The past few decades of medical research and technological development have brought enormous advances in plastic surgery. The practice of plastic surgery or the reshaping of the body for cosmetic or reconstructive purposes dates back to the beginning of human civilization. The term "plastic surgery" comes from the Greek term for mold or shape "plastikos." Cultures across the world have shaped or molded the bodies of their societies to look different. Some cultures enlarge their lips with disks, elongate their necks with rings, pierce earlobes for earrings, bind feet or waits to limit their growth, file teeth to make them sharper or different in shape or tattoo and scar their skin. Today, the second most commonly performed plastic surgery procedure in the Unites States is breast augmentation. History indicates reconstructive surgery techniques in India since 2000 B.C. Sushruta, considered the father of surgery, made important contributions to the field of plastic and cataract surgery in 6th century B.C. The translation of the medical works of both Sushruta and Charak into Arabic occurred during the Abbasid Caliphate in 750 AD. The Arabic translations made their way into Europe via intermediaries. In Italy the Branca family of Sicily and Gaspare Tagliacozzi became familiar with the techniques of Sushruta. British physicians traveled to India to see medicine men perform rhinoplasties by native methods. Physicians published reports about rhinoplasties in India performed by Kumhar Vaidya in the Gentleman's Magazine in 1794. The procedure involved reconstructing the nose by cutting skin from either the cheek or forehead, twisting the skin over a leaf of the appropriate size and sewing the skin back into place. To keep the air passages open during healing, doctors would insert of two polished wooden tubes into the nostrils. This method became the "Indian Method of Rhinoplasty." Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods. Carpue could perform the first major rhinoplasty surgery in the Western world by 1815. He described the modification of Indian instruments of Sushruta Samhita to the Western world. The ancient Egyptians and Romans also performed plastic cosmetic surgeries. The Romans acted simply by repairing damaged ears starting around the 1st century B.C. Aulus Cornelius Celsus left some surprisingly accurate anatomical descriptions; his studies on genitalia and the skeleton are of special interest to plastic surgery. In 1465 Sabuncuoglu wrote a book that contained descriptions and classifications of hypospadias, which was informative and up to date. It describes in detail the localization of urethral meatus and ambiguous genitalia. In mid-15th century Europe, Heinrich von Pfolspeundt described a process "to make a new nose for one who lacks it entirely and the dogs have devoured it" by removing skin from the back of the arm of a patient and suturing it in place on the face. However, because of the dangers associated with surgery in any form, especially that involving the head or face, it was not until the 19th and 20th centuries that such surgery became commonplace. Up until the techniques of anesthesia were established, all surgery on healthy tissues involved great pain. Sterlie techniques and disinfectants reduced infection in patients. The invention and use of antibiotics, beginning with sulfa drugs and penicillin, was another step in making elective surgery safe. In 1792, Chopart performed an operative procedure on a lip using a skin flap from the neck. In 1814, Joseph Carpue successfully performed an operation on a British military officer who had lost his nose to the toxic effects of mercury. In 1818, a German surgeon, Carl Ferdinand von Graefe, published his major work entitled "Rhinoplastik." Von Graefe modified the Italian method using a free skin graft from the arm instead of the original pedicle flap. The first American plastic surgeon was John Peter Mettauer. In 1827 he performed the first cleft palate operation with instruments of his own design. In 1845, Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty, entitled "Operative Chirurgie" and introduced the concept of re-operation to improve cosmetic appearance of a reconstructed nose. In 1891, American otorhinolaryngologist John Roe reduced a dorsal nasal hump on a young woman for cosmetic indications. In 1892, Robert Weir experimented unsuccessfully with xenografts (duck sternums) in an attempt to reconstruct sunken noses. In the late 1890s, James Israel, a urological surgeon from Germany and George Monks of the United States each described the successful use of heterogeneous free-bone grafts to reconstruct saddle nose defects. In 1898, Jacques Joseph, the German orthopedic-trained surgeon, published his first account of reduction rhinoplasty. In 1928, Jacques Joseph published "Nasenplastik und Sonstige Gesichtsplastik." During World War I, a New Zealand otolaryngologist working in London, Harold Gillies developed many of the techniques of modern plastic surgery by caring for soldiers suffering from disfiguring facial injuries. His cousin, a former student Archibald McIndoe, pioneered treatments for RAF aircrew suffering from severe burns and expanded upon Gillies' work during World War II. McIndoe's radical, experimental treatments led to the formation of the Guinea Pig Club. In 1946, Gillies carried out the first female-to-male sex reassignment surgery. Plastic surgery, as a specialty, evolved remarkably during the 20th century in the United States. One of the founders of the specialty, Vilray Blair, was the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis, Missouri. In one of his many areas of clinical expertise, Blair treated World War I soldiers with complex maxillofacial injuries and his paper on "Reconstructive Surgery of the Face" set the standard for craniofacial reconstruction. The modern and more well-known history of plastic surgery begins in the 1960s and '70s. Plastic surgeons contributed to the filed in many ways: one became Surgeon General and another won a Nobel Prize. The past few decades in the history of plastic surgery have brought enormous advances in treatment and awareness among the public.

Effective Treatment Principles

Addiction is a complex but treatable condition that affects brain function and behavior. The abuse of drugs alters the structure and function of the brain, resulting in changes that persist long after drug use. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences. No single treatment is appropriate for every user in recovery. Matching treatment settings, interventions and services to the particular problems and needs of a patient is critical to achieving success in returning to productive functioning in the family, workplace and society. Treatment needs to be readily available. Because individuals addicted to drugs may be uncertain about entering treatment, it is critical to take advantage of available services the moment people are ready for treatment. Patients can be lost if treatment is not immediately available or readily accessible. As with other chronic conditions, the earlier the user seeks treatment, the greater the likelihood of positive outcomes. Effective treatment addresses the multiple needs of the individual, not just drug abuse. To be effective, treatment must address the drug abuse and any associated medical, psychological, social, vocational and legal problems. It is also important that treatment be appropriate to the age, gender, ethnicity and culture of the user. It is critical that the user remain in treatment for an adequate recovery period. The appropriate duration for an individual depends on the type and degree of problems and needs. Research indicates that most addicted individuals need at least three months in treatment to significantly reduce or stop drug use. Studies also suggest that the best recovery outcomes occur with longer durations of treatment. Recovery from drug addiction is a long process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and signifies that treatment should be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment. The most commonly used forms of drug abuse treatment are counseling in individual and or groups and other behavioral therapies. Behavioral therapies vary in focus and may involve addressing a the motivation of a user to change, providing incentives for abstinence, building skills to resist drug use, replacing activities involving drugs with constructive and rewarding activities, improving problem solving skills and facilitating better interpersonal relationships. Participation in group therapy and other peer support programs during and following treatment can help maintain abstinence from drugs. Medications can be an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. For example, methadone and buprenorphine are effective in helping individuals addicted to heroin or other opioids stabilize and reduce illicit drug use. Naltrexone is also an effective medication for some individuals addicted to opioids and some patients with alcohol dependence. Other medications for alcohol dependence include acamprosate, disulfiram and topiramate. For persons addicted to nicotine, a nicotine replacement product such as patches, gum or lozenges or an oral medication such as bupropion or varenicline can be an effective component of treatment when part of a comprehensive behavioral rehab program. Doctors must modify and monitor the treatments and services for each patient to ensure that the rehabilitation meets the changing needs of the addict in recovery. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation and or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to changing needs. Many individuals addicted to drugs also have other mental disorders. Because drug abuse and addiction, which are both mental disorders, often occur together with additional mental illnesses, doctors should carefully assess patients that present with one condition for the other. When these problems occur together, treatment should address both by the use of medication. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change the effects of drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and, for some, can pave the way for effective addiction treatment in the end, detoxification alone is rarely sufficient to help addicted individuals achieve a new lifestyle of abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement. Specialists must continually monitor drug use during treatment, as patients can lapse during treatment. Another powerful motivator to get clean is if patients know that doctors monitor the drug intake of each patient. Monitoring also provides an early indication of a return to drug use, signaling the possible need to adjust the treatment plan of an individual to better meet changing needs. Drug abuse treatment can facilitate adherence to other medical treatments. Patients may be reluctant to accept screening for HIV and other infectious conditions. Specialists should encourage and support HIV screening and inform patients that highly active antiretroviral therapy can be effective in combating HIV. Treatments vary, depending on the type of drug and the characteristics of the patient. The best programs provide a combination of therapies and other services.

Nail Med

Care of the fingernails and toenails is important. Poor nail care causes problems. Recommendations for maintaining nail health include: keeping nails clean and dry in order to keep bacteria and other infectious organisms from collecting under the nails; cutting nails straight across with only slight rounding at the tip; using a fine-textured file to keep nails shaped and free of snags; and avoiding nail-biting. Nail changes, swelling and pain can signal serious problems that may require a physician and medical nail care. Medical nail care includes preventing and treating diseases. Nail diseases are distinct from diseases of the skin. Although nails are a skin appendage, they have their own signs and symptoms, which can relate to other medical conditions. Nail conditions that show signs of infection or inflammation require medical assistance beyond a beauty parlor. Deformity or diseases of the nails are onychosis. Onychia is an inflammation of the nail folds of the nail with formation of pus and shedding of the nail. Onychia results from the introduction of microscopic pathogens through small wounds. The medical term for ingrown nails is onychocryptosis. Ingrown nails can affect the fingers and the toes. With this condition, the nail cuts into one or both sides of the nail bed, resulting in inflammation and possibly infection. The relative rarity of this condition in the fingers suggests that pressure from the ground or shoe against the toe is a prime cause. The movements involved in walking or other physical disturbances can contribute to the problem. Mild onychocryptosis in the absence of infection is treatable by trimming and rounding the nail. In more advanced cases including infection, doctors perform matrixectomy by surgically excising the in growing portion of the nail down to its bony origin and thermally or chemically cauterizing the matrix to prevent recurrence. The best results are by cauterizing the matrix with phenol.