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Furthermore, contrary to Delinsky’s findings, they found that media exposure did not influence the likelihood of undergoing cosmetic surgery for either sex. They accounted for this finding by suggesting that the saturation of media sources with cosmetic surgery messages has caused awareness to reach a peak (5). Thus, they suggest that the effect of media influence is no longer as pronounced as it once was. This finding, however, needs to be replicated in a different culture. Sarwer et al (10) proposed that the growing awareness of this beauty bias is partly responsible for the increased number of people altering their appearance through cosmetic procedures. This awareness may cause some individuals to attribute their low life satisfaction to their physical appearance and seek cosmetic alteration as a consequence. Related to life satisfaction is self-esteem, which previous studies have shown to be negatively associated with the likelihood of having cosmetic surgery (7). Swami et al (7) also showed a strong correlation with participants’ self-rated attractiveness and self-esteem. The trait variable of openness was consistently negatively associated with acceptance of cosmetic surgery. The increasing number of television programmes concerning cosmetic surgery, both fact and fiction, has increased public awareness of the benefits it can offer and has mainstreamed society’s awareness of cosmetic procedures (19). Crockett et al (20) showed that cosmetic surgery reality television plays a significant role in cosmetic surgery patient perceptions and decision making. Patients who watched a considerable amount of cosmetic surgery reality shows reported a greater influence from television and media to have cosmetic surgery, compared with low-intensity viewers. High-intensity viewers felt more knowledgeable about cosmetic surgery in general and believed that cosmetic surgery reality television was more similar to real life than did low-intensity viewers. Research exploring religiosity as a possible factor predicting the likelihood of undergoing cosmetic surgery is sparse. Previous research has shown that religiosity significantly predicts attitudes toward controversial topics in Western society such as abortion (21), genetic screening (22) and euthanasia (23). It is also suggested that religiously conservative individuals of all faiths will have stricter views about ‘deception’ and sins of vanity. and will be less likely to undergo cosmetic surgery than more liberal or atheist individuals. The current study aimed to expand the knowledge concerning the spectrum of reasons one may have for undergoing cosmetic surgery. It is an extension and partial replication of the studies by Brown et al (5) and Swami et al (6), focusing on the role of media consumption. Three hypotheses of the current study attempt to replicate previous findings: women will be more likely to have cosmetic surgery than men; lower self-ratings of attractiveness will predict the likelihood of undergoing cosmetic surgery; and lower ratings of self-esteem and life satisfaction will be associated with the likelihood of having cosmetic surgery. described the forehead flap. His successful use of this procedure in 1814 marked the dawn of the rebirth of plastic surgery. 1. Multiple surgeons throughout Europe compared and advanced techniques in rhinoplasty, facial reconstruction, cleft lip and cleft palate repairs including key surgeons such as Carl von Grafe (1787-1840), Johann Dieffenbach (1794- 1847) in Germany, and Jacque Delpech (1777-1832) in France. 12 B. The advent of anesthesia in 1846 introduced new capabilities for all surgical fields and allowed for the blossoming of the golden age of plastic surgery. C. Key Achievements in the golden age of Plastic Surgery: 1. Giuseppe Baronio (1758-1811) from Italy first describes the use of autologous skin graft in 1804. 2. First attempts at closing cleft palate defects by Roux and Von Grafe in France in 1819 and 1820, respectively. 3. Pietro Sabattini described lip reconstruction with the “lip switch” technique in 1838. (Figure 3) 4. Bernhard Von Langenbeck (1810-1887) outlines two mucoperichondrial flaps for cleft palate closure, described in 1862. Figure 3. Lip Switch technique described by Sabattini (1838) V. KEY FIGURES AND ACHIEVEMENTS IN MODERN PLASTIC SURGERY A. World War I created a tremendous amount of disfigured casualties with devastating reconstructive challenges which catalyzed the formation of our modern conceptualization of plastic surgeons as specialists focused on restoring bodies ravaged by war. 1. Hippolyte Morestin (1868-1919) and Charles Valadier (1873-1931) worked together, pioneering facial reconstructive surgery. 2. Sir Harold Gilles (1882-1960) – Father of the modern era of plastic surgery, developed a referral center in Europe for causalities of facial disfigurement. 3. Developed and systematically applied flap reconstructions of facial injuries. a. Employed the tubed flap, skin flaps and bone, cartilage and skin grafts. 4. Published landmark text Plastic Surgery of the Face (1920). 5. Aesthetic Plastic surgery as a distinct field is initiated with the description of the correction of prominent ears in 1881 by Edward Ely. 13 a. John Roe (1848-1915), Robert Weir (1838-1927), Jacques Joseph (1865- 1934) were early pioneers in Rhinoplasty. 1. Between 1916 and 1918, Johannes Esser (1877-1946) reported on local flaps commonly used today; cheek rotation, bilobed, island and “arterialized” flaps. 2. Training programs began developing after World War I, and spread throughout Europe and North America. 3. The American Society of Plastic Surgeons was founded in 1931 by Jacques Maliniac. 4. The American Board of Plastic Surgery was founded in 1937. 5. The Plastic and Reconstructive Surgery Journal was founded in 1946. 6. The Plastic Surgery Foundation was established in 1948. B. Since the 1960s, new discoveries have brought about a new wave of reconstructive options. 1. Paul Tessier (1917-2008) – Father of modern craniofacial surgery, revolutionary combination of intra and extra-cranial approaches for complex cranial deformities. 2. Dawn of microsurgical techniques and advancements in knowledge of anatomy leading to free tissue transfer. 3. Angiosome concept by Taylor and Palmer in 1987 led to the development of perforator flaps (Figure 4). Figure 4. History of flap development 14 REFERENCES 1. Tagliacozzi G. De curtorum Chirurgia per insitionem. Venice: Bindoni; 1597:43. 2. BL. Letter to the editor. Gentleman’s Magazine 1794;64 891–892 3. Langenbeck B. Die Uranoplastik mittelst Ablösung des mucös-periostalen Gaumenüberzuges. Arch kl Chir 1862;2:205–287. 4. Ollier L. Greffes Cutanées ou Autoplastiques. Bull Acad Méd. 1872;1:243–250. 5. Breasted J. The Edwin Smith Surgical papyrus. Published in facsimile and hieroglyphic transliteration with translation and commentary. Chicago: University of Chicago Press; 1930. 6. Tessier P, Guiot G, Derome P. Orbital hypertelorism. II. Definite treatment of orbital hypertelorism (OR.H.) by craniofacial or by extracranial osteotomies. Scand J Plast Reconstr Surg. 1973;7:39–58. 7. Tessier P. Experiences in the treatment of orbital hypertelorism. Plast Reconstr Surg. 1974;53:1–18. 8. McDowell F. The Source Book of Plastic Surgery. Baltimore: Williams & Wilkins; 1977. 9. McDowell F. History of Rhinoplasty. Aesth Plast Surg.1978;1:321–348. 10.Klasen H. History of free Skin Grafting. Berlin: Springer;1981. 15 CHAPTER 4 TECHNIQUES AND PRINCIPLES Nicole A. Phillips, MD and Ash Patel, MBChB, FACS Plastic surgery is a specialty defined by principles and techniques, rather than by organ system or disease process. The subdivision of plastic surgery into two types of surgical procedures—reconstructive and cosmetic—is another unique aspect of the specialty. While the dividing line between the two is sometimes very clear, there is often a significant amount of overlap. The goal of reconstructive surgery highlights this overlap: “the restoration of form and function.” Both reconstructive and aesthetic surgery rely on a detailed knowledge of anatomy and the foundational principles and techniques outlined below. I. EVALUATION AND PLANNING A. Define the defect 1. What is missing or abnormal? a. Tissue layers B. Disruption of vascular or neural network C. What is left behind? D. Is the surrounding tissue healthy, or has it been compromised (i.e. radiation therapy, burns, traumatic injury)? E. What local tissues are
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