Plastic surgery is often thought of as the surgery of face lifts, invisible scars, and the body beautiful. Interestingly enough, it is often the most attractive who request treatment, as well as those with gross abnormalities.
More and more people in the U. S. are having their face lifted and wrinkles and crow feet removed, as they believe it makes them feel and look good and improve their performance at work. In some countries, however, debate continues on whether or not this sort of surgery is a luxury and whether it should be available on the public health service. The commonest cosmetic operation is nose reduction or reshaping – one of the most satisfying operations carried out by a plastic surgeon, since its effect is immediate. The result depends not only on the surgeon’s technique, but also on the way in which the patient’s tissues heal.
Breast operations, in which breasts are enlarged by the insertion of silicone implants, are becoming common. Unfortunately, in about 10-20 per cent of these operations the breasts become hard, ugly, and tender and require surgery to remove and replace the implant. Simple breast massage can sometimes prevent this distressing side effect. There are also operations for reducing breast size and for firming up drooping breasts. In recent years, there has been an attempt to reconstruct breasts for women who have had a breast removed because of cancer. These reconstructions are never breasts in the true sense, but rather a mound of flesh of similar size. Patients, therefore, have to be properly counseled before these operations, to avoid disappointment.
In the management of people requesting a sex change, the plastic surgeon will carry out surgery only at the request of a psychiatrist. Most operations are carried out to change men into women, of which the most radical is amputating the male genitalia and using the skin of the penis to line a newly created vagina. Other surgical sex-change procedures include increasing the size of breasts, changing the shape of the face and electrolysis to remove hair from the beard. The surgical change of a woman into a man has been much less successful, however, mainly because of the difficulty in constructing a satisfactory penis.