Plast Aesthet Res 2017;4:13-14.10.20517/2347-9264.2016.104© 2017 OAE Publishing Inc.
Open AccessLetter to Editor

Five “Ds” of plastic surgery

Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India.

Correspondence Address: Dr. Ravi Kumar Chittoria, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India. E-mail:

  • Dr. Ravi Kumar Chittoria is born and brought up in Delhi, India. He completed his post graduation (MCh plastic surgery from Mumbai), post doctorate (PhD in plastic surgery) and MBA (hospital administration) in India. He received higher training in laser surgery from Boston Medical Centre, Boston University, USA, and endoscopic plastic surgery from Emory University, Atlanta, Georgia, USA. He is recipient of 29 awards including BMJ Award, author of 3 textbooks, 5 chapters, chief editor of 3 journals, more than 120 publications with 1 patent. At present he is the Professor and Head of Department of Plastic Surgery, JIPMER, Pondicherry, India.


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Although there are a variety of definitions that describe plastic surgery, confusion persists in the minds of both the lay public and doctors. A common lay misconception is that actual pieces of plastic are used to repair injured tissues or placed over defects to make them appear better. On the other hand, resident doctors from specialities such as ear-nose-throat and general surgery fail to appreciate the vast scope that plastic surgery specialty entails. In recognition of this, trainee plastic surgeons are often asked to briefly define our specialty in their final exams, so that subsequent misconceptions are minimized.

Plastic surgery is a specialised branch of surgery that is primarily concerned with deformities of the integument and underlying musculoskeletal system.[1] It is a surgical specialty involving the restoration, reconstruction, or alteration of the human body and includes cosmetic or aesthetic surgery, reconstructive surgery, craniofacial surgery, hand surgery, microsurgery, and the treatment of burns.[2] The term “plastic” is derived from the Greek word plasticos that means “mouldable”.[3]

From a practical perspective, it is imperative that every practising plastic surgeon has a clear reconstructive plan for every case that is salient and easily recalled. To this end, we have distilled this into five categories represented by the following five “Ds”:

1. Defect - Loss or breach in tissue continuity;

2. Deformity - Alteration in shape and contour;

3. Dysfunction - Abnormality and impairment of a bodily organ or system;

4. Disability - Impairment, limitation of activity and participation;

5. Disfigurement - An aesthetically unacceptable surface abnormality that overlies normal contour.

Any plastic surgery condition can be placed into one of categories above and managed accordingly. This five “Ds” concept brings the key elements of the vast specialty of plastic surgery into focus. It is our hope that it will make it easier to understand the problems and their solutions more effectively.

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Conflicts of interest

There are no conflicts of interest.

Patient consent

Not appliable.

Ethics approval

Not appliable.


  • 1. Converse JM. Introduction to Plastic Surgery. In: Converse JM, editor. Plastic Surgery. Philadelphia: WB Saunders; 1977. p. 1.

  • 2. McCarthy JG. Introduction to Plastic Surgery. In: McCarthy JG, editor. Plastic Surgery. Philadelphia: WB Saunders; 1990. pp. 20-2.

  • 3. Mazzola RF, Mazzola IC. History of reconstructive and aesthetic surgery. In: Neligan PC, Gurtner GC, editors. Plastic Surgery. 3rd ed. London: Elsevier; 2013. pp. 11-29.

Cite This Article

Babu P, Chittoria RK, Kumar SH, Marimuthu SK, Subbarayan EK, Reddy KS, Chavan V, Mohapatra DP, Friji MT, Sivakumar DK. Five “Ds” of plastic surgery. Plast Aesthet Res 2017;4:13-14.


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