Psychological aspects of plastic surgery
Between pressure sore surgery and cosmetic surgery? No complete definition exists. What is plastic surgery? Joe McCarthy defines it as the “problem-solving specialty. An even more grandiose definition is the following from a plastic surgery resident: “Plastic surgery is surgery of the skin and its contents.” There is no way to define this specialty that has acquired “turf” through a combination of tradition and innovation.
No specialty receives the attention from the lay press that plastic surgery receives.Traditional areas of expertise can be lost as other specialties acquire the skills to perform the procedures developed by plastic surgeons. Because plastic surgery has loose boundaries and no specific anatomic region, it faces competition from regionally oriented specialties. Plastic surgery has only traditional areas of expertise and principles on which to rely for its existence and future. Unlike other surgical specialties, plastic surgery is not organized around a an organic system. Even if one asks, as an insurance company does, about the functional importance of a particular procedure, the answer often hinges on the realization that the function of the face is to look like a face (i.e., function = appearance).
Certain anatomic areas routinely produce unfavorable scars that remain hypertrophic or wide. The shoulder and sternal area are such examples. Conversely, eyelid incisions almost al¬ways heal with a fine-line scar. Skin loses elasticity with age. Stretched-out skin, combined with changes in the subcutaneous tissue, produces wrinkling, which makes scars less obvious and less prone to widening in older individuals. Children, on the other hand, may heal faster but do not heal “better,” in that their scars tend to be red and wide when compared to scars of their grandparents. In addition, as body parts containing scars grow, the scars become proportionately larger. Beware the scar on the scalp of a small child!
Just as the recoil of healthy, elastic skin in children may lead to widening of a scar, tension on a closure bodes poorly for the eventual appearance of the scar. The scar associated with a simple elliptical excision of a mole on the back will likely result in a much less appealing scar than an incisional wound. The body knows when it is missing tissue. The direction of a laceration or excision also determines the eventual appearance of the scar. The lines of tension in the skin were first noted by Dupuytren. Langer also described the normal tension lines, which became known as “Langer lines.”
Elective incisions or the excision of lesions are planned when possible so that the final scars will be parallel to the relaxed skin tension lines. Maximal contraction occurs when a scar crosses the lines of minimal tension at a right angle. Wrinkle lines are generally the same as the relaxed skin tension lines and lie perpendicular to the long axis of the underlying muscles.
Plastic surgery is a branch of the Medicine and its modern developments are discussed in
chirurgia estetica while its psychological issues are in
idee regali
