Plastic and reconstructive surgeries are statistically one of the most frequently performed surgeries worldwide. Their popularity is constantly growing. According to official statistics of ISAPS (International Society of Aesthetic Plastic Surgeons), there were 10,129,528 procedures performed in 2020 worldwide. We can clearly see that they are in the mainstream now, but have you ever wondered when and where did plastic surgery start? What were the most ancient techniques of reconstructive and aesthetic procedures? Who performed the first plastic surgery? In this article we will answer to all these questions, solemnly inviting you to dip into incredible history of plastic surgery.
Why plastic surgery is “plastic”? – the etymology of plastic surgery name
Surprisingly “plastic” in this pair has nothing to do with synthetic material, that surrounds us almost everywhere. Word “plastic” in plastic surgery origins in ancient Greek plastikē (tekhnē) and means “giving form” or a “mold”. So, plastic surgery is literally a surgery that gives a new form to the human body. Term’s etymology is deeply connected with plastic surgery’s original function of “giving a form to what’s been deformed”. First plastic surgeries were performed to reconstruct body parts that were severely misshapen or even severed due to accidents or fights.
When and where was the first plastic surgery performed?
First mentions about plastic surgeries are found in an ancient Egyptian papyrus dated back to 1600 BC. However, Egyptians didn’t seem to perform plastic surgery on living people. It was one of the ways to prepare a noble dead for the afterlife. Ramses II is believed to have such a posthumous procedure by surgical insertion of seeds and bones into his nose.
Historians date first plastic surgery, performed on a living person, back to 800 BC in Ancient India and regard Suśruta as its pioneer. Suśruta was an ancient Indian physician known as an Indian “Father of Surgery” and the author of “Suśruta Samhita” – The Book of Suśruta, an antique text, accounted as the first compendium of medicine and surgery and a foundational text of Ayurveda – traditional Indian medicine that is practiced to this day.
In Samhita, Suśruta described for the first time a cheek flap method of nasal reconstruction. Regardless of the full rejection of Suśruta Samhita by modern medicine, the book is reputed as astonishingly accurate and technically developed, stepping ahead of its times.
During the surgery, the right size of the patient’s cheek skin was measured and dissected and the flap was used to form an absent or seriously damaged nose.
Plastic surgery development in the West
Aulus Cornelius Celsus (25BC – 50AD) – an ancient Roman physician and medical writer, author on “De Medicina”, described plastic surgery of the face, using skin from other parts of the body along with numerous medical procedures and surgeries. Interesting is that his work remained a useful medical knowledge compendium until the early 19th century.
In Medieval times, there was little possibility of the development of plastic surgery as the surgery itself was viewed rather negatively by the Catholic Church, which unquestionably hold most of the power in Medieval Europe. According to historians, separation of surgery from the practice of medicine had begun to develop in early medieval times but a huge progress couldn’t be achieved, as in 1215 by the Fourth Lateran Council, a papal edict that forbade physicians (most of whom were clergy) from performing surgical procedures, as contact with blood or body fluids was viewed as contaminating to men of the church.
However, domains under Islamic influences were more enthusiastic about science and medicine, thus surgery and plastic surgery achieved certain developments in the region. In the 15th century, Ottoman surgeon and physician Serafeddin Sabuncuoglu discussed maxillofacial and eyelid surgery in his compendium “Imperial Surgery”, which included 191 surgical topics. He also introduced the treatment of gynecomastia, which is regarded as a foundation for modern breast reduction surgery.
Despite some developments in Middle Ages and Renaissance eras, surgery involving the face was too dangerous to become more common. It was mainly due to a lack of proper disinfection and anesthesia techniques.
The 19th century brought the greatest progress in plastic and reconstructive surgery. Significant is the achievement of Joseph Constantine Carpue – a military surgeon who performed a successful nose reconstruction using a forehead flap. His patient was a British military officer, who lost his nose due to the side effects of toxic mercury treatment. 19th-century medical regimen was truly gruesome!
This is how he described the operation:
“The parts of the face being prepared for the reception of the new nose, I began that part of the operation which belongs to the forehead, by making an incision along the lines I had drawn. I then dissected the integuments, merely leaving the pericranium. (…) My next steps were to make the turn of the dissected parts, and, introduced (sic) the septum into the incision of the upper lip, where I confined it by ligature. After this, I brought the integuments exactly into contact with the integuments on the left side, and fixed them off by two ligatures; and then I did the same on the right. I introduced lint to distend the nostrils, and applied straps of adhesive plaster to keep the integuments in contact.”
Joseph Carpue’s method of nose reconstruction was then improved by Karl Ferdinand von Graffe. In his magnum opus “Rhinoplastik” von Graffe introduced a completely new approach, involving graft from patient’s arm, instead of forehead, or cheek. This novel technique, known as Italian method, allows surgeons to reconstruct the nose without damaging other parts of the face.
It seems that plastic surgery in general was utilized for reconstructive purposes, and it is a fact. However, there were cases of plastic surgery performed only for aesthetic objectives, such as the case of Dr. John Roe’s patient who got her nasal hump removed successfully in the late 19th century.
Plastic surgery progress brought by the war – 20th century
The development of explosives-based weaponry and the break out of major military conflicts resulted in increased demand for face reconstructive surgeries. The most famous case of face reconstruction is the case of Walter Yeo – an English sailor who fought in the First World War. His face was terribly injured while manning the guns during the Battle of Jutland. Injuries included complete loss of upper and lower eyelids. He was treated by Dr. Harold Giles, a pioneer of skin graft surgery. The skin flap was grafted from undamaged parts of Walter’s body and transferred into totalled face parts. The operation was successful and the patient could live a relatively normal life. The example of Walter Yeo is considered a great milestone in the development of plastic and reconstructive surgery.
What about the history of breast augmentation surgery and liposuction?
Almost all cases described above evolve around the face, and most of them are examples of, what we would call a reconstructive rhinoplasty. But what about breast and body surgeries? Is it something completely new? Well, not.
The first case of breast surgery is dated to the end of the 19th century, more the precisely year 1895. What would not be surprising, it was also reconstructive surgery. An Austrian surgeon Vincent Czerny performed a tumor removal on the patient’s breast and then augmented missing tissue with the patient’s own fat, which was cut out of her thighs. We might say it was a little uglier version of breast fat graft.
In the late 19th and early 20th centuries, women were regular victims of cosmetic quackery. There were numerous “doctors” who offered breast augmentation treatments with rather doubtful materials, such as paraffin wax and liquid silicone injections, implants made of glass, sponges, steel and rubber balls. As you might expect, those procedures had disastrous consequences.
The first safe sillicone breast implant was invented in the year 1962 by Drs. Frank Gerow and Thomas Cronin. The first operation was performed on the dog and was successful, but the implant was removed as she constantly wanted to chew it off. First silicone breast implant augmentation was performed on Timmie Jean Lindsey who volunteered for the surgery.
With the rising popularity of cinema and TV, many women were showng the desire to look like Hollywood stars. Everyone wanted the perfect, hourglass body of Marylin Monroe, with full breasts and a slim waist. Besides demands for fuller breasts, they wanted to remove fat from where it was undesired. Therefore physicians started to work on fat removal techniques development. I will just mention, that there was a case of unsuccessful fat removal surgery performed in 1920 when the surgeon removed an excessive amount of fat from a dancer’s knees and she ended up with gangrene, which required leg amputation. What a tragic story!
In the 60s and 70s, still, the most common way of diet-unrelated fat loss was fat dissection. Liposuction as we know was born in 1974, where Italian gynecologist Dr. Giorgio Fischer invented a cannula – a suction tool that allowed to remove the fat while avoiding huge damage to blood vessels and skin tissue.
The history of plastic surgery is gruesome, yet fascinating. Techniques came a long way from autologous skin graft rhinoplasty to modern synthetic material augmentations, intelligent tissues almost identical with human skin or 3D printed nasal bridge implants, designed based on patient’s individual features and expected effect. Most of all, plastic surgery now, unlike in the past, has become very safe so more and more people decide to correct their imperfections and gain self-confidence by safe and effective aesthetic procedures.
“Sushruta: father of plastic surgery” by Manish C. Champaneria, Adreinne D. Workman, Subhas C. Gupta, National Library of Medicine
“The staged cheek-to-nose interpolation flap for reconstruction of the nasal alar rim/lobule” by D J Fader 1, S R Baker, T M Johnson, National Library of Medicine
Aulus Cornelius Celsus Biography on Encyclopedia Britannica.
Bagwell CE. “Respectful image”: revenge of the barber surgeon. Ann Surg. 2005;241(6):872-878. doi:10.1097/01.sla.0000165185.88634.d0
Basagaoglu, I; Karaca, S; Salihoglu, Z (April 2006). “Anesthesia techniques in the fifteenth century by Serafeddin Sabuncuoglu”. Anesthesia and Analgesia. 102 (4): 1289. doi:10.1213/01.ANE.0000199205.23697.F6. PMID 16551944.
“A brief history of breast enlargements” By Claire Bowes & Cordelia Hebblethwaite. BBC World Service