Plastic surgery, a defined surgical specialty, can be viewed as an ecosystem facing perturbatory forces, both internal and external, that will disrupt healthy checks and balances. This is an evolving system which will adapt to these disturbances and evolve as will a natural ecosystem. Returning to the beginning of the plastic surgery ecosystem, dating to World War I, identification of the challenges and forces within the ecosystem will raise awareness in the plastic surgery community. A graphic representation of the ecosystem is offered to represent the description and challenges offered to the plastic surgery ecosystem. Will this ecosystem return to balance or be radically altered and bear little resemblance to the past?