Plastic surgery is broadly classified into two categories: cosmetic enhancements and functionally reconstructive operations. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic. Plastic surgery includes many types of reconstructive surgery which include hand surgery, microsurgery, and the treatment of burns
Reconstructive plastic surgery is performed to correct functional impairments caused by burns; traumatic injuries, such as facial bone fractures and breaks; congenital abnormalities, such as cleft palates or cleft lips; developmental abnormalities; infection and disease; and cancer or tumors. Reconstructive plastic surgery is usually performed to improve function, but it may be done to approximate a normal appearance. The most common reconstructive procedures are tumor removal, laceration repair, scar repair and hand surgery. Some other common reconstructive surgical procedures include cleft lip and palate surgery, contracture surgery for burn survivors, and creating a new outer ear when one is congenitally absent. Plastic surgeons use microsurgery to transfer tissue for coverage of a defect when no local tissue is available. Free flaps of skin, muscle, bone, fat, or a combination may be removed from the body, moved to another site on the body, and reconnected to a blood supply by suturing arteries and veins as small as 1 to 2 millimeters in diameter.
Techniques and Procedures involved in Plastic urgery are: Endoscopic surgery. Endoscopic surgery is performed with an endoscope, a tubular probe that has a tiny camera and a bright light, which is inserted into a small cut in the skin. Images from the camera are transmitted back to a screen, which the surgeon watches while manipulating the endoscope inside the body. The endoscope is a device to assist the surgeon during surgical procedures. Instruments to actually perform the surgery are inserted through a different incision. Flap surgery. Flap surgery involves moving healthy, live tissue from one location of the body to another--often to areas that have lost skin, fat, muscle movement, and/or skeletal support. Laser technology. Lasers used in plastic surgery often provide for minimal bleeding, bruising, and scarring. There are many different types of lasers that may be used, depending on the purpose and location of the surgery to be performed. Tissue expansion. A tissue expansion is a surgical procedure that involves inserting a balloon-like device (called an expander) under the skin. The expander is then slowly filled with liquid to actually stretch and expand the skin over time. This serves the function of "growing" extra skin to repair nearby lost or damaged skin. Skin grafts. A skin graft may be used to cover skin that has been damaged and/or is missing. This surgical procedure involves removing healthy portions of skin from one part of the body to restore normal appearance and/or function to another part of the same body.
1. PLASTIC AND RECONTRUCTIVE SURGERY
Dr Sumer Yadav
Mch plastic and reconstructive surgeon
2. What Is Plastic Surgery?
The name is taken from the Greek word
“plastikos”, which means to form or mold!
Plastic surgery is a special type of surgery that
involves both a person's appearance and his or
her ability to function.
It intends to improve patients' appearance, selfimage, and confidence through both
reconstructive and cosmetic procedures.
4. There are two main kinds of plastic
surgery: employed for medical
1. Reconstructive surgery - is usually
purposes, and some common examples include:
* cleft lip surgery
* breast reconstruction surgery for those who have had
* contracture surgery for burn survivors
2. Cosmetic surgery - is done mostly for aesthetic
enhancement and includes:
- Different types of cosmetic surgery include:
Tummy tuck (abdominoplasty)
* Breast lift
* Cheek augmentation
* Breast reduction/enlargement (augmentation
5. Why do people get Plastic
To improve the appearance.
Some people ore addicted to cosmetic
To correct a physical defect or to alter a
part of the body that makes them feel
To feel better about the way they look
• To correct functional impairments caused by:
Traumatic Injuries (Facial bone fractures & breaks)
• Most common reconstructive procedures
• Microsurgery to transfer tissue
TECHNIQUES AND PROCEDURES
9. HISTORY OF
10. FIRST DESCRIPTIONS
 Description of replantation in Vedic times.
 Sushruta Samhita, compiled in 600 BC describes
Indian rhinoplasty. Also a tilemaker method.
 Indian rhinoplasty brought to attention in 1794,
B.L., Letter to Editor, Gentleman’s Magazine.
 Nicolo Manuzzi probably described Indian
rhinoplasty in early 18th century but it was not
published until 1907.
11. FATHER OF INDIAN PLASTIC
12. SUSHRUTA’S CONTRIBUTIONS TO
 Classification of mutilated ear lobe defects and
techniques for repair of torn ear lobes (15
different types of otoplasties)
 Cheek flap for reconstruction of absent ear lobe.
 Repair of accidental lip injuries and congenital
 Skin grafting.
13. SUSHRUTA’S CONTRIBUTIONS TO
Piercing children’s ear lobe with a needle or awl.
Classification of burns into four degrees and explaining
the effect of heat stroke, frostbite, and lightning
Fourteen types of bandaging capable of covering
almost all the regions of the body and different
methods of dressings with various medicaments.
Use of leeches to keep wounds free of blood clots.
14. PERIOD OF CELSUS
 First century AD.
 Compiled The Eight Books of Medicine, or De
medicina octo libri.
 Plastic surgery for repair of nose, lips and ears.
 Double pedicled advancement flap and a form
of subcutaneous island flap.
 Washing wounds with vinegar, removal of part
15. 14 – 15 CENTURIES
 14th century Flemish surgeon Jehan Yperman:
repair of harelips.
 Serafeddin Sabuncuoglu: first illustrated surgical
textbook in Turkish-Islamic literature – eyelid
problems, facial fractures, reduction
 Branca: cheek flaps for nasal reconstruction.
16. 16 CENTURY
 Tagliacozzi of Bologna: author of De Curtorum
Chirurgia per Insitionem – delayed arm flap for
nasal, ear and lip reconstruction.
 Antonio, son of Branca: upper arm flaps for
nose, ear and lips.
 Vianeo family from Calabria: reconstruction of
17. TAGLIACOZZI OF BOLOGNA
18. 17 – 18 CENTURIES
 Art of facial restoration was in much disrepute
following false ideas and perceptions.
 Reemergence from India: article published in
Gentleman’s Magazine in October 1794 in
19. 19 CENTURY
 Joseph Carpue: reconstructed 2 noses using the
 von Graefe: “Rhinoplastik” – reconstructed
noses using 3 different methods; lower eyelid
reconstruction, cleft soft palate repair.
 Dieffenbach: leeches in nose reconstruction,
bone flaps for cleft hard palate, “nose” creation
in patient’s arm & transfer – Die Operative
20. 19 CENTURY
 von Langenbeck: principles of modern cleft lip
& palate surgeries.
 Serre: advancement flap – French method of
 Dupuytren: palmar fibromatosis, burn
classification (6 degrees according to depth),
removal of lower jaw, wry neck treatment.
21. 19 CENTURY
 Z plasty: Denonvilliers – lower lid ectropion.
 Sir Astley Cooper: first human skin graft.
 Jacques Reverdin: detached pinch grafts (STSG).
 Wolfe, Krause: full thickness grafts.
22. 20 CENTURY
 Morestin: French army surgeon-reconstruction,
 Harold Gillies: NZ ENT surgeon-Father of
Modern Plastic Surgery; tubed pedicle flaps for
facial reconstruction (done earlier by Filatov),
epithelial outlay technique, intranasal skin graft,
replantation, cosmetic surgery, sex reassignment.
 Kazanjian: IMF, facial clefts, bone grafting for
facial bone loss, prosthetic devices.
23. SIR HAROLD GILLIES
24. SEPARATE SPECIALTY (USA)
 Education not standardized.
 Resistance from traditional surgeons.
 1921: American Association of Oral & Plastic
 1931: American Society of Plastic &
 1937: American Board of Plastic Surgery-efforts
25. WORLD WAR II
 Refinement in plastic surgery.
 McIndoe: early skin grafting for burns.
 Sterling Bunnell: reconstructive hand surgery.
 Converse: scalping flap.
 Earl Padgett & George Hood: development of
 Work on transplantation: Joseph Murray
received Noble Prize - work on kidney
 Millard & Marks: better approach to cleft lip and
cleft palate repairs.
 Paul Tessier et al: development of craniofacial
 McGregor’s groin flap, Bakamjian’s
 Ralph Ger: muscle flaps.
 Malt (1962): reattached an amputated arm.
 Komatsu & Tamai (1968): digital replantation.
 McClean & Buncke (1972): microvascular
28. DEVELOPMENTS IN
 Sheen: improvements in rhinoplasty.
 Cronin & Gerow: silicone gel.
 Botswick: LD for breast reconstruction.
 Hartrampf: RA for breast reconstruction.
 Illouz: fat aspiration through hollow cannulas.
29. PLASTIC SURGERY IN INDIA
 Sushruta Samhita & tilemaker method.
 Maharishi Atreya & modification to classical
 Description of rhinoplasty by Tribhovan &
Keegan in late 19th century.
 !945: maxillofacial surgical units at Kirkee &
 1950: Plastic surgery dept at Patna & Nagpur.
30. PLASTIC SURGERY IN INDIA
 1957: Plastic Surgery section of ASI: Sir Gillies.
 1960: MS degree in plastic surgery at Nagpur.
“Nagpur classification” of cleft lip & palate by
 1966: first microvascular surgery in humans in
the world done by Dr. Antia & Dr. Buch.
 1961: KEM Hospital, Dr. Pinto; “Hole-in-one”
procedure for cleft lip & palate.
31. FORMATION OF ASSOCIATIONS
 1971: Burns Association of India.
 1974: Indian Society for Surgery of the Hand.
 1992: Indian Society for Reconstructive
32. “Through all of Sushruta’s flowery language,
incantations and irrelevancies, there shines
the unmistakable picture of a great surgeon.
Undaunted by his failures, unimpressed by
his successes, he sought the truth unceasingly
and passed it on to those who followed. He
attacked disease and deformity definitively,
with reasoned and logical methods. When the
path did not exist, he made one.”