Plastic surgey today is synonymous with the quest for youth, however it actually dates back to antiquity and may be one of the world’s oldest healing treatments. Learn about its history from antiquity to WW2 to the modern day.
Introduction
Each year, the lives of millions of people around the world who suffer from congenital malformations, disfiguring injuries, severe burns, and more, are improved by plastic and reconstructive surgeons.
These days, plastic surgery has become synonymous with the eternal quest for youth and beauty, and the development of the field is popularly believed to have taken place over the last 30 years or so. It may come as a surprise then that plastic surgery actually dates back to antiquity and may well be one of the world’s oldest healing treatments, driven by medical necessity. The oldest known medical text referring to surgical procedures to correct injuries is the *Edwin Smith Papyrus*, named after the American Egyptologist that discovered it in the late 19th century, and is considered to be around 4500 to 5000 years old.
Plastic surgery is a bit of misnomer and the term in English is misleading – *plastic* is actually derived from the Greek word ‘plastikos’, which means “capable of being shaped or molded.”
Plastic Surgery in Ancient Times
Around 800 BCE, an Indian physician named Sushruta was carrying out procedures very similar to modern-day rhinoplasty. In those times, people who committed adultery would get their noses cut off as a public sign of shame. Sushruta would graft skin from the cheek to the nose, with plant pieces holding the shape inside the nostrils.
His advanced technique for skin grafts was recorded in detail in a text called *Sushruta Samhita*, the first of its kind in ancient history, establishing Sushruta as the father of plastic surgery. The text was translated into Arabic in 750 BCE, eventually making its way into Europe.
During the Greco-Roman period, a Roman medical writer named Aulus Cornelius, documented procedures very similar to today’s eyelid rejuvenation in a text called *De Medicina*. And later, in the early Byzantine period, a detailed medical encyclopedia titled *Synagogue Medicae* contained various reconstructive techniques dedicated to repair facial defects.
Middle Ages and the Renaissance
During the Middle Ages, developments in plastic surgery stalled, partly due to the spread of Christianity. As science gave way to mysticism and religion, plastic surgery was considered a sign of witchcraft, a view further encouraged by Pope Innocent III who declared that surgery was prohibited by Church Law.
During the Renaissance, plastic surgery enjoyed a revival as significant advances in science and technology resulted in safer and more effective surgical techniques. In the 1400s, Italian physician Antonio Braca pioneered his own version of nose reconstruction. Also in the 15th century, Ottoman physician Serafeddin Sabuncuoglu wrote a significant medical book called *Imperial Surgery* which included countless surgical topics. One of them was *gynecomastia*, i.e., enlarged breast tissue in men, and Sabuncuoglu included a treatment protocol for the condition and which is believed to be the foundation of modern-day surgical breast reduction.
In 1597, Italian surgery and anatomy professor Gaspare Tagliacozzi wrote *The Surgery of Defects by Implantations*, which is considered the first true plastic surgery text.
World War I
The development of germ theory and the invention of anesthesia in the 19th century contributed to the advancement of plastic surgery, as with most other medical fields. As the world engaged in the First World War, reconstructive surgery became a necessity to treat injured and disfigured soldiers. The scale of head and facial injuries caused by modern weaponry in the battlefield had never been encountered before, and military doctors were required to come up with innovative techniques in facial reconstructive surgery to heal the wounded.
One of the most prominent plastic surgeons of the time was Dr. Varaztad Kazanjian, sometimes called the founding father of modern plastic surgery, who developed new methods in prosthetic dentistry and maxillofacial surgery.
The developments of plastic surgery during WWI brought about a new understanding on how someone’s wellbeing can be potentially influenced by their appearance, thus paving the way for a new era in the field and the beginning of aesthetic plastic surgery.
The 1940s & ‘50s
In the post WWI era, the field of plastic surgery took off. Johns Hopkins University started a plastic surgery training program in 1924, while the American Society of Plastic Surgeons (ASPS) was established in 1931. During WWII, developments in skin grafting methods and the dermatome instrument allowed doctors to treat wounded soldiers with even better results than WWI.
In 1946, the first issue of the *Journal of Plastic and Reconstructive Surgery* was published, whose goal ever since has been to “inform readers about significant developments in all areas related to reconstructive and cosmetic surgery.”
By 1950, with board certification in place in the U.S., plastic surgery had become fully integrated in the medical establishment. The ‘50s also brought many innovations in the field, some originating in Korean hospitals as a result of the Korean War. Technique advancement included internal wiring for facial fractures and the use of rotation flaps to correct major facial deformities.
Modern Plastic Surgery
In the 1960s, the modern era of plastic surgery started taking shape with silicone, a newly created material, being used by plastic surgeons initially to treat skin imperfections. In 1962, silicone was used as a breast implant for the first time by American surgeons Thomas Cronin and Frank Gerow.
In the 1980s, public awareness and perception of plastic surgery improved and, with more disposable income due to the economic boom, plastic surgery entered the mainstream. It was also during the ‘80s that the groundbreaking *TRAM flap* technique was developed by Dr. Carl R. Hartrampf, transforming the field of breast reconstruction. TRAM (Transverse Rectus Abdominis Myocutaneous) flap procedure involves moving a small amount of abdominal tissue to the chest in order to rebuild the breast mound.
By the 1990s, cosmetic procedures such as liposuction and breast augmentation were becoming increasingly popular, albeit among controversy caused around the safety of silicone breast implants.
Plastic Surgery in the 21st Century
The popularity of cosmetic plastic surgery exploded in the 2000s. With celebrity culture on the rise, so are cosmetic procedures. According to ASPS, 15.6 million cosmetic procedures took place in 2020 in the U.S. alone, an increase of 131% from 2000.
In the wake of the COVID-19 pandemic, skin clinics have reportied an increased demand for procedures on the parts of the face showing on camera, such as neck liposuctions and lower facelifts.
However, the advancement in reconstructive surgery techniques in the 21st century has also been astounding. In 2005, the first ever partial face transplant took place in France during a 15-hour operation on a woman who had been mauled by a dog. Procedures that were once unthinkable such as double arm transplants and full-face transplants are considered modern-day miracles in a medical field that continues to grow and evolve.
