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[The history of plastic surgery (author's transl)].

The plastic surgery begins with rhinoplastic methods in the early medieval India and was unknown to Western medicine until 1400. The first European surgeon, who restored a lost nose, was Branca de'Branca in Sicily. He took the flap from the cheek, but his son Antonio Branca took the reparative flap from the upper arm, and this "Italian method" was first described by the knight of Teutonic Order Heinrich von Pfalzpaint in 1460. Antonio Branca repaired also mutilated lips and ears, and the methods employed by him and by the Vianeo family in Calabria are described by various authors, most extensively by Gaspare Tagliacozzi in his "Chirurgia Curtorum" (1597). -Soon after Tagliacozzi's death, plastic surgery fell into disuse, until in 1794 the description of a rhinoplastic operation in India brought the methods again to the attention of European surgeons and initiated the revival of the practice. German surgeons as Carl Ferdinand Graefe, Johann Friedrich Dieffenbach and Bernhard Langenbeck leaded it to its full modern development.

Ear, External↗

Cosmetic surgery procedures as luxury goods: measuring price and demand in facial plastic surgery.

OBJECTIVES: To evaluate the relationship between cosmetic facial plastic surgery procedure price and demand, and to test the hypothesis that these procedures function as luxury goods in the marketplace, with an upward-sloping demand curve. METHODS: Data were derived from a survey that was sent to every (N = 1727) active fellow, member, or associate of the American Academy of Facial Plastic and Reconstructive Surgery, assessing the costs and frequency of 4 common cosmetic facial plastic surgery procedures (face-lift, brow-lift, blepharoplasty, and rhinoplasty) for 1999 and 1989. An economic analysis was performed to assess the relationship of price and demand for these procedures. RESULTS: A significant association was found between increasing surgeons' fees and total charges for cosmetic facial plastic surgery procedures and increasing demand for these procedures, as measured by their annual frequency (P</=.003). After a multiple regression analysis correcting for confounding variables, this association of increased price with increased demand holds for each of the 4 procedures studied, across all US regions, and for both periods surveyed. CONCLUSIONS: Cosmetic facial plastic surgery procedures do appear to function as luxury goods in the marketplace, with an upward-sloping demand curve. This stands in contrast to other, traditional, goods for which demand typically declines as price increases. It appears that economic methods can be used to evaluate cosmetic procedure trends; however, these methods must be founded on the appropriate economic theory.

Attitude to Health↗

[Indications for plastic surgery (author's transl)].

The paper deals with the three main areas of indications for plastic surgery: 1. Reconstructive plastic surgery or treatment of defects resulting from trauma or disease. 2. Constructive plastic surgery or treatment of innate defects. 3. Anaplastic surgery or treatment of disfunction of appearance. By defining these different branches of plastic surgery criteria are elaborated that govern all plastic surgery. Differences between the general surgical approach and the plastic surgical approach are explained and emphasis is put on the patients' subjective situation and possible pressures from outside as well as environmental influences that may have bearing on the indication.

Breast↗

Outcomes instruments in facial plastic surgery.

The accurate measurement of patient-related outcomes of facial plastic surgery procedures relies upon the development, standardization, and use of validated, procedure-specific quality of life instruments. Although other fields of medicine and surgery have embraced the use of such instruments for the quantification and measurement of otherwise subjective or qualitative aspects of patient satisfaction, in the fields of both general and facial plastic surgery, little has been done in this realm. The study of outcomes research and the application of outcomes research to facial plastic surgery have already been discussed in this issue. Outcomes research is founded upon the ability to measure in some fashion those aspects of patient satisfaction that have hitherto been ignored or at best poorly quantified in the assessment of the results of a medical or surgical intervention. In facial plastic surgery, particularly cosmetic facial plastic surgery, the overwhelming majority of results are subjective in nature, be they patient related or based upon the surgeon's own personal assessment of outcome. For this reason, the use of validated instruments to quantify and measure these results is of particular importance in facial plastic surgery compared with other fields of medicine where many outcomes are objectively determined, such as mortality. This article outlines the background of the use of quality of life instruments in the field of outcomes research to provide a basic understanding for the application of such tools to the work of facial plastic surgery. Specific instruments that have already been developed and validated are described as well. Finally, future directions are highlighted that may allow the improved measurement of patient satisfaction as the field of outcomes research in facial plastic surgery continues to evolve.

Attitude to Health↗

A day of day plastic surgery in a district general hospital.

In spite of the suitability of the day surgery environment for most patients undergoing elective plastic surgery, day plastic surgery has not been universally adopted in the United Kingdom. The experience of one plastic surgeon gained in treating 5970 patients as day cases out of a total of 12,461 patients over 10 years is described, with emphasis on the organisation of the service by only the consultant surgeon in collaboration with a medical secretary. Thus, neither the trainee surgeon nor GP clinical assistant in the team have any administrative duties. Within a day surgery unit with a twin theatre and 12 beds, it was possible on 1 day each week between July 1991 and June 1992 to treat 954 patients of whom 678 were treated under local anaesthesia and 276 under general anaesthesia. Three patients required admission to the main hospital overnight. By this day of day plastic surgery an effective service is provided to patients convenient to their home while also releasing facilities in the main regional centre which is equipped and staffed to a higher level of reconstructive expertise. However, the patients themselves should also play a part in improving the service intended for them, and a failure to attend for surgery without prior warning adds an avoidable element of inefficiency.

Adult↗

The presentation of personalities in plastic surgery.

This research was of 133 plastic surgery patients over a 1.5-year period. Data compilation and assessment began with the initial consultation and continued through the postoperative period of care. Patients were categorized according to their similarity to the personality disorder descriptions found within the Diagnostic and Statistical Manual of Mental Disorders, third edition revised, of the American Psychiatric Association. In addition, each patient was evaluated on 13 separate psychological and social factors. It was found that many of the factors that precede a favorable plastic surgery experience, for both patients and physician, are the same characteristics disproportionately represented in various personality types. Objective assessments of surgical outcome were not found to be necessarily predictive of a patient's ultimate satisfaction. This research identified those personality types most likely to be dissatisfied, along with those personalities who tended to withhold their approval of an excellent surgical result. This research provided both statistical and qualitative analysis of the impact of personality, as well as several psychological and social variables, on plastic surgery. Numerous suggestions have been offered for successful patient care as derivative of personality type. The impact of patient and physician personality upon medical malpractice was explored. Reference summaries have been provided that describe and categorize patient behavior according to personality.

Adult↗

Periodontal plastic surgery.

Mucogingival surgery has evolved in the past decade into periodontal plastic surgery. Periodontal plastic surgery deals with those regenerative and reconstructive procedures designed not only to restore form and function but also to enhance esthetics. This paper reviews those techniques that currently comprise periodontal plastic surgery as well as the current literature pertinent to this topic. The role of the dental laser as well as its limitations will also be discussed.

Gingiva↗

Plastic surgery.

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Humans↗

Factors affecting nausea and vomiting in the plastic surgery patient.

In plastic and reconstructive surgery, nausea and vomiting are annoying and often dangerous phenomena, yet attempts to suppress them therapeutically may cause physiological actions of an undesirable nature. Nevertheless, it is possible, through clinical observation and the taking of a careful history, to identify many patients who are at highest risk of suffering undue damage from emetic episodes. Skillful selection of surgical and anesthetic measures that safely limit provocation of the vomiting reflex and the careful use of effective antiemetic drugs in patients particularly at risk can effectively reduce the incidence of what may be our patient's most unpleasant and dangerous perioperative experience.

Anesthesia↗