Differences between cosmetic and reconstructive surgery

Stanley Okoro, MD

Article by
Atlanta Plastic Surgeon

Cosmetic surgery was born out from reconstructive surgery experience. There is a direct relationship between cosmetic surgery and reconstructive surgery. For thousands of years, people of different cultures have sought to correct or restore the their looks. The ancient Indian used reconstructive surgery to restore damage or deformed body part. The Romans and Indians used reconstructive surgery to repair war wounds, such as damaged earlobes and noses.

Many of the breakthroughs in reconstructive surgery occurred as a result of war, during which surgeons sought to reconstruct tissues and organs of marines, soldiers, and airmen. During World War I, advances in facial reconstructive surgery allowed many victims of disfiguring facial injuries to lead more comfortable lives. These efforts advanced the field of facial cosmetic surgery on people without injury. Experiments and advances in reconstructive surgery were perfected to improve bodily function and achieve a more normal appearance. Hence cosmetic surgery was born.

The formation of the American Society of Plastic and Reconstructive Surgeons in 1931 fostered the introduction of reconstructive and cosmetic surgery in the United States. As technology advanced and surgical procedures became much more commonplace, reconstructive surgery evolved. Elective cosmetic surgery emerged as people seek to maintain, improve or enhance an otherwise healthy and normal body. Modern cosmetic surgery became more commonplace in the early nineteenth century with better anesthesia, introduction of the sterile operating environments, and antibiotics.

Today, reconstructive surgery is still performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance. Reconstructive surgery is generally covered by most health insurance policies although coverage for specific procedures and levels of coverage may vary greatly.


Unlike reconstructive surgery, elective cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient's appearance and self-esteem. In 2009, over $10 Billion was spent in cosmetic procedures here in the United States. Cosmetic surgery is usually not covered by health insurance because it is elective. Many insurance plans exclude coverage of cosmetic surgery that is not medically necessary, but generally provide coverage when the surgery is needed to improve the functioning of a body part or otherwise medically necessary even if the surgery also improves or changes the appearance of a portion of the body

Most cosmetic surgery performed today is modifications of reconstructive surgery. Most reconstructive surgeons are cosmetic surgeons. Some may choose not to perform cosmetic surgery. Breast cosmetic surgeries, such as augmentation (enhancement), mastopexy (breast lift), are direct descendants of reconstructive breast surgery after mastectomy for breast cancer.

Today, there are a number of "gray areas" between cosmetic and reconstructive. These areas usually involved surgical operation, which may be reconstructive or cosmetic, depending on each patient's situation. For example, eyelid surgery (blepharoplasty) - a procedure normally performed to achieve cosmetic improvement may be covered if the eyelids are drooping severely and obscuring a patient's vision.

All surgery carries some risk. Plastic surgery involves many choices. The first and most important is selecting a surgeon who is well trained and experienced.

Stanley A. Okoro, MD, FACS
Georgia Plastic & Reconstructive Surgery