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Plastic surgery is the branch of surgery specialising in repairing and reconstructing missing or damaged tissue and skin, usually because of surgery, illness, injury or an abnormality present from birth.
The main aim of plastic surgery is to restore the function of tissues and skin to as close to normal as possible. Improving the appearance of body parts is an important, but secondary, aim.
Plastic surgery is different to cosmetic surgery, which is surgery carried out solely to change a healthy person’s appearance to achieve what they feel is a more desirable look. There are separate pages on cosmetic surgery.
Plastic surgery can be used to repair:
Plastic surgery can also help a person recover their self-esteem and confidence following surgery.
Read more about why plastic surgery is used.
Plastic surgery for reconstructive purposes is usually carried out free of charge on the NHS. However, availability can vary around the country and is determined by local clinical commissioning groups (CCGs).
Plastic surgery is performed by plastic surgeons with extensive training who belong to professional associations, such as the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS).
Most people are referred to NHS plastic surgeons by their GP or a specialist consultant they see about their condition.
Plastic surgery is also available privately, but can be very expensive. It's still a good idea to speak to your GP or specialist first if you're considering private treatment, even if a referral isn't required.
Plastic surgery uses a wide range of reconstructive techniques, but the main ones are:
As well as these main techniques, plastic surgeons use a wide range of other methods, such as fat transfer or grafting (where fat is removed from one area and inserted in another area, usually to correct unevenness), vacuum closure (where suction is applied to a wound through a sterile piece of foam to draw out fluid and encourage healing), camouflage make-up or cream, and prosthetic devices, such as artificial limbs.
Read more about how plastic surgery is performed.
As with any type of surgery, there are risks and complications associated with plastic surgery. The degree of risk will depend on a number of factors, including whether the surgery is to a small or large area of tissue and the overall health of the person having the procedure.
Some procedures carry specific risks, but general risks include:
Read more about the possible complications of plastic surgery.
Plastic surgery can be used to correct defects present from birth or to repair skin and tissue damage caused by disease, illness or injury later in life.
It can also improve a person’s confidence, self-esteem and overall quality of life.
There are many different situations where plastic surgery may be needed, and a variety of surgical procedures can be used. Some of the most common reasons why it's carried out are outlined below.
Plastic surgery can be used to correct defects present at birth (congenital defects), including:
Plastic surgery can also be used to repair and reconstruct damaged tissue caused by problems that develop later in life (acquired problems), such as:
Plastic surgery can involve a number of different techniques to move and manipulate body tissue.
Before having plastic surgery, you should have a consultation with a plastic surgeon. They will explain in detail what will happen before, during and after surgery. You may also be given a psychological assessment.
Plastic surgery used to be confined to a procedure called a skin graft, but newer techniques such as tissue expansion and flap surgery are often used these days. These techniques are discussed in more detail below.
A skin graft is a surgical procedure where healthy skin is removed from an unaffected area of the body and used to cover lost or damaged skin.
There are two main types of skin graft:
The skin graft will usually be held in place using stitches, staples, clips or special glue. The area will be covered with a sterile dressing until it has connected with the surrounding blood supply, which usually takes around five to seven days.
A dressing will also be placed over the area where the skin has been taken from (the donor site) to help protect it from infection. The donor area of partial thickness skin grafts will usually take about two weeks to heal. For full thickness skin grafts, the donor area only takes about 5 to 10 days to heal, because it's normally quite small and closed with stitches.
At first, the grafted area will appear reddish-purple, but it should fade over time. It can take a year or two for the appearance of the skin to settle down completely. The final colour may be slightly different to the surrounding skin, and the area may be slightly indented.
Tissue expansion is a procedure that encourages the body to "grow" extra skin by stretching surrounding tissue. This extra skin can then be used to help reconstruct the nearby area.
Examples of when tissue expansion may be used include breast reconstruction and repairing large wounds.
The technique involves inserting a balloon-like device called an expander under the skin near the area to be repaired. This is then gradually filled with salt water over time, causing the skin to gradually stretch and grow.
The operation to insert the expander is usually carried out under general anaesthetic.
The time involved in tissue expansion can vary, and largely depends on the size of the area to be repaired. If a large area of skin is involved, it can take as long as three or four months for the skin to grow enough. During this time, the expander will create a bulge in the skin.
Once the skin has expanded sufficiently, a second operation is needed to remove the expander and reposition the new tissue.
This technique ensures that the repaired area of skin has a similar colour and texture to the surrounding area. There is also a lower chance of the repair failing (see complications of plastic surgery for more information) because the blood supply to the skin remains connected.
Flap surgery involves the transfer of a living piece of tissue from one part of the body to another, along with the blood vessels that keep it alive.
Flap surgery may be used for a variety of reasons, including breast reconstruction, open fractures, large wounds and improving cleft lip and palates.
In most cases, the skin remains partially attached to the body, creating a "flap". The flap is then repositioned and stitched over the damaged area.
Occasionally, a technique called a free flap is used. This is where a piece of skin, and the blood vessels supplying it, are entirely disconnected from the original blood supply and then reconnected at a new site. A technique called microsurgery (surgery using a microscope) is used to connect the tiny blood vessels at the new site.
Depending on the location and size of the flap, the operation can be carried out under general or local anaesthetic.
As flap surgery allows the blood supply to the repaired area to be maintained, there is a lower risk of the repair failing compared to a skin graft.
As with any type of surgery, plastic surgery has associated risks and complications.
The degree of risk depends on whether the surgery is in a small or large area, the surgeon's level of experience and the overall health of the person having the procedure.
Complications from plastic surgery can include:
You should discuss with your surgeon the risks associated with your particular type of plastic surgery.
If you have any concerns regarding your recovery from a surgical procedure, such as pain, swelling, discharge or any other unexpected side effects, speak to your surgeon, GP or healthcare team immediately.