A plastic surgeon is a doctor who repairs, reconstructs, or reshapes the human body. The specialty splits into two broad categories: reconstructive surgery, which restores function and appearance after injury, disease, or birth defects, and cosmetic surgery, which enhances appearance for nonmedical reasons. Most plastic surgeons practice some combination of both. In 2023, board-certified plastic surgeons in the U.S. performed roughly 1.6 million cosmetic surgeries and over 1 million reconstructive procedures, plus more than 25 million minimally invasive cosmetic treatments like injections and chemical peels.
Reconstructive Surgery
The reconstructive side of the specialty focuses on restoring normal function and appearance when something has gone wrong. That includes repairing birth defects like cleft lip and palate, rebuilding a breast after mastectomy, grafting skin over severe burns, and closing complex wounds from infections or cancer removal. The underlying goal is always the same: help the body work the way it should and look as natural as possible afterward.
Trauma is a major part of this work. In hospital trauma centers, plastic surgeons handle facial fractures, hand injuries, deep lacerations, and crushing injuries that damage blood vessels or nerves. Facial trauma accounts for about 41% of plastic surgery trauma referrals, followed by hand trauma at 36%. When a severed finger or limb needs to be reattached, or a major blood vessel needs to be reconnected, the plastic surgeon performs the delicate vessel and nerve repair under a microscope.
Cosmetic Surgery
Cosmetic procedures address features that bother a person but don’t pose a medical problem. The most common cosmetic surgeries are breast augmentation, liposuction, nose reshaping (rhinoplasty), eyelid surgery, tummy tucks, and facelifts. These operations aim to bring someone’s appearance closer to how they want to look, whether that means reducing the size of a nose, removing excess abdominal skin after weight loss, or reversing visible signs of aging around the eyes and jawline.
Cosmetic work isn’t limited to the operating room. A huge and growing portion of what plastic surgeons do happens in the office with minimally invasive treatments. Neurotoxin injections (like Botox) temporarily relax facial muscles to smooth out forehead lines, frown lines, and crow’s feet. Dermal fillers add volume to thin lips or soften creases by replenishing moisture-attracting compounds in the skin. Chemical peels and laser skin resurfacing treat surface-level concerns like uneven texture, sun damage, and fine wrinkles. These office-based procedures have grown 180% since 2000, far outpacing the growth of surgical procedures.
Subspecialties Within Plastic Surgery
After completing their core training, some plastic surgeons pursue fellowship training in a narrower focus area. The five major fellowship categories are aesthetic surgery, burn surgery, craniofacial surgery, hand surgery, and microsurgery.
- Craniofacial surgery concentrates on the skull, face, and jaw. About 73% of craniofacial fellowship programs focus primarily on cleft and jaw alignment surgeries, while others handle complex orbital, midface, or skull reconstructions.
- Hand surgery covers everything from carpal tunnel release to nerve and vessel repair after traumatic injury. Plastic surgeons share this space with orthopedic surgeons, but the microsurgical skills from plastic surgery training make them particularly well suited for reconnecting tiny structures.
- Microsurgery involves operating under a microscope to reconnect blood vessels and nerves as small as one to two millimeters in diameter. This is what allows free tissue transfer, where a surgeon moves skin, muscle, or bone from one part of the body to another to rebuild areas devastated by trauma or cancer.
- Burn surgery treats acute burn injuries and the long-term scarring and contractures that follow, often using skin grafts and staged reconstructions over months or years.
- Aesthetic surgery fellowships offer additional training in cosmetic procedures of the face, breast, and body for surgeons who want to focus their practice on elective appearance-related work.
Training and Certification
Becoming a board-certified plastic surgeon is one of the longest training paths in medicine. After four years of medical school, a surgeon completes either an integrated plastic surgery residency lasting six years or a three-year plastic surgery residency after first finishing a full five-year general surgery residency. Either path totals at least nine to ten years of post-college training before independent practice.
The American Board of Plastic Surgery requires candidates to pass both a written and an oral examination. Applicants must demonstrate major operative experience across a diverse range of procedures, hold an unrestricted medical license, and maintain active hospital privileges. Peer evaluations from surgical colleagues are part of the credentialing process. After certification, surgeons participate in ongoing maintenance-of-certification programs to stay current.
What a Consultation Looks Like
Whether you’re considering a cosmetic procedure or being referred for reconstruction, the first step is a consultation. You’ll be asked for a thorough medical history, including conditions that run in your family, every medication and supplement you take (including herbs, teas, and vitamins), and any prior surgeries. Sharing all of this information, even details that seem unrelated, helps the surgeon plan safely and anticipate complications.
For cosmetic consultations, the surgeon will discuss your goals, explain what’s realistically achievable, and outline the specific procedure, recovery timeline, and risks. For reconstructive cases, the conversation centers on restoring function and appearance, often in coordination with other specialists like oncologists or trauma surgeons. In both scenarios, the consultation is your chance to ask questions and understand exactly what to expect before, during, and after the procedure.
Reconstructive vs. Cosmetic in Practice
The line between reconstructive and cosmetic surgery isn’t always sharp. A rhinoplasty might fix a deviated septum that impairs breathing (reconstructive) while also refining the nose’s shape (cosmetic). Breast reduction can relieve chronic back and shoulder pain while also changing appearance. Many plastic surgeons blend both goals in a single operation, which is part of what distinguishes the specialty. The training equips them to think about form and function at the same time, whether they’re reattaching a severed thumb or performing a facelift.