There were 17.5 million non-invasive cosmetic surgical procedures carried out in the US in 2017, according to the American Society of Plastic Surgeons. This 200% increase compared to the year 2000 can be attributed to technological advancements. Technological innovation and advancements in healthcare have shaped the evolution of plastic surgery in the last century. Evidence suggests that a high correlation between patents and publications during periods of growth is indicative of substantial innovation. In the plastic surgery field, between the year 1960 and 2010, there were 43,118 publications and 4651 patents retrieved. In the same period, the best performing technology lots in cosmetic surgery were tissue engineering, reconstructive prostheses, and non-invasive practices.
The evolution of cosmetic surgery
Classically, plastic surgery dealt with congenital deformities, management of trauma, cancer removal and reconstruction and aesthetic surgery. Presently, plastic surgery over the last half-century, has seen radical mind-blowing changes. The practice has become more specialized. These specialists, have started to perform surgeries formerly done by plastic surgeons, like; breast surgeons reconstruct breasts, maxillofacial surgeons repair cleft lips and palate, ENT surgeons do head and neck reconstructions, and orthopedic surgeons treat hand problems. More developments in the cosmetic surgery field are evident through surgical advances. These include microvascular surgery, tissue engineering, and minimally invasive endoscopic approaches.
Microvascular surgery – tissue transfer
Microvascular surgery has come to stay. The practice has now become mandatory training for younger plastic surgeons as well as those in other specialties. It has enhanced the possibilities of transferring small and large chunks of tissue from one part of the body to another. Large deformities created in resulting cancers are now aesthetically covered by these free flaps. Breast surgery, both constructive after mastectomy, or cosmetic like mammoplasty, has developed with the TRAM and other muscle flaps tissue expansion. A free flap for the reconstruction of breasts is the preferred method of many surgeons compared to the pedicled flap.
Tissue engineering revolutionizes burn therapy
With a better understanding of the fundamental cellular response to external stimuli and the tissue culture technique, medical scientists are able to manipulate the behavior of cell lines in vitro, and wound care is one of the first fields to recognize the benefit of tissue engineering. In burns, the older technique of frequent painful dressing, wound infection and high morbidity and mortality has given way to treatment in specialized intensive care units. Specialists are more informed on inhalation injuries, early excision and grafting, early enteral nutrition, and tissue engineering. They can create skin culture in spray form and in fewer days. Newer skin substitutes like Integra for example, have considerably brought down the morbidity and mortality of burns.
Minimally invasive endoscopic approaches
In plastic surgery, which does not involve cavities, the advantages of minimally invasive procedures are less in terms of decreasing morbidity but are potentially still substantial. In addition, there is a necessity to create an optical cavity in soft tissue dissection rather than work on a preexisting space, and this has necessitated the development of endoscopes that also hold tissues apart. Since then, the techniques of limited-incision surgery have been widely adapted, with the endoscope frequently serving as an assist or adjunct, but nonetheless important. The areas in which this type of surgery has found the broadest applications in plastic surgery are: selected cosmetic procedures of the face; particularly the browlift, and the carpal tunnel approach – which avoids a scar across the proximal palm.
Technological advancements will continue to revolutionize and transform this specialty for decades to come. There is an extensive list of resources plastic surgeons can use to make surgery more personalized and efficient. Simulation applications for example, allow surgeons to practise required procedures before doing it on actual patients. Computerized planning using CT Scans is another major way technology has improved on plastic surgery procedures. The use of technology is indeed crucial to advancing the next generation of plastic surgeons.