The field of plastic surgery
Plastic surgery restores impaired body function and appearance through surgical and non-surgical treatment, for example after injury, tumour removal or congenital differences. It treats people across the lifespan. “Plastic” derives from the Greek “plassein”, meaning to shape or mould; “surgery” has roots in words referring to work by hand. Together, the terms convey the idea of a shaping craft. Aesthetic or cosmetic surgery is one branch of the field and includes procedures undertaken primarily in response to a person’s wish to change their appearance.
Fields of plastic surgery
In Germany, the 1978 medical training regulations introduced plastic surgery as a recognised subspecialty, later than in some English-speaking countries. Unlike specialties centred on a particular organ, plastic surgery is defined largely by its methods, which can be applied across the body. Microsurgery, laser applications and endoscopic techniques form part of its approach. Its four main fields complement one another through shared methods and surgical techniques.
The four pillars of plastic surgery
1. Reconstructive plastic surgery
2. Aesthetic surgery
3. Hand surgery
4. Burn surgery
History of plastic surgery
The Indian physician Sushruta described surgical techniques in the Sushruta Samhita. Methods of nasal reconstruction using forehead skin were developed in ancient India, where amputation of the nose could be a punishment. This entered the history of plastic surgery as the “Indian” method of nasal reconstruction. Ancient Greek and Roman medical writings also describe approaches to nasal deformities and cleft lip repair.
Plastic surgery in the Middle Ages
The transmission and development of reconstructive techniques varied by region. During the Renaissance, detailed descriptions appeared in Europe. Gaspare Tagliacozzi (1545–1599) of Bologna left an extensive surgical work. His “De curtorum chirurgia per insitionem” describes nasal reconstruction with a pedicled skin flap from the upper arm, as well as ear reconstruction and closure of tissue defects, including those caused by syphilis.
Plastic surgery in the nineteenth century
Plastic surgery developed considerably in the nineteenth century as scientific and anatomical knowledge advanced. In the German-speaking world, Johann Friedrich Dieffenbach (1795–1847) made important contributions, with interests including transplantation, rhinoplasty and tendon surgery. His work “Der Äther gegen den Schmerz” addressed ether and pain relief. The development of modern anaesthesia during that century broadened the possibilities of surgery.
Plastic surgery after the Second World War
Following the Second World War, microsurgery developed from the 1960s onwards. It enabled surgeons to join very small vessels and nerves and transfer tissue to distant body areas with its blood supply reconnected. Refined instruments and techniques expanded reconstructive possibilities. Examples include toe-to-thumb transfer, replantation of limbs or facial tissue, and free transfer of skin and muscle to cover defects.
The modern history of plastic surgery
The development of fine sutures, improved surgical techniques and a deeper understanding of anatomy advanced surgical rejuvenation. The French surgeon Suzanne Noël was a pioneer of aesthetic facial surgery in the early twentieth century. Early experience was gained with face, breast and abdominal lifts, as well as lip and eyelid correction. Other pioneers of plastic surgery included Johann Friedrich Dieffenbach, Carl Ferdinand von Graefe, Jacques Joseph and Erich Lexer.
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Specialist training: DGPRÄC · History and four pillars: DGPRÄC