Plastic Surgery from Reconstruction to Aesthetics: A Guide

Plastic surgery is the specialty that moves and reshapes the body's own tissue to rebuild what injury, cancer or a birth defect has taken, and to refine appearance where function is intact. It has two branches: reconstructive surgery, which covers trauma, cancer and congenital defects, and aesthetic (cosmetic) surgery. A wound that has not healed in three weeks is a key signal that a plastic surgeon should see the patient.

Dr. Pradeep Kumar Singh, Head - Cosmetic & Plastic Surgery, Artemis Hospitals, Gurugram, India, has practised across that whole range, from finger replantation and free flaps to lymphoedema surgery, brachial plexus nerve transfers, pectus correction and facial aesthetics. His department is a team of three plastic surgeons covering reconstructive and aesthetic work, surgical and non-surgical, at a JCI-accredited hospital that treats patients from many countries. This guide sets out what plastic and reconstructive surgery covers, how a referring doctor can tell which patients need it, what aesthetic surgery involves, and what treatment costs.

Two companion articles go deeper. One covers replantation golden time, free flaps and microsurgical bone and soft tissue reconstruction. The other covers lymphoedema surgery, brachial plexus nerve transfer, pectus correction and gender-affirming surgery.

What plastic surgery is, and why it has nothing to do with plastic

The "plastic" in plastic surgery has nothing to do with plastic material. The word comes from the Greek plastikos, meaning to form or to mould, and the plastic surgeon's craft is to take tissue that already exists in the patient's body and mould it into something else: to fill a defect, to rebuild a missing part, or to reshape one that is already there. Patients still ask Dr. Singh whether the operation means putting plastic into the body; it does not.

The old shorthand for the specialty is "robbing Peter to pay Paul". Skin, fat, muscle, bone, nerve or lymph nodes are borrowed from a site that can spare them and moved to a site that needs them. That principle explains why plastic surgeons turn up in so many operating theatres. Dr. Singh describes the specialty as the problem solver for most others: ENT surgeons, neurosurgeons and urologists call in a plastic surgeon whenever a defect of any tissue has to be closed or rebuilt.

A short history of plastic surgery

The oldest written record of a plastic surgical procedure is Indian. Around 600 BC the surgeon Sushruta described the reconstruction of the nose and ear in the Sushruta Samhita, which is why he is regarded as the father of reconstructive plastic surgery.

The modern specialty was shaped by war. The First World War, with its unprecedented facial and limb injuries, was the biggest single boost the field has received, and it produced two founding figures of modern plastic surgery: Sir Harold Gillies in Britain and Dr. Vilray Blair in the United States. Gillies went on to perform one of the earliest male-to-female gender-affirming operations, in 1951, a reminder that gender-affirming surgery has been part of the specialty for more than seven decades.

Reconstructive vs aesthetic (cosmetic) surgery: the two branches

Dr. Singh divides plastic surgery into two broad groups: reconstructive surgery, which restores form and function after trauma, cancer or a congenital defect, and aesthetic surgery, which changes appearance where function is intact.

The boundary is not always sharp. A post-traumatic nasal deformity can be corrected with the same rhinoplasty techniques used for a purely cosmetic nose, and an abdominoplasty can be combined with a hernia repair. Most of the clinical substance sits in reconstruction, which is where the specialty began.

How one plastic surgery practice spans the whole field

Dr. Singh's career is a useful map of the specialty, because each phase added a different set of skills.

1. Trauma and replantation. His first hospital sat in an industrial area surrounded by factories, so hand injuries arrived constantly. He began replanting amputated fingers and hands, alongside the standard reconstructive work of cleft lip and cleft palate repair and scalp reconstruction with tissue expansion after burns.
2. Aesthetic surgery. After two to three years the work became repetitive, and he went abroad for a fellowship in aesthetic and cosmetic surgery. Rhinoplasty, facelifts, breast surgery, abdominoplasty and hair restoration followed, while trauma and cancer reconstruction continued.
3. Super-microsurgery and complex reconstruction. Seven to eight years into practice, the COVID-19 lockdowns brought elective surgery to a halt and gave him time to reflect. During that period a man with severe lymphoedema, whose affected leg alone weighed 45 kg, came to him after other centres had closed. Treating him required a specialised microscope and lymphography equipment, and it opened a new phase: lymphoedema surgery, brachial plexus nerve transfer, pectus deformity correction and gender-affirming surgery.

The result is a department whose work ranges from a single finger to a rebuilt jaw, femur or penis.

When to refer a patient to a plastic surgeon

Dr. Singh gives referring doctors four triggers: a wound that has not healed in three weeks, any congenital defect, a cancerous skin lesion, and leg swelling that does not settle with conservative care.

• A wound that has not healed in three weeks. Traumatic wounds, burns and wounds left after cancer resection all qualify. Any wound that remains open after three weeks will need surgical intervention, and the case can be sent directly.
• Any congenital defect. Hand anomalies, facial clefts and other soft tissue deformities present from birth should be referred directly. His department also performs orthognathic (jaw-straightening) surgery for congenital deformities of the mandible and maxilla.
• Cancerous skin lesions. Excision and reconstruction go together, so a plastic surgeon can remove the lesion and close the defect in one plan.
• Leg swelling that does not settle. Oedema of the leg that persists despite limb elevation and conservative management needs a surgical opinion. This is the specific trigger for a lymphoedema referral.

Two further referrals are time-critical: amputations, where the clock for replantation and microsurgical repair starts at the moment of injury, and brachial plexus injuries, covered with lymphoedema surgery.

Aesthetic (cosmetic) surgery procedures: rhinoplasty, facelift and body contouring

Aesthetic surgery reshapes normal structures to improve appearance. The procedures in Dr. Singh's practice include:

• Rhinoplasty: surgery to reshape the nose, done both for purely cosmetic reasons and to correct a post-traumatic nasal bone deformity.
• Facelift: tightening of the deeper tissues and skin of the face and neck; in a case he presented, it restored jaw definition and chin projection.
• Breast augmentation and breast reduction: enlargement, or removal of excess breast tissue and skin.
• Abdominoplasty (tummy tuck): removal of excess abdominal skin and fat with tightening of the abdominal wall. In a patient with a hernia, he performs the abdominoplasty and the hernia repair in a single operation. A mini-abdominoplasty treats a smaller area below the navel.
• Hair and beard transplant: moving hair follicles to areas of baldness or to the beard.
• Liposuction: removal of fat deposits through small cannulas, often combined with other procedures.

Minimum age for cosmetic surgery

Dr. Singh's minimum age for a facial aesthetic procedure is 15 or 16; for the rest of the body, 17 or 18 is the optimum age. He usually operates on a body part once its growth is complete. In his view, facial growth is complete by about 15, so a 15-year-old's face is effectively an adult face. Facial growth generally finishes later in boys than in girls, so timing is judged on each patient's maturity. His centre performs facial cosmetic procedures for 15-year-olds with parental consent. For the rest of the body, the later age reflects maturity: by 17 or 18 patients are able to think about their body image and to understand what aesthetic surgery implies.

Cosmetic surgery success rate

Dr. Singh puts the success rate for cosmetic procedures at around 90 to 95% when the patient's expectations are reasonable. In cosmetic surgery, success depends on the patient's expectations as much as on the operation.

Complications and side effects of plastic surgery

Dr. Singh puts the complication rate of plastic surgery at roughly 4 to 5% in each case, and his department has developed protocols to minimise it. Where a complication is anticipated, the decision to operate rests on a cost and benefit analysis for that patient.

The nature of the problem depends on the patient:

• Keloid scarring. Some patients are strongly prone to keloids, raised scars that grow beyond the original wound. This matters most in aesthetic surgery, where the scar is part of the result.
• Comorbidities. Patients with diabetes, hypertension or thyroid disease are more likely to have wound dehiscence (the wound edges separating) and infection.
• Common minor problems. Wound problems, infection, haematoma (a collection of blood) and seroma (a collection of clear fluid) are the most frequent. Dr. Singh regards these as side effects of the procedures rather than complications.

Microsurgical procedures carry their own record, about 99% success over two years, covered in the microsurgery article.

Cost of plastic surgery in India for international patients

Dr. Singh puts microvascular reconstruction at about USD 6,000 to 10,000 and purely cosmetic surgery at USD 2,000 to 7,000, far less than in Western countries, with a wide range depending on the procedure.

• Microvascular reconstruction: Dr. Singh put the cost at about USD 6,000 to USD 9,000 or 10,000, with a hospital stay of around four to five days. The figure depends on whether the patient needs a single procedure or several within a defined period.
• Purely cosmetic surgery: USD 2,000 to 4,000 or 5,000, and sometimes up to 7,000, in his estimate.
• Mommy makeover: at the time of the session his department offered a combined breast reduction, liposuction and tummy tuck at a fixed price of USD 7,000.

These are the doctor's figures from July 2025; an individual quotation depends on the case. Indicative partner-hospital quotations are listed on the cost pages for other reconstructive and cosmetic surgery procedures and wound reconstruction and skin grafting.

Plastic surgery training and doctor-to-doctor referral

At the time of the session, Dr. Singh's department was developing fellowships in microsurgery and maxillofacial surgery, and an online plastic surgery course delivered through an app with study material, intended to open within a few months. For referring doctors, the more immediate route is a direct doctor-to-doctor discussion of cases, which Dr. Singh sees as the most reliable way to decide how a patient should go forward.

The questions doctors asked during the session, on golden time, birth brachial plexus palsy, success rates and age limits, are collected in the Live Discussion.