Plastic Surgery — Find Specialists & Top Hospitals Worldwide | MyMedicPlus

Plastic surgery is a broad surgical specialty that encompasses two distinct but overlapping domains: reconstructive surgery, which aims to restore normal form and function lost to disease, trauma, or congenital conditions; and cosmetic (aesthetic) surgery, which enhances appearance in patients without a medical deformity. The word 'plastic' derives from the Greek 'plastikos' meaning to mould or shape — reflecting the specialty's fundamental commitment to reshaping tissue to meet individual patient goals.

Reconstructive plastic surgery is performed to correct structural abnormalities that impair function or cause psychological distress. It addresses a vast range of problems including post-mastectomy breast reconstruction, complex wound closure after cancer resection, repair of cleft lip and palate in newborns, restoration of hand function after tendon or nerve injury, coverage of severe burn injuries with skin grafts and flaps, and correction of congenital facial deformities. Reconstructive procedures are medically necessary and are typically covered by health insurance.

Cosmetic plastic surgery modifies aesthetically normal structures to improve appearance and body image. Common cosmetic procedures include rhinoplasty (nose reshaping), facelift, blepharoplasty (eyelid surgery), breast augmentation, abdominoplasty (tummy tuck), and liposuction. These procedures are elective and generally not covered by health insurance.

Within plastic surgery, several subspecialties have developed. Microsurgeons perform complex free tissue transfers using operating microscopes to anastomose vessels as small as 1 millimetre. Hand surgeons address nerve, tendon, and bone injuries of the hand, wrist, and forearm. Burns surgeons manage complex burn injuries requiring excision and grafting. Craniofacial surgeons correct craniosynostosis, midface hypoplasia, and complex facial fractures. Paediatric plastic surgeons address congenital deformities. Oculoplastic surgeons reconstruct eyelids and orbits.

Plastic surgeons manage a wide spectrum of reconstructive and cosmetic conditions:

• Cleft lip and palate: Congenital failure of facial fusion causing a split in the upper lip and/or roof of the mouth, requiring staged surgical repair beginning in the first months of life.
• Post-mastectomy breast reconstruction: Restoring breast shape after mastectomy for breast cancer using implant-based techniques, autologous flap procedures (DIEP, TRAM, LD flap), or a combination.
• Burn injuries: Thermal, chemical, or electrical burns requiring acute excision of non-viable tissue, skin grafting, and subsequent scar management and reconstructive procedures.
• Complex wounds and skin defects: Traumatic wounds, post-surgical defects, and pressure ulcers requiring local, regional, or free flap closure when primary closure is not possible.
• Hand injuries and disorders: Including flexor and extensor tendon lacerations, digital nerve injuries, Dupuytren's contracture, and complex hand fractures requiring surgical expertise in microsurgical techniques.
• Facial trauma: Repair of facial fractures (zygomatic, orbital, mandibular, nasal), soft tissue lacerations, and eyelid injuries.
• Skin cancer excision and reconstruction: Wide local excision of melanoma, squamous cell carcinoma, and basal cell carcinoma with reconstruction of the resulting defect using flaps, grafts, or primary closure.
• Lymphoedema: Surgical management of chronic limb swelling from lymphatic obstruction using lymphovenous anastomosis or vascularised lymph node transfer.
• Keloid and hypertrophic scars: Abnormal scarring after injury or surgery treated with excision, steroid injection, silicone gel, pressure garments, and radiation.
• Congenital hand deformities: Including syndactyly (fused fingers), polydactyly (extra digits), and thumb hypoplasia requiring staged surgical correction.

Plastic surgeons perform an exceptionally diverse range of surgical procedures across both reconstructive and cosmetic domains:

• Split-thickness and full-thickness skin grafting: Harvesting skin from a donor site (thigh, back) and transplanting it to cover burns, wounds, or post-excision defects where primary closure is not possible.
• Local and regional flap reconstruction: Rotating adjacent vascularised tissue to cover nearby defects — including rotational, advancement, and transposition flaps for wound closure on the scalp, face, trunk, and extremities.
• Free tissue transfer (microsurgery): Harvesting a block of tissue (skin, fat, muscle, bone) along with its supplying blood vessels from a distant donor site and microsurgically anastomosing these vessels to local recipient vessels at the defect site.
• DIEP flap breast reconstruction: Deep inferior epigastric perforator flap using abdominal skin and fat — while preserving the rectus muscle — to create a natural breast mound after mastectomy.
• Cleft lip and palate repair: Staged surgical correction beginning with lip repair at three months and palate closure at 9–12 months, with subsequent procedures for alveolar bone grafting and orthognathic surgery.
• Rhinoplasty: Surgical reshaping of the nasal framework — bones, cartilage, and soft tissue — for cosmetic improvement or functional correction of airway obstruction.
• Facelift (rhytidectomy): Tightening of facial skin and underlying SMAS layer to reduce the signs of facial ageing.
• Blepharoplasty: Excision of excess upper or lower eyelid skin and fat to improve hooding, puffiness, and age-related eyelid changes.
• Abdominoplasty (tummy tuck): Removal of excess abdominal skin and fat with rectus muscle plication to restore abdominal contour after significant weight loss or pregnancy.
• Dupuytren's contracture release: Surgical fasciotomy or fasciectomy to release the contracted palmar fascia causing finger flexion deformity.

Plastic surgery consultation is appropriate in the following situations:

• Cancer reconstruction: After excision of any skin, breast, oral, head and neck, or soft tissue cancer that leaves a defect requiring reconstruction beyond simple primary closure.
• Mastectomy planning: Women undergoing mastectomy for breast cancer should ideally be referred to a plastic surgeon before surgery to discuss immediate versus delayed breast reconstruction options.
• Burn injuries: Any burn covering more than five percent of total body surface area, full-thickness burns of any size, or burns of the hands, face, or perineum should be assessed by a burns and plastic surgery team.
• Complex traumatic wounds: Wounds with exposed bone, tendon, joint, or neurovascular structures that cannot be closed primarily require plastic surgery consultation for flap coverage planning.
• Congenital deformities: Children born with cleft lip and palate, ear deformities, haemangiomas, or hand abnormalities should be referred to a paediatric plastic surgery centre in the first weeks of life for planning.
• Hand tendon or nerve injury: Lacerations over the palm, fingers, or wrist with suspected tendon or nerve involvement require urgent plastic or hand surgery assessment.
• Functional scar management: Scars causing contracture that limits joint movement or functional impairment warrant plastic surgery assessment for release and resurfacing.

Plastic surgery requires one of the most extensive surgical training pathways in medicine. In the United States, the pathway begins with a four-year medical degree (MD or DO). Two training routes are available: the independent pathway (a three- to five-year general surgery residency followed by a two- to three-year plastic surgery residency or fellowship) and the integrated plastic surgery pathway (a six-year combined programme that directly trains in plastic surgery from the start).

During training, residents develop competency in wound management, skin grafting and flap surgery, microsurgery, hand surgery, burns surgery, craniofacial surgery, breast reconstruction, and both reconstructive and cosmetic procedures across the face, breast, trunk, and extremities. Microsurgical training is intensive and requires practice on animal models before clinical application.

Subspecialty fellowships of one to two years are available in hand surgery, microsurgery, craniofacial surgery, burns, and aesthetic surgery. Hand surgery fellowship is required for Certificate of Added Qualifications (CAQ) in Hand Surgery, which is shared with orthopaedic and general surgeons.

Board certification is awarded by the American Board of Plastic Surgery (ABPS) upon passing written and oral examinations. In the UK, plastic surgeons hold FRCS (Plast). Patients should verify that any surgeon performing plastic or cosmetic procedures is board-certified in plastic surgery through the ABPS or their national equivalent — many non-surgeon practitioners offer cosmetic procedures without equivalent surgical training.

Reconstructive plastic surgery referrals typically come from oncological surgeons, burns units, orthopaedic trauma surgeons, paediatricians, and emergency surgeons. For breast reconstruction, ask your breast surgeon to refer you to a plastic surgeon before mastectomy, so reconstruction options can be discussed as part of your overall surgical plan.

For cosmetic procedures, always verify board certification in plastic surgery through the American Board of Plastic Surgery (ABPS) or your national surgical board. The term 'cosmetic surgeon' is not a protected title in many countries — practitioners from non-surgical backgrounds may offer cosmetic procedures without equivalent training. Ask your surgeon for their specific training credentials, their annual volume of the procedure you are considering, before-and-after photographs from their own patients, and a clear explanation of risks, recovery, and realistic outcomes before proceeding with any elective cosmetic procedure.