What is Plastic, Reconstructive, and Aesthetic Surgery? What do they do?

This surgical field can be introduced by dividing it into two parts: „Plastic and Reconstructive“ Surgery and „Aesthetic“ Surgery.

Plastic and Reconstructive Surgery (Restoration and Repair Surgery)

Plastic and Reconstructive Surgery deals with the restoration and improvement of congenital or acquired anomalies, functional and shape defects, and the improvement of body image. The word „plastic“ comes from the Greek word plasticos, which means „to shape“ or „to mold.“ „Reconstructive“ is a Latin word meaning „to rebuild.“

Plastic and Reconstructive Surgery addresses any surgical problem occurring on the body’s surface. These problems can arise from congenital conditions, trauma, or acquired causes. For example, congenital issues like cleft lip and palate, syndactyly (webbed fingers), vascular tumors (such as hemangiomas); traumatic problems like burns, facial injuries from traffic accidents, cuts, and organ amputations; and acquired conditions such as various skin and soft tissue tumors, chronic wounds, are all part of this discipline. Bone (especially facial and hand bones) and cartilage (such as ear and nasal cartilage) loss, deformities, and pathological events (tumors, cysts, infections, etc.) are also treated in this field. To address these issues, techniques such as microsurgery, laser systems, endoscopy, and various chemical agents and medications can be used.

In summary, Plastic and Reconstructive Surgery works to repair any defects (spaces) affecting the skin, subcutaneous tissue, and bones on the entire body surface. The basic principle is to repair the lost tissue with tissue similar to the one that was lost.

Areas of Interest in Plastic and Reconstructive Surgery:

• Facial deformities – Asymmetries, congenital masses, rare facial clefts
• Cleft lip and palate
• Craniofacial – maxillofacial anomalies (e.g., jaw, facial, and skull bone deformities, irregularities, deficiencies)
• Orthognathic surgery (jaw closure issues)
• Absence of the ear or prominent ear deformities
• Nasal defects, tumors, amputations
• Salivary gland issues
• Congenital tumors, nevi (moles), masses, vascular malformations, hemangiomas
• Trauma to facial bones and soft tissues
• Maxillofacial surgery (bone defects/fractures caused by accidents, tumors, and other causes, jaw surgery)
• Head and neck tumors and their repairs
• Breast absence, asymmetry, or excess breast tissue
• Post-cancer breast reconstruction
• Gynecomastia (large breasts in men)
• Congenital anomalies of genital organs (epispadias, hypospadias, vaginal agenesis, etc.)
• Genital organ repairs, replantation of amputated organs
• Chest and abdominal wall defects
• Hand surgery (trauma, tumors, finger transfers, repairs, extensions)
• Defects and deformities in hands and feet
• Peripheral nerve issues (trauma, neuropathies, defects, masses)
• Skin and soft tissue tumors
• Acute burns and deformities, contractures, shrinkages, chemical and electrical soft tissue damage
• Various infections, radiation, and other causes of wounds in the skin and subcutaneous tissue
• Chronic wounds (pressure sores, venous ulcers, diabetic foot ulcers)

The rule in plastic surgery is to first choose the simplest and least damaging method for repair. If a tissue defect is present, a graft (skin patch) is applied. If this is not suitable (for deep and complex tissue losses, open bone, and tendon injuries), flaps are used. Flaps are planned in a flowchart according to the condition and location of the defect, ranging from simple local flaps (e.g., skin flaps) to composite flaps (containing multiple tissues).

In both plastic and aesthetic surgery, autologous tissues (taken from the patient’s own body) are preferred. However, if autologous tissues are not available or suitable, other sources such as homografts, heterografts, and alloplastic materials can be used. For example, in extensive burns, skin grafts taken from healthy areas of the patient’s body are preferred. If these areas are insufficient, skin from other humans (homograft) or even animals (heterograft) can be used. Allografts other than autografts are used as temporary biological coverings and do not adhere to the wound. Another example can be given for bone loss: In cases of facial bone loss, bone is primarily taken from other parts of the body and applied to the defect. However, if this resource is insufficient or unusable, alloplastic materials (such as porous polyethylene, hydroxyapatite, titanium, etc.) can be used.

Aesthetic Surgery (Cosmetic Surgery)

Aesthetic (or cosmetic) surgery is a subfield within plastic surgery. It deals with operations and interventions aimed at enhancing body image and achieving more beauty and perfection. In aesthetic surgery, there are usually aesthetic issues rather than medical problems. Media often highlights the aesthetic aspect of plastic surgery, which is why the public may perceive plastic surgeons as only doing cosmetic surgery. However, plastic surgeons predominantly engage in reconstructive surgery (restoration surgery) in their clinics. All plastic surgeons undergo training in aesthetic surgery during their specialization and are the only specialists authorized to perform these operations. Aesthetic surgery requires long training and experience, and these operations require both surgical and artistic skills.

In aesthetic surgery, the function of an organ is just as important as its aesthetics. For example, in aesthetic rhinoplasty (nose surgery), both the shape and breathing problems must be corrected together. Common aesthetic procedures in Turkey include breast surgery (augmentation, reduction, lifting), rhinoplasty (nose surgery), body contour surgery (liposuction, lipectomy, abdominoplasty), facelift, blepharoplasty (eyelid surgery), and correction of protruding or malformed ears.

Aesthetic Surgery Areas:

• Functional and aesthetic nose correction (Rhinoplasty, septorhinoplasty)
• Facial rejuvenation (facelift, eyelid and mouth area revisions, wrinkle treatment)
• Endoscopic face-lifting, brow lifting
• Eyelid aesthetics (Blepharoplasty)
• Correction of prominent ear and other ear deformities
• Chin augmentation and reduction (Mentoplasty)
• Scar and skin irregularity treatments
• Hair transplants and replacements
• Laser applications (facial resurfacing, removal of spots, and vascular malformations)
• Aesthetic breast surgeries: Augmentation, reduction, and lifting
• Excess skin and subcutaneous fat reduction (liposuction, lipectomy)
• Abdominal surgery (Abdominoplasty)
• Leg contour correction (fat removal, injections, or implants)
• Contour corrections with implants (buttocks, thigh implants, pectoral implants in men)
• Skin care and treatments

In aesthetic surgery, both operative and non-operative methods can be used together or separately to achieve the goal. For example, in facial rejuvenation, a facelift (rhytidectomy) may be performed first, followed by chemical peeling and injection of fillers for fine lines and spots. However, aesthetic problems requiring surgery (e.g., sagging skin, localized fat deposits, hypertrophic breasts) can only be addressed through surgical methods. Some unproven methods, like mesotherapy or carboxytherapy, often performed by non-plastic surgeons, generally do not provide significant benefits.

Sub-specialties within Plastic Surgery:

• Aesthetic (Cosmetic) Surgery: Operates to improve the aesthetic and proportional appearance of the patient’s body.
• Maxillofacial Surgery: Deals with the surgery of facial bones, including fractures, tumors, and orthognathic corrections (e.g., jaw alignment).
• Craniofacial Surgery: Focuses on correcting skull bone abnormalities and deformities.
• Microsurgery: Involves operations under a microscope with specialized instruments, used for replantation (e.g., reattaching severed hands or feet) and other tissue transfers.
• Hand Surgery: Addresses traumatic injuries, congenital anomalies, and other hand-related conditions.
• Endoscopic Surgery: Uses endoscopic techniques for surgeries such as facelifts, breast implants, and vascular surgery.

Plastic and aesthetic surgery in Turkey is highly regarded for both its scientific and surgical proficiency, and patients from around the world travel to Turkey for these procedures.