Plastic surgery: no longer just for the rich and vain.

• Author: Rosenthal, Sheldon A.E.

THROUGHOUT the centuries, plastic surgery intimately has been involved in the re-creation of missing body parts, reanimation of paralyzed faces, and the restoration of the function of hands. It encompasses the creation, maintenance, and rejuvenation of self-esteem.

Plastic surgery comes from the Greek word plastikos, which means to fit for molding. Its origin can be traced to India, approximately 600 B.C., with the practitioner Sushruta, who reconstructed criminals' and captured prisoners' noses and earlobes that had been amputated.

The cornerstone of modern plastic surgery was laid by Gaspare Tagliacozzi in the late 1500s. His reconstructive works were known throughout Europe, and people traveled from all over to Bologna to receive his assistance.

Wars always have offered the greatest training fields for the plastic surgeon, beginning with the Napoleonic Wars. In each succeeding conflict, major breakthroughs were made in technique in the treatment of burns, facial injuries, and reconstruction, as well as prosthetic devices that offered some sort of normality, allowing injured warriors the opportunity to reclaim a form of self-esteem and dignity.

Plastic surgery as a specialty involves not only the cosmetic portion of surgery, but also the reconstruction and treatment of head and neck cancers, burns, and severe hand injury; transfer of tissue to cover defects; and the re-animation of portions of the face and extremities that lack normal movement due to trauma or paralysis.

Once thought to be only accessible to the very rich, it now is available to people in all walks of life, from the business executive who must maintain his appearance in order to hold on to a high-pressure job to the secretary who must extend her working life into her 60s and 70s. A youth orientation dominates the job market, with the best positions available to those who look the fittest, healthiest, and most youthful.

Men have realized that they, too, are entitled to look their best. During the past 20 years, the percentage of male patients seen in the plastic surgeon's office has grown from one to approximately 40.

Within the area of plastic and reconstructive surgery, four basic indications call for these procedures: genetic malformation, changes induced by childbirth, damage caused by physical trauma, and changes created by aging and excessive sun exposure.

Starting at the top of the body, the lack of hair or a chin, a prominent nose, and recessive cheekbones would...