PLASTIC SURGERY
PATIENTS BENEFIT GREATLY FROM an Era
of Enormous Progress in Plastic Surgery
Gordon Tobin, MD
P
lastic surgery has experienced
spectacular progress over the
past half-century, with greatly
increased benefits to the patients
served. American plastic surgeons
have led the world in this effort, and Louisville
has contributed substantially to the progress.
During this time, the field has generated many
areas of focused skills, with involved practitioners developing sub-
specialty expertise. This report will summarize the broad progress of
the recent era, as well as significant developments in specialty areas.
The term “plastic surgery” is derived from Ancient Greek de-
scribing the creation and molding of form. Broadly, the specialty
combines aesthetic skills focused on improvement of appearance,
reconstructive skills focused on restoring lost function, and applied
wound healing science. In practice, these three elements are assem-
bled as needed in customized surgical plans to address individual
patient needs. Thus, plastic surgery is a blend of art and science that
requires creativity and a broad set of skills that can be drawn upon
in unique combinations to create optimal outcomes. An interesting
feature of modern plastic surgery is incorporation of the newest
biologic technology alongside some of the oldest known surgical
procedures. Examples of new technologies include transplantation
of hands, faces and other structures; a field that was pioneered in
Louisville. Examples of ancient surgical procedures still used are
current nasal reconstruction techniques, which closely resemble
those developed in India over 2,500 years ago. Vascularized tissue
transfers called “flaps” originated in Europe in the Middle Ages,
but these have become much more effective by modern discover-
ies of vascular anatomy and microvascular vessel suturing; again,
techniques pioneered in Louisville.
AESTHETIC SURGERY
The public image of plastic surgery is largely that of aesthetic surgery,
the crafting of enhanced appearance and beauty. The origins of this
field come from early 20 th century efforts to surgically sculpt and
improve features, such as in aesthetic rhinoplasty, or to modify skin
relaxation and sagging associated with aging by selective excisions
and tissue repositioning, such as in the classic face-lift procedure.
In recent years, these procedures have been refined and joined by
new technology such as tissue fillers and skin resurfacing/rejuve-
nating agents. In addition to facial surgery, a substantial component
of aesthetic surgery is focused on aesthetic remodeling of breasts.
Reductions of excess size combine reconstructive and aesthetic goals.
Augmentations use prostheses developed in the US from advances
in the silicone industry in the 1960s. Another significant aesthetic
area is liposuction for selective subcutaneous fat reduction, which
was pioneered in France in the 1970s. Coming from the liposuction
procedure have been techniques for reintroduction of aspirated fat
as subcutaneous grafts to enhance form in a variety of sites. Now,
biochemical products of modified fat aspirates are showing great
promise in emerging new therapies. Studies at the University of
Louisville (UofL) Cardiovascular Innovation Institute place UofL
in the forefront of this area.
CANCER RECONSTRUCTION
A major plastic surgery technique is tissue transfer via vascularized
flap of skin, muscle and other tissues. These techniques, many
introduced at UofL, have become a pillar of reconstruction for
cancer resection defects in all areas of the body. A common current
application is breast reconstruction after mastectomy using large
skin-muscle flaps that were pioneered in the 1970s. Additional
breakthroughs derived from these flap transfers have been recon-
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