We can no longer use only the term “cosmetic surgery” to describe the wide and increasing array of medical procedures available for the purpose of enhancing appearance. Therefore, I use the terms cosmetic medical care, cosmetic medical service, cosmetic medicine, cosmetic intervention, and cosmetic procedure to refer to any operation or less invasive medical procedure that is performed on what most people would consider normal features, usually for the purpose of lessening or enhancing their prominence, correcting minor irregularities that would be too minimal to qualify as reconstructive surgery, or reducing the signs of childbearing or aging. In general, people seek cosmetic interventions to change aspects of their bodies that they consider unfl attering.
Certain cosmetic procedures may be described as minimally invasive; these are procedures such as injections, laser treatments, dermabrasion, and chemical peels that may cause less severe injury than a major operation. Minimally invasive does not necessarily mean minimally risky patients have died from procedures that are sometimes dismissed as minor and certain procedures, like liposuction, are considered invasive surgery even though they are performed through very small incisions. In fact, the size of skin incisions per se has little to do with the invasiveness or risks of a procedure. It is also inappropriate to consider procedures such as full-face ablative laser resurfacing and phenol chemical peels to be minimally invasive, as both create significant burns.
Noninvasive procedures are those in which there is no significant penetration of or damage to skin and underlying tissues. These procedures include certain laser and light-based treatments, microdermabrasion, and numerous newer procedures that may or may not have any measurable effects. Nonphysicians in nontraditional medical facilities such as spas and salons offer a variety of minimally invasive and noninvasive procedures.
Because many cosmetic medical services are not surgical and many providers are not surgeons, I frequently use the general terms “provider” and “practitioner” to refer to anyone offering cosmetic medical care services.
Cosmetic surgery is any invasive surgical procedure performed by anyone, regardless of training, for the purposes mentioned above. Most people do not understand the distinction between a cosmetic surgeon and a plastic surgeon. Cosmetic surgeon means the same thing in this article as it does in the marketplace: it refers to any physician, regardless of qualifications, who performs cosmetic operations. Aesthetic surgery and aesthetic surgeon are terms used interchangeably with “cosmetic surgery” and “cosmetic surgeon.” In this article I use the term plastic surgeon only in reference to physicians fully trained in cosmetic surgery.
Cosmetic surgery is used to denote the spectrum of operations typically performed by plastic surgeons, which includes operations on virtually all body parts rather than on a defined anatomic area (for example, the head and neck region or the eye region) or on an organ system (such as the digestive system or the skin). Many people have no idea what plastic surgeons do beyond cosmetic surgery.
Plastic surgeons can replant an amputated finger and keep it alive, build a missing ear from scratch using other body parts, close a gaping leg hole that resulted from a motorcycle accident, repair an infant’s cleft lip and palate, and treat the wounds of a child burned in a house fire. Most people do not know that the first successful kidney transplant was performed by a plastic surgeon who won a Nobel Prize for this accomplishment. Plastic surgeons also perform breast reconstructions and reductions, treat facial trauma and burns, perform hand surgery, correct congenital deformities, treat skin cancers, execute many forms of tissue transfer to heal wounds, and perform all types of cosmetic surgery.
Certain features of cosmetic medical care make the physician patient encounter quite different from most other kinds of medical interactions:
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