The Reconstructive Plastic Surgeon versus the Aesthetic Plastic Surgeon: Perspective

Abdulrauf Badr MD FRCSC

Published on: 2020-04-21


Although the scope of practice among plastic surgeons is quite variable in terms of Reconstructive versus Aesthetic however many are exclusively Aesthetic plastic surgeons and others are Reconstructive plastic surgeons.


Reconstructive plastic surgeons; Aesthetic plastic surgeons


Although the scope of practice among plastic surgeons is quite variable in terms of Reconstructive versus Aesthetic however many are exclusively Aesthetic plastic surgeons and others are Reconstructive plastic surgeons. Here are some thoughts after spending our first 20 years of practice in a tertiary care academic setting and experience with both Reconstructive plastic surgery and Aesthetic surgery. Reconstructive surgery has many subdivisions including: post cancer surgery reconstruction, congenital anomalies reconstruction, hand surgery, burn surgery and craniofacial surgery. There are surgeons who might have subspecialty fellowships or special interests in any of those areas, however it always comes under Plastic surgery. Aesthetic surgeons can be either originally Plastic surgeons who decided to focus mainly on Aesthetic surgery otherwise they can also be primarily Maxillofacial surgeons, ENT surgeons or Dermatologists. The Reconstructive surgeon is soften looked at as someone who deals with complex deformities and or debilitated patients, requiring staged and lengthy procedures, hospitalization, and hence a source of increased burden on health care. On the other hand the Aesthetic surgeon is looked at as someone who deals with near normal and healthy individuals undergoing certain procedure(s) for sake of improving self-image, therefore considered as an easier and swift source of income. However it is unfortunate from such authorities and administration to understand the potentials of the Reconstructive surgeon who is expected to provide aesthetically acceptable results following complex procedures [1]. An example is shown in (Figure 1), adult patient with severe sequelae of bilateral cleft lip and nose deformity. These type of cases can’t be treated by a nose job kind of routine operations. Patient is also missing the philtrum (central portion of upper lip) which needs to be recreated. This patient used to have a mask on all the time to hide his face, however finally got rid of it after completion of his reconstruction (Figure 2). It is very well known among all Reconstructive surgeons that patient’s expectations are usually very high and often unrealistic. The reason being simply is that Reconstructive surgeons are in essence Plastic surgeons.

Figure 1: Front and profile pictures of an adult with severe facial sequelae of bilateral cleft lip and nasal deformity.

Figure 2: Results two years post staged reconstruction beginning with the nose with prolabial flap and rib cantilever graft; followed by a stage of Upper lip reconstruction with an “Abbe” lip switch flap taken from Lower lip, to replace like with like.

Many people in the community including educated ones consider Plastic surgeons have a magic touch, to the extent of scar-less wound healing abilities. Every Reconstructive surgery is in essence aesthetic as well and vice versa. The reason for this can be realized by understanding the meaning of plastic surgery:

“Changing tissue’s structure while maintaining viability”. Z plasty is one of the most common simple techniques of tissue rearrangement done by plastic surgeons for various indications. If proper design and technique not followed, the tips of the Z flaps can slough or necrose due to poor perfusion. Microsurgical free tissue transfer involves distant transfer of any tissue component and reestablishing flow micro-surgically. This also carries risk of necrosis if anastomosis fails. Aesthetic surgery is not different. Wounds from Facelifts, Rhino plasty, Mammoplasty, Mastopexy, Abdomino plasty or Thigh lift may get compromised in smokers or due to poor selection or poor technique. Fat transfer procedures for face or buttocks augmentation may end up by fat necrosis. Filler injections into the face for beautification if injected to certain danger zones may lead to blockage of micro vessel and tissue necrosis. This proves the fact what Sir Harold Gillies, the father of modern plastic surgery stated over a century ago: “Plastic surgery is a constant battle between blood supply and Beauty” [2]. In fact majority of the globally known Authors of Aesthetic surgery procedures and textbooks are well known Reconstructive surgeons in the first place. As per personal communication with trainees of the late Mr. Ivo Pitanguy, who revolutionized Plastic and Aesthetic surgery in Brazil and rest of the world, often expressed to them, Reconstructive surgery and Aesthetic surgery are inseparable. Plastic Reconstructive surgery and Aesthetic surgery go hand in hand. A well trained Board certified Reconstructive surgeon is potentially capable of doing safe and successful Aesthetic practice, certainly more so than Non-Plastic surgery kind of specialties [1]. Both Reconstructive or Aesthetic surgery lines require optimum knowledge of Anatomy, surgical skills and Aesthetic sense [3]. Realizing one’s limits is a universal rule for safe practice in any given specialty.