic surgery was shaped by war. Early twentieth century plastic surgeons such as Sir Harold Gillies3 and Vilray Blair4 served in World War I and helped develop many of the fundamental techniques and principles still used today. World War II and the Korean and Vietnam wars later produced great numbers of complex wounds. Advances in critical care and trauma surgery meant that patients with increasingly devastating injuries could potentially be saved. In this setting, the plastic surgeon earned two relatively new responsibilities. First, it was recognized that acute wound coverage was necessary to prevent ...

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