This information is intended to assist those who have general questions about plastic surgery. It includes information about how plastic surgery fits into medical care, how plastic surgeons are trained, and the types of cases that plastic surgeons commonly treat. For more detailed information about a particular surgical procedure, request one of the brochures listed on the back cover of this publication. Remember, each case is unique and a great deal depends upon the patient's individual circumstances. Specific questions about surgery can be best answered in a consultation with a board-certified plastic surgeon.
History suggests that the practice of plastic surgery has ancient roots. However, plastic surgery as a defined specialty became fully recognized during World War I. Today, scientific advances in the field allow plastic surgeons to achieve improvements in form and function thought to be impossible 10 years ago.
Patients are encouraged to consider a doctor certified by the American Board of Plastic Surgery (ABPS). By choosing a plastic surgeon who is certified by the ABPS, a patient can be assured that the doctor has graduated from an accredited medical school and completed at least five years of additional residency training usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the ABPS, a doctor must also practice plastic surgery for two years and pass comprehensive written and oral exams. Good credentials do not guarantee a successful outcome, but they can guide you to select a surgeon whose training and background will help you to meet your personal goals.
Although much depends upon the patient's unique circumstances, there are certain situations that almost always warrant the specialized care that a plastic surgeon can provide. Typically, a plastic surgeon is consulted when a child is born with a defect that affects function and/or normal appearance or when accident, injury, disease, or aging causes a physical abnormality. Plastic surgeons also are consulted in hand surgery, microsurgery, and craniofacial and maxillofacial surgery.
Emergency cases, such as facial lacerations, burns, trauma, and bite wounds, are also commonly treated by plastic surgeons. A patient who requests a plastic surgeon in the emergency room -- rather than allowing the "on-duty" doctor to close a significant wound -- is more likely to be satisfied with the end result. Reconstructive surgery is covered by most health insurance policies, although the specifics of coverage may vary greatly. Some carriers may fully cover reconstructive procedures, others may pay only a portion of the cost.
Cosmetic surgery, however, is usually not covered by health insurance because it is elective and not considered a medical necessity. Some plastic surgeons accept major credit cards or offer financing programs that allow patients to make manageable monthly payments for cosmetic surgery. Keep in mind that there are a number of "gray areas" in plastic surgery that sometimes require special consideration by an insurance carrier. For example, eyelid surgery -- a procedure normally performed to achieve cosmetic improvement -- may be covered if drooping eyelids obscure a patient's vision. In assessing whether the procedure will be covered, the carrier often looks at the primary reason the procedure is being performed: is it for relief of symptoms or for aesthetic improvement.
A patient's age, skin type, general health, genetic background, and the nature of his or her condition can all affect any final result. Patients who smoke may not heal as quickly as non-smoking patients. Patients with sun-damaged skin may not achieve the same degree of improvement as those without sun-damaged skin.
Though there is no way to exactly predict a surgical outcome, the surgeon will examine the known patient variables before surgery begins and can project an estimate of the surgical result. Patients can take comfort in knowing that most of the procedures performed today have been refined over several decades.
In recent years, some plastic surgeons have begun using computer-imaging machines during consultations to show patients an estimate of post-operative appearance. A photograph of the patient is transferred to a computer screen and then altered by the surgeon to approximate the post-operative result. Doctors who use imaging find that computer-generated pictures can enhance doctor-patient communication. It's important for the patient to realize that a computer image may not match reality and represents no guarantee of outcome. No computer can take into account a patient's skin elasticity, bone structure, blood supply, and healing ability.