The History of Plastic Surgery

Extracts from The Cosmedic Coach’s Book: Antonia Mariconda ‘The Cosmetic Surgery Companion -Look and Feel Beautiful’ Apple Press 2010,

The History of Plastic Surgery

There are two major branches of aesthetic surgery cosmetic surgery and reconstructive surgery. The first has only come to the fore in recent decades, though its development has been quite extraordinarily swift and sure.

Reconstructive surgery, by contrast, stretches back thousands of years and grew over centuries of trial and error.

The history books record that the first fully recorded reconstructive surgery procedures were performed way back in Ancient Roman times.

One ancient Roman report told how a patient had repairs to his earlobes, which had grown excessively long after years of bearing heavy earrings. The lobes were trimmed and the patient must have decided ‘Never again!’ as he asked for the holes in the lobes to be sewn up.

A particularly expensive treatment was one which was often undergone by freed slaves, who were only too glad to pay for the removal of the branding marks inflicted by their former owners.

There is also evidence that Indian physicians were skilled in the techniques of facial enhancement hundreds of years BC. This also involved largely reconstructive work using skin grafts to repair damaged noses, ears and lips.

However, it wasn’t until the 15th century that a German physician named Heinrich von Pfolspeundt carried out the first European facial surgery, a rhinoplasty procedure to build a new nose for a patient. In Italy, in the same century, similar rebuilding and repairing techniques were being developed and refined.

Gasparo Tagliacozzi (1546-99) wrote an important text on reconstructive surgery, which described how damaged facial features could be repaired or replaced using skin grafts. However, he incurred the wrath of the Church authorities who believed such surgery was against the will of God.

He was excommunicated even after death, and his body removed from its grave in consecrated ground.

Sadly, like all medical procedures of the time, cosmetic surgery was a risky business. There was little knowledge or no knowledge of hygiene or the causes of infection, and there was of course no anaesthetic.

The first American plastic surgeon, John Mettauer performed the world’s first cleft palate operation in 1827. His was a huge step forward in the field of facial surgery and Dr Mettauer’s work was especially impressive as he had designed the instruments he used himself.

Other US pioneers were John Roe, who around 1891 reduced a young woman’s nose hump and George Monks, who in the previous decade worked on bone-grafting techniques to improve sunken noses.

However, the great leap forward in reconstructive surgery came during World War 1; one of the founders of modern techniques, American Vilray Blair, treated soldiers with complex facial injuries. wrote a paper, Reconstructive Surgery of the Face, this set the standard for craniofacial reconstruction.

Vilray Blair taught many men who became famed for their expertise in reconstructive surgery.

In modern times, such surgery is performed for many reasons including repairing congenital abnormalities and improving limb function, largely through skin grafts, for burns patients.

Cleft palate surgery and breast reconstruction after mastectomy, are common procedures.

Aesthetic cosmetic surgery was rarely performed until the early years of the last century. It was simply too dangerous to attempt non-vital surgery when the risks of any type of surgery were so great.

However, the experiences of surgeons working with World War I soldiers brought a new awareness of how facial damage can impact dreadfully on self-esteem. Soldiers whose faces were wrecked in the battleground were profoundly affected, their confidence lost.

This led to a new respect for purely aesthetic procedures.

The importance of hygiene had already become recognised, and antiseptics and antibiotics were working their magic.

Meanwhile, cosmetic surgery pioneers were developing their skills and techniques. As the years went by, procedures became ever more sophisticated, safe and effective.

The earliest purely cosmetic operations included rhinoplasty and breast augmentation. Both saline and silicone breast implants were introduced in the 1960s and liposuction followed some 20 years later.

Also from the mid-century, surgeons were able to help their patients enhance their appearance through facelifts, tummy tucks and eye bag removal.