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Frequently Asked Questions (FAQ)

Q: Why Plastic Surgery is called Plastic Surgery?
A: Actually when field of Plastic surgery was evolving after world war II , the material of plastic was discovered and people were making different items from one single material by moulding it, like they were making cup, spoon and bowel from the same plastic. In the same way surgeons were moulding tissue and using it for making nose, ears, lips etc.etc. So basically it was the moulding property of plastic and this surgical specialty that earns its name to Plastic Surgery.

Q: Tell us brief history of Plastic Surgery in Pakistan?
A: Plastic surgery basically is a branch of surgery that deals with the restoration of form and function. In Pakistan this specialty unit in teaching hospital was started at Dow Medical College & Civil Hospital, Karachi by Prof.K.M.Durrani in 1965.In 1973 Dr.Gool Talati joined this unit as Honorary Senior Registrar. In 1976 Prof.Faiz Mohammad Khan Started Unit at JPMC.In mid eighties Prof.Shaista joined the dept. and at same time plastic surgery unit were established at King Edward, Lahore and PIMS, Islamabad. In early nineties Units were established in teaching institutes at Hyderabad, Faisalabad , Multan, Peshawar and Quetta.

Q: There is common concept among lay public and even among some of doctors that Plastic surgery is just for beautifying the people. What do you say about it?
A: Yes ,you are very right in this regard .People have this concept I think , because of fiction novels or movies. The real concept is this that Plastic Surgery is broadly divided into Reconstructive Surgery and Aesthetic (Cosmetic) surgery. In reconstructive surgery we correct or repair all those defects or deformities present since birth or acquired latter on because of trauma, accident, cancer surgery and burns. In Cosmetic surgery we make the things from normal to better which nature has given to us. Remember Cosmetic surgery is one of the branches of Plastic Surgery. Plastic surgery is not only cosmetic surgery. The other branches are Hand surgery, Dermatological surgery , Head and neck surgery, Cleft Surgery, Uro-genital Surgery & Hair Restoration Surgery.

Q: What Congenital problems you commonly encountered in Reconstructive Surgery and at what is optimal age for their repairs?
A: The most common congenital problems we encountered in reconstructive surgery are of Cleft lip, Cleft palate and Hypospadias.

Cleft lip can be reapired at any time after three months of age.Cleft palate should be reapired between one to one and half year of age and Hypospadias should reapired at the age of three years.

One should avoid circumcision in cases of Hypospadias.

Q: Why the patients develop deformities after burns and which deformities you correct?
A: When patient gets burn two types of wound occur, one the superficial and other deep. Superficial wounds they heal in about two to three weeks time. Deep wounds they never heal and require skin grafting of wounds. If deep wounds are present on the flexor aspect of joints and they are not skin grafted, they ultimately heal by process of contraction of wound by myo-fibroblasts. This result in contracture and deformity like contracture of neck, axilla, elbow, hands , groin and knee.

Q: What post traumatic deformities you correct?
A: Trauma to any part of the body result in loss or dysfunction of that part. We mostly correct all post traumatic deformities of hands, face, scalp, penis, feet etc.

Q: You said that Dermatological surgery is branch of Plastic Surgery. Can you elaborate on this?
A: Plastic surgeons deal with both benign & Malignant skin lesions. Benign skin lesions dealt by Plastic surgeon are Rhinophyma, Keratoacanthoma, Lymph edema, Hairy nevus, Diabetic trophic ulcers, Xanthoma Palpebarum, Post traumatic scar marks, Tattoo marks, Enlarged Ear piercing, Hypertrophic scars & Keloids, Non healing wounds, Mole, Cyst, Lipoma.

Among malignant lesions Basal cell carcinoma, Squamous cell carcinoma & Malignant melanoma involving any part of body are dealt.

Q: There is a common concept among lay public that Plastic Surgeons can change the face of any person, like you can become any celebrity you like. How far it is true?
A: Because of fiction, movies and electronic media mis-information, there are many false concepts among lay public and this is one of them. In Plastic surgery you cannot change the face of a person, yes, you can modify it slightly, like you can modify lips, nose, and ears and remove wrinkles. This will alter the features of a person but will not change the face.

Q: Do you use any plastic material in plastic surgery?
A: No we don’t. Most of the time tissue used in plastic surgical procedures is autogenous i.e. obtained from the patient,i.e. skin,bone,and cartilage. Implants made of silicone are available and sometime used in nose reconstruction and breast augmentation.

Q: Are there any scars after plastic surgery?
A: This is also very common mis-concept. Scars are always in plastic surgery but we try to put our incisions in such way as to avoid ultimate and final scars that are obvious. Usually scar in natural skin lines fades in 3 to 6 months time.

Q: Is it true that Plastic surgery involves many stages?
A: Yes in a way you are right. In complex reconstructive problems we require large amount of tissue which we raised in the form of flaps and transform in stages to maintain its blood supply.

Q: Is plastic surgery is very expensive?
A: Well this is economic question and based on the principle of demand and supply. The more the plastic surgeons would be there, more would be the competition and less would be the cost. At the moment in Pakistan there are 40 plastic surgeons and in Karachi alone there are 20 plastic surgeons. Every major city has got plastic surgery unit in teaching hospital. People can go there for surgery. In Karachi there are many trust hospitals that offer plastic surgery at very nominal rates.

Q: Do every procedure of plastic surgery require skin graft?
A: Lay public think that only those procedures in which skin and bone is taken form one part of body and transplanted to other part is plastic surgery procedure. This is a wrong concept. No doubt this is a plastic surgical procedure, but, there are many procedures in which we donut add tissue but we remove tissue to give it better look and function like breast reduction, excision of Rhinophyma, excision of neuro fibroma etc. etc.

Q: Can skin of one person can be applied to another?
A: No, not on permanent basis. Yes for few days one can place a skin graft of one person to another ,which is usually a burn patient, so that it acts as a bio-logical dressing.

Q: Can you make the person color fair by plastic surgery just like Michael Jackson?
A: No ! you can not change the complexion of any person by means Plastic surgery.

Q: Do you change the sex in Plastic surgery?
A: Few children are born with Ambigious genitalia in which it is difficult to assertion the sex by means of external examination. In such type of cases with Karyotyping and hormonal assays we determine the sex and reconstruct organs according to the tests report.

We do, sometime indulge in sex change surgery in-patients of “gender dysphoria” after very thorough clinical and psychiatric evaluation.

Q: Do you reconstruct the lost tissue exactly as it was before?
A: No. This thing has to understand by patient undergoing plastic or reconstructive surgery that we can not recreate the nature. We can reconstruct the lost part near to normal appearance and function.

Q: Burn management is a very important aspect of plastic surgery. What common errors do you think Family Physicians made when dealing with burns?
A: I think family physicians are doing a remarkable job in dealing with burn patients. I think following points should receive attention from them:

  1. They must advocate putting water on burns as first aid measure.
  2. They must refer patients with hand burns, perineal burns and face burns to plastic surgeon.
  3. They must maintain I/V line with Ringer’s Lactate and refer the patient more than 10% in children and more then 15% in adults.

Q: You are also founder member of Pakistan Association of Plastic Surgeons (PAPS). What do you think is the scope of plastic surgery in Pakistan?
A: We started our PAPS with 15 members throughout Pakistan in 1994. In 12 years we have swollen to 75. I think that more the number of plastic surgeons would be there the more would be public awareness and more would be better work. It is not that plastic surgery cases were not there before. Surgeons of other specialties with lesser knowledge, skill & competency are there performing them. So the scope of plastic surgery is wide open in Pakistan for new surgeons to get them recognize in sub specialty of plastic surgery like hand surgery, micro vascular surgery, head and neck surgery, cosmetic surgery and many more.

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