Created on 31st July 2008
Cosmetic Surgery Magazine UK takes a look at the history of cosmetic surgery from its beginnings, almost 4,000 years ago, to its current day manifestation as a billion pound industry in the UK alone
The shape of things to come
There is little clear division between what constitutes plastic surgery and cosmetic surgery. In the past there have been negative connotations around plastic surgery summoning up images of people having their body parts exchanged with new shiny plastic replacements, like some sort of Barbie doll graft. In fact, the word plastic is derived from the Greek word ‘plastikos' which means ‘to mould' or ‘to shape'. So the literal meaning of plastic surgery is really ‘moulding surgery'.
Today we tend to refer to plastic surgery as that which is a medical procedure carried out by a surgeon to correct a problem, be it a birth defect or as a result of an accident or trauma. Cosmetic surgery is generally considered to be a treatment carried out by an expert, sometimes a surgeon, as a lifestyle choice. The lines between the two are blurred at the edges when you consider that a rhinoplasty for some might seem frivolous and unnecessary, but to the person having the treatment it can give them fresh confidence and a new outlook on life.
The progress of humans has been marked by the never ceasing pursuit of self-improvement so it should not be surprising that altering the way we look is one of the most ancient of practices. Whether it be to arrest the inevitable ageing process, to alter our physical appearance to attract a mate or to correct an injury, the practice of changing our appearance is as old as time. As our species became more sophisticated we devised more permanent and more physically intrusive methods of changing our appearance. Indeed, there is evidence of the use of surgical procedure for correcting facial injuries dating back more than 4,000 years ago.
Sushruta, ‘the father of plastic surgery', was utilising skin grafts in India for reconstructive work as early as 800 BC and around AD 30 Roman medical writer Aulus Cornelius Celsus wrote De Medicina, which laid out surgical methods for reconstructing ears, lips and noses.
The Middle Ages were not a particularly productive era for scientific and medical advancement and development in the area of surgery was stifled. The void left by the Romans was filled with pagan religions and scientifically distrusful fanatical Christianity. This, coupled with unhygienic medical standards and a generally mystical approach to medicine, meant that the practice of cosmetic alteration made slow progress. Indeed it was not until the age of enlightenment when great thinkers during the seventeenth and eighteenth centuries sought to understand the world around them based on evidence and proof that science and technology took a giant leap forwards.
The pace picked up considerably in the nineteenth century and, in quick succession, a series of groundbreaking surgical facial procedures were made. In 1814, Joseph Carpue successfully performed an operation on a British military officer who had lost his nose to the toxic effects of mercury treatments. In 1818, German surgeon Carl Ferdinand von Graefe published his major work entitled Rhinoplastik. In 1845, Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty, entitled Operative Chirurgie, and introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose.
In 1891, American otorhinolaryngologist John Roe presented an example of his work, a young woman on whom he reduced a dorsal nasal hump for cosmetic reasons. And one year later, Robert Weir experimented unsuccessfully with xenografts (duck sternum) in the reconstruction of sunken noses. Later that decade James Israel, a urological surgeon from Germany, and George Monks of the United States each described the successful use of heterogeneous free-bone grafting to reconstruct a nose defect.
War
As with many developments in science it was war that propelled surgery forwards and was responsible for many medical advancements, cosmetic surgery included. World War I saw human destruction on a level never seen before. The wholesale mechanisation of warfare bought with it not only death on an unprecedented scale but also horrific injuries of a range which had never been seen before. Medical advancements in anaesthesia and sterilisation led to the saving of wounded combatants who in previous years would have died from shock or infection. The new advances enabled injured soldiers to go back into society (or often back onto the battlefield). Military physicians were required to treat many extensive facial and head injuries caused by this new style of warfare. Some of Europe's most skilled and innovative surgeons dedicated themselves to restoring their fellow soldiers to wholeness during and after the war.
It was around this time that surgeons saw the potential influence that an individual's appearance could have on the quality of a person's life. This understanding led to aesthetic surgery taking its place as a more respected aspect of plastic surgery.
The progresses in anaesthesia and infection prevention crossed over from the military arena into civilian life allowing surgeons to successfully perform a wider variety of increasingly complex procedures. These procedures included the first recorded instances of surgery that was truly only ‘cosmetic' in nature, such as the first rhinoplasty and breast augmentation procedures.
Glamour
We think plastic surgery is a modern obsession but almost immediately after the great advances that took place in the theatre of war, Hollywood turned its attention to cosmetic surgery and pushed forwards the pace of innovation and expertise in this field.
Plastic surgery in Hollywood dates back as far as the 1920s. However, some of the earlier operations proved disastrous, leaving patients permanently disfigured. "My mother [Debbie Ryenolds] was made to have her ears pinned back and they wanted her to have a nose job," says Carrie Fisher. "But she refused the nose job because they were really butchering them then." Mary Pickford - the silent film star known as ‘America's sweetheart'- was left looking almost mummified by an unsophisticated facelift in the early 1930s and it is claimed Carmen Miranda and Lucille Ball were also victims of this stretch-and-pull surgery.
It is surprising to realise how many stars of the Golden Age of Hollywood used plastic surgery to enhance their looks. In 1949 when Marilyn Monroe was desperate to break into the movies, she agreed to have a chin implant to strengthen a weak jawline. A short while after the secret operation Marilyn landed her breakthrough role in The Asphalt Jungle and within three years she had become one of Hollywood's biggest stars.
It was not just the female stars who went under the knife; a number of celluloid's leading actors underwent highly secretive surgery. Clark Gable had his teeth fixed and his ears pinned back, Burt Lancaster and Gary Cooper had facelifts and Dean Martin underwent rhinoplasty. Even the toughest of the Hollywood heroes, John Wayne had a number of procedures when he entered his sixties, including one to correct his flabby neck, a facelift and upper eyelid surgery.
Modern plastic surgery
The modern history of plastic surgery really started to take shape in the 1960s and the 1970s and there were many significant scientific developments during this time. Silicone was a newly created substance which was growing in popularity as a staple of certain plastic surgery procedures. Then, in 1962, Dr Thomas Cronin created a new breast implant device which was made from silicone. Over the next decade silicone implants were developed for use in just about every imaginable part of the face and body.
In the 1980s, plastic surgeons and plastic surgery advocates made a big push to expand public awareness and improve public perception of plastic surgery. This increase in both the quantity and quality of information available to consumers, together with the economic boom of the 1980s, began to make plastic surgery much more accessible to the mainstream population.
At the start of this new millennium, cosmetic surgery has enjoyed an explosion in popularity, and medical advances have made possible reconstructive procedures that were once considered an impossibility. Currently, the most recent trend in cosmetic surgery is a move towards less invasive procedures designed to reduce the visible signs of ageing. The most popular procedures use injectable substances, such as facial fillers and Botox. There is no doubt that people are discussing cosmetic surgery more than ever before and procedures that only a few years ago required a general anaesthetic are today performed in a lunch hour. More importantly, the stigma that was once attached to cosmetic surgery has fallen by the wayside.
CSMUK
