Discover the article Principles of plastic surgery which gives a very original vision of the essence of the profession, and introduces the encyclopedia

Plastic surgery brings together cosmetic surgery and reconstructive surgery (CPRE). The plastic surgeon has a therapeutic arsenal used for different purposes: to restore a so-called “normal” form/aspect in the first and to perfect a “normal” form/appearance from the outset in the second. To better understand this specialty, it is necessary to integrate the fuzzy limits of its definition. While other specialties are defined by the organ (heart, lungs, etc.) or function they treat (locomotion, hearing, etc.), aesthetic and reconstructive plastic surgery has no no organ or function limit. Some call it a “specialty of non-visceral soft tissues” to refer to the skin and soft tissues of which we are the surgical specialists in the same way as the dermatologists who are their medical equivalents. However, this definition ignores the competence of plastic surgeons in bone surgery when covering the limbs or even rhinoplasty or any facial bone procedure. Moreover, the boundaries with other specialties are thin, if not non-existent. This is the case for breast surgery, which is performed sometimes by gynecologists and/or senologists, sometimes by plastic surgeons. The latter are most often interested in the form, in the plastic in the common sense of the term, while the senologists are more concerned with the gland and its diseases.

This peculiarity can give some people the illusion that it is enough to learn the technical gestures to become a visual artist when this is not the case. The technique must certainly be learned and mastered, but it cannot be sufficient on its own. Only the multifactorial approach of the patient’s field, his expectations, the objective of the treatment and the context in which the surgeon works will be able to qualify the plastic surgeon and define the protean contours of the specialty. The practitioner’s “multientry” way of thinking is not unique to our specialty, but it is exacerbated in our field. Applying the methods without this multiple data

The art of cheating

Cheating, in the noble sense of the term of course, by adapting the processes, the tissues, and the means available to a given patient. The illustrations of this principle are numerous and here are some examples:

the scars of our approaches are as far as possible hidden or at least placed where they are discreet, respecting the lines of tension and the natural folds of the skin. This concept is particularly implemented in cosmetic surgery (breast implant placement via the submammary or axillary route, cervicofacial lifting with an incision around the ear, etc.) but also in reconstructive surgery (closure of a cleft lip with a scar on the philtral crest, removal of a skin graft from the scalp, brachioplasty with scar on the inside of the arm, etc.). This notion sometimes gives our patients the illusion that we are working without a scar. The art of cheating with elegance.

The art of plugging holes

As a corollary to the previous concept, plastic surgeons excel in the art of moving tissue in order to cover or reconstruct another part of the body. All tissue grafts (skin, fat, bone and cartilage) testify to this. Already, directed healing, at its modest but useful level and far from being as simple as it looks, makes it possible to obtain the healing of many wounds without surgery provided that the analysis of the terrain is relevant. However, it is obviously flap surgery in the broad sense that best expresses this concept. Moreover, it is these shreds that most often appeal to young students attracted by the specialty. The beauty of the gesture.

The art of rebuilding

Repairing missing parts of the body, such as the breast or the nose, repairing the body damaged by massive weight loss, restoring skin traumatized by an animal bite, a serious burn or a road accident are all examples of this objective center of the plastic surgeon.

More implicitly, reconstruction also has a psychological content, the importance of which is willingly underestimated by our detractors who see a certain futility in our actions, especially when it comes to cosmetic surgery. These people are seriously mistaken and misunderstand the impact of these gestures that allow patients to literally feel better about themselves.

Eye for detail

Visual artists are often obsessed with detail, the well-done overlock, the appropriate dressing, the precise line. This meticulousness is put to the service of microsurgery which makes it possible to revascularize displaced tissues, for example during digital or limb replantation, elsewhere for coverage after mutilation imposed by dermatological cancer surgery. This attention to detail is obviously found at the heart of cosmetic surgery, which is wrongly despised. The fine analysis of the anomalies of a nose deemed unsightly is a fine example of this exacerbated sense of detail.

The beautiful is not contemptible

If most often the plastic surgeon thinks by using the algorithm “from the simplest to the most complicated” for his therapeutic choices, he tends readily to imagine other different and creative solutions. Routine does not necessarily suit this specialty and those who practice it and who constantly seek to evolve, advance and invent. It is in this desire to renew itself that this specialty finds all its charm and its raison d’être.

Conclusion

Aesthetic and reconstructive plastic surgery is a multiple and protean surgery which in essence is practiced in many fields, hence the willingly multidisciplinary care, and at all ages in the life of our patients. As such, it is readily considered the last general surgery.