Plastic surgery is one of the oldest medical practices known to man. It was practised in ancient Egypt as early as 2,500 BC. A stone figure dating back nearly 5,000 years shows the Egyptian mother goddess Tjet holding her breasts with both hands. The figurine has depressions at the spots where Tjet likely wore copper or stone breast ornaments. However, because the ancient Egyptians believed in life after death, they preserved the bodies of deceased rulers through mummification. They made them look like they appeared while alive by creating new eyelids with dark ink and painting on eyebrows and lips. The Egyptian god Osiris is also depicted on stone carvings as having his genitals restored by a few strategically placed figs and vines.
In addition to Tjet, other Egyptian deities like Isis and Hathor had their breasts enlarged for symbolic or religious reasons.
Hathor’s ample bosom was not simply an aesthetic preference; it had a practical function: she was one of the goddesses who held up the sky. The famous bust of Nefertiti, believed to be the queen of Egyptian ruler Akhenaten (1375 BC), shows her breasts as well-rounded and elegant.
Ancient Egyptians used papyrus soaked in milk for surgical dressing and moulded metal mirror cases to store mirrors. The first mummies were buried with worldly possessions, including personal grooming tools like tweezers made from bone or copper, cases for stone razors, bottles for kohl eyeliner, and clamshells containing rouge. According to some scholars, these grave goods prove that ancient Egyptians practised facial reconstruction surgery on the dead because a person’s bones could not open a cosmetic case. But there is no evidence that they ever attempted such a procedure on a living person.
The ancient Greeks were the first to extract healthy teeth instead of simply pulling them out. They tried other surgical procedures too, but these earliest attempts at plastic surgery were not particularly successful.
Athenaeus wrote that Greek general Scipio Africanus (236-183 BC) had an ulcer on his leg that was treated by cutting away healthy flesh and, while stitching up the wound, applied crushed leaves of certain plants to promote healing. Some scholars hypothesize that this method may have been inspired by Carthaginian physician Hanno who experimented with different types of leaves to heal soldiers. But it is generally accepted among historians that Scipio probably did not receive anything beyond emergency care because there is no record found so far of Romans performing any facial surgery.
The first successful reconstructive plastic surgeries were performed by an Indian surgeon Sushruta in the 6th century BC, considered the father of Indian medicine and one of Time magazine’s “Asian Heroes” (April 18th, 2010 issue). He and his students did not experiment with transplantation but used animal skin to repair noses amputated as punishment for crimes such as adultery.
The ancient Chinese introduced wooden pegs into patients’ heads to keep their skulls straight after healing from injuries such as fractures or head wounds. They also wrapped infants’ heads tightly with bandages at a very young age to reshape their skulls. But this rather barbaric procedure was abandoned in the early century when X-ray imaging was developed because it was found that head bandages used in one place to reshape the skull cause abnormal growth elsewhere.
The first known account of plastic surgery was recorded by the Greek historian Herodotus (c. 484-430 BC), who writes about how Egyptian ruler Necho treated a man with a paralyzed arm by cutting into the flesh and fixing the bones back into their original position. At this point, there are no reliable reports of successful facial repair surgeries performed on living people. Still, it is believed that Egyptians successfully reconstructed noses lost as punishment for crimes such as adultery.
Noses were amputated during times of peace, too, if they happened to be distorted or out of proportion. For instance, in the late 19th century BC Egyptian Queen Hatshepsut had her stepson’s nose cut off because he complained about her affair with army commander Senenmut. She then ordered Senenmut to marry her because she was afraid of punishment for what she did; however, he committed suicide before their wedding.
During the same period in ancient Rome, surgeon Aulus Cornelius Celsus (25 BC-50 AD) included plastic surgery techniques in his encyclopedic medical work called De Medicina (On medicine). He assumed that a person must be healthy or not suffer from severe injuries or diseases to receive surgical intervention. This assumption stands until the modern era. His clinical practice was based on four main principles:
- Make the wound as small as possible;
- Do not harm any healthy part while cutting something diseased or damaged;
- Try to close wounds with minimal damage to tissue;
- Seek assistance from nature because it is wiser than any human being.
Celsus’ method for repairing noses amputated due to adultery was fairly straightforward; he opened the skin to get rid of the cartilage, then stitched up the wound and applied bandages that covered half of the face to shape it like a natural nose after healing. Celsus did not mention any instruments for nasal repair surgery, but American surgeon John Hutchinson said an early instrument used for nose surgery was a pessary.
It consisted of two pieces placed inside the nostrils and then pushed together to hold them in place while stitching the wound.
After Celsus, not much is known about successful plastic surgeries performed on living people. Physicians tried to avoid plastic surgery because it could lead to death due to blood loss or infection, so they focused more on traditional treatment methods such as wound dressings, leeches and bloodletting.
For example, British surgeon John Hunter (1728-1793) was renowned throughout Europe for his innovative surgical tools, which included button hook forceps designed specifically for facial repair work; however, despite all his efforts, he managed only one success with facial repair surgery.
The first successful nose reconstruction occurred in 1814 thanks to French army surgeon Baron Guillaume Dupuytren (1777-1835), who transplanted a piece of rib cartilage into the patient’s forearm for later use. His patient reportedly liked the result, but it is believed that the new nose didn’t last very long because he died of sepsis.
The world of plastic surgery came closer to modern techniques with contributions made by American surgeons during the 19th century. In 1827, Charles Joseph Lauth performed his first experimental operation on a young girl whose upper lip was badly burned. He tried alternative treatments without success, so he decided to cut away the destroyed and grafted skin from her arm.
Even though the patient healed well, Lauth didn’t use this type of procedure again because it made him feel very uncomfortable. He believed that working on women without their consent was wrong and immoral because they would have to endure pain induced by burns while being operated on so shortly after injuries occurred. This belief led him to try other methods for treating facial disfigurement, such as using wax models or taking sketches of injured body parts to reconstruct them at home during recovery.
British army surgeon Reginald Southey (1835-1907) improved upon Dupuytren’s technique by using healthy cartilage instead of ribs. In 1845 he used a patient’s healthy septum, inserted it into a nasal cavity and then successfully stitched the wound. In 1855 he used this method to reconstruct a woman’s nose that was amputated due to cancer. Southey didn’t publish his work in medical journals until 13 years later, when he presented his results in front of the British Medical Association at their annual meeting. His contribution inspired many other surgeons in London and Paris to start performing similar procedures.
The man who brought modern plastic surgery out of its infancy was Swiss surgeon Auguste-Arthur Reber (1843-1907), an army doctor from Neuchâtel. He began treating injured soldiers during the Franco-Prussian War in 1870 and immediately noticed that not much could be done for patients who had suffered from facial injuries.
In 1883, he presented a paper at the annual meeting of the Swiss Surgical Society that included his idea of reconstructing faces by transplanting tissues and even entire organs. His work was well-received, and he soon saw many patients with severe disfigurements walk through his doors. He performed countless successful surgeries and gained world recognition for his work.
One of Reber’s most famous cases was following the tragic Lake Sepluved accident in 1900 when the ferry “König Albert ” sank on Lake Constance, killing more than 400 people. Reber was invited to help injured victims and managed to rebuild noses, lips and even eyelids for some of them using skin grafts taken from the healthy parts of their bodies.
On the one hand, his work with injured soldiers and his famous accident patient allowed him to rebuild the whole faces of three people. This was a huge success considering that only two years earlier, Reber tried to restore the function of facial muscles in one of his patients but failed due to a lack of knowledge about facial nerve pathways. Reber achieved his most memorable accomplishment in 1908 when he restored everything but the vision to a French woman who suffered from severe injuries after she jumped off her horse-drawn carriage into an open fire. The woman came out of surgery looking normal except for complete blindness.
Many advancements were made up until World War I thanks to brilliant surgeons like Georges Portmann (1870-1937), who perfected cheek reconstruction and Tancredo and Fritz Tornow (1880-1956 and 1878-1930, respectively), who developed a method for using x-ray to locate glass debris in faces. Unfortunately, this progress was destroyed during the war when biological warfare agents were used, frequently leading to severe scarring. In an attempt to conquer these obstacles, surgeons at that time mainly focused on scar camouflage techniques rather than facial reanimation.
After World War I
It wasn’t possible to restore many soldiers’ faces because of a lack of knowledge about nerves responsible for face movement and general postoperative care. Furthermore, doctors could no longer take skin from living patients to reconstruct other people’s bodies, so they had to look elsewhere. They found a solution in cadavers’ skin, a technique improved during World War II when wounded soldiers were frequently treated by doctors who had recently returned from Nazi concentration camps. Those surgeons realized that skin grafts taken from prisoners held at those places healed better due to less exposure to sunlight.
Furthermore, Austrian surgeon Fritz Baldamus (1891-1976) developed a method for using dermis and epidermis as well as fat tissue from cadavers after he noticed how fast certain patients’ infections were healing compared to other similar patients who didn’t have access to such tissue. In time this method was widely used all around the world and turned out to be essential in developing modern plastic surgery procedures.
After World War II
Plastic surgery slowly started regaining popularity, but it wasn’t until the 1950s that this discipline experienced significant progress. During the first half of that decade, “plastic” was used more frequently than “cosmetic” to describe procedures like rhinoplasty (nose job) and otoplasty (ear correction). Furthermore, new subspecialties emerged that supported cosmetic surgery, for example, maxillofacial surgery, which is now essential in performing most face surgeries.
Unfortunately, the latter half of the 1950s wasn’t as successful as patients often suffered from severe deformities following previous reconstructive surgeries. At that time, surgeons were advised against using skin grafts taken from cadavers less than 6 hours after death because of the risk of hepatitis. Still, it turned out that the “golden period” was between 6 and 10 hours postmortem. This finding allowed plastic surgeons to learn how to repair damaged skin in patients, which led to the increasing popularity of facelifts in the mid-1960s.
One of the most remembered events in plastic surgery history happened when René (Rene Jules) Leuillet (1913-1987), a French doctor, performed the first breast transplantation on February 27th, 1965. It’s interesting how this is one of the main reasons plastic surgery is constantly associated with women; however, if we look at its history, we will see that it originally proved itself very helpful in restoring men’s faces.
Another important event happened in 1969 when three separate groups of surgeons, led by Cournand, Bailey and Bremer, published data about their first successful heart transplants. This type of surgery is frequently linked to the medical instruments used during that time. However, it still has much more to do with speed than accuracy since its success rate was close to zero until 1987 when cyclosporine became available. Cyclosporine proved very effective at preventing organ rejection, allowing doctors to transplant human hearts almost every day for five consecutive years until 1992.
Many medical devices widely used in plastic surgery were developed during the 1970s. For example, disposable laryngeal mask airways were created in 1974; the very first practical microlaryngoscope appeared in 1976. This device has allowed surgeons to perform laser tumour removal since 1993, referred to as Laser-Assisted Intra Operative (LAIO) surgery. Just like lasers, ultrasound has also proven itself highly effective in facial rejuvenation procedures, but unlike them, it was rarely used for this purpose until 1988.
Another interesting event happened when Dr Orentreich performed the world’s first hair transplantation on September 14th, 1952. Hair restoration surgeries proved useful in the 1990s when Dr Uebel was using them to save people who had been badly wounded in the war.
It’s interesting how the US military played a significant role in advancing plastic surgery when in June of 1970, Congress passed the “Family Practice and Preventive Medicine Act.” This was followed by two more acts which led to The Commission on Accreditation of Rehabilitation Facilities (CARF) in January 1972. A year later, CARF approved using physical medicine technologies, including massage tables. Still, most importantly, they made it possible for medical companies to manufacture devices specifically for rehabilitation purposes. That was crucial since these new medical tools helped treat people who had been wounded in a war which was precisely what happened at the end of that decade when the Vietnam War ended.
Modern Plastic Surgery
Plastic surgery is a broad field and has created revolutionary changes in the medical world. This field offers countless options to correct any issue and thus helps you attain that perfect look. One such area where plastic surgery has done wonders is reconstructing the breast after mastectomy. The reconstruction of the breasts can be achieved through implantation, latissimus dorsi flap or expander option. Implants are one of the most commonly used procedures in plastic surgery, which involve the insertion of silicone or saline implants into damaged tissue to provide support or cover up deformities. Severely disfigured patients are often referred to as having ‘The Breast Cancer Blues.’ A mastectomy surgery follows an instance of some cancer affecting the breast tissues, which are removed. This surgery is often combined with another procedure involving healthy tissue being moved from other body parts to restore the breast shape. The procedures are also done in cases where no malignant cells are present in the tissues. Yet, a woman feels embarrassed or uncomfortable because of her appearance, opting for an artificial reconstruction by implants or latissimus dorsi flap.
Plastic Surgery Today
Surgery today is no longer based on the type of surgery practised by our ancestors. Surgery has grown into science by itself, specializing in different fields with various branches of study. The field of plastic surgery is one of these modern sciences which has an invaluable place in the medical world. Plastic surgery has developed specialities like hand surgery, burn surgery, cosmetic surgery and many more.
Doctors who practice plastic surgery are called plastic surgeons. Plastic surgery is mainly done to regain lost body parts or for reconstructive purposes, which include the restoration of form and function after congenital anomalies, developmental abnormalities, trauma (accidents), disease (e.g., cancer) and infection that cannot be cured with the help of conventional surgery, and also for reshaping normal structures of the body.
Types of Plastic Surgery
These are the main types of plastic surgery performed to rebuild or form new body parts.
Breast Reconstruction Surgery
After mastectomy, breast reconstruction is done to give shape and structure back to the breasts after they have been surgically removed due to cancer. Breast implants, latissimus dorsi flap (flap reconstruction), transverse upper gracilis (free flap), transposition with deep inferior epigastric perforators, and pedicled abdominal flaps are some of the surgical procedures used in reconstruction surgery.
Burn Reconstruction Surgery
Reconstructive surgery is done after burn injuries to restore a normal appearance, feeling and functioning to the injured body parts.
Thumb reconstruction, fingers reconstruction, below elbow amputation and microsurgery are some of the specialities in hand surgery.
Wound reconstruction is done to repair wounds caused by trauma or surgery. Grafts for skin replacement may be taken from the patient’s skin (autograft) or another person (allograft).
Limb reattachment is performed after amputation to restore the normal structure and function of the body.
This plastic surgery covers surgeries related to the restoration of form and function in various parts of the eye after trauma, surgery or infection.
Pedicle Suture Surgery
This surgery closes muscles and other soft tissues in the body.
Ear Reconstruction Surgery
Ear reconstruction surgery is done to overcome the deformities of ears caused by burns, accidents, developmental abnormalities, etc.
This surgery is done to remove tumours and cysts from the body.
Cosmetic surgeries like facelifts, blepharoplasty (double eyelid), liposuction, etc., are performed for contouring and reshaping normal structures of the face and body.
Aesthetic Plastic Surgery
This type of plastic surgery includes procedures that improve the body’s appearance with or without any functional impairment.
After-effects of Plastic Surgery
Plastic surgery has good and bad side effects and positive and negative results for its recipients. As far as positive results are concerned, there is no doubt about them, but negative results are not so easily dealt with.
The scars of plastic surgery are permanent and will be visible throughout your life, no matter how careful you are. It is also possible to get skin infections after surgery, even though they may be mild in most cases. One must remember that all surgeries involve some risk that can be minimized by following medical advice to the letter.
In conclusion, plastic surgery is a specialized branch of medicine and has produced excellent results for those who have undertaken it under qualified hands. So, if you are looking for a way to rescue yourself from a severe deformity or illness, do not lose hope, as your saviour may be just around the corner!