Plastic Surgery’s Surprising Past, Present, and Future

Author: Dr. Bobby Buka

Plastic surgery has been around for centuries, but it became mainstream during the world wars of the 20th century. And although plastic surgery procedures are still used as corrective measures, cosmetic surgery has become a personal choice and a statement. At The Dermatology Specialists, we celebrate the choice many of our patients make to become truer versions of themselves.

Contemporary humans are already far more “enhanced” than our ancestors of even a century ago, and the availability and practice of plastic surgery is one of the main factors in that assessment. As medicine grows increasingly sophisticated, plastic surgery options will offer even more options for individual modification.

The first documentation of plastic surgery dates back to the 6th century BC, though the practice may predate these writings. Susruta’s Compendium describes an early form of rhinoplasty, using skin from the forehead and cheek to build a new nose.

Sushruta practiced this procedure in the Ganges Valley of North India, on patients whom had suffered societal punishment for “religious, military, or criminal” offenses. “Reconstructed noses of one kind or another were popular precisely because the removal of noses (and ears) was a common punishment in wartime or for those who committed adultery or treason.” This horrific discipline continued throughout the centuries: in the Germanic tribes of the 400s, in Jerusalem in the 900s, and throughout the Middle Ages. It even manifests today.

A syphilis epidemic that plagued Europe in the late 1500s saw a surge in rhinoplasties, as syphilis ravaged the nasal cavities of its victims. Such a blemish could seriously impact a person’s social standing and mobility. In these cases, skin would often be taken from the arm and used to fashion a new nose, similar to Sushruta’s method.

Cosmetic enhancement procedures were popular in the 1800s, judging by advertisements in publications, and were fed by (sometimes racial and ethnic) stereotypes of nose shapes. In the late 1800s and early 1900s, Charles Conrad Miller of Chicago, who is commonly considered the first cosmetic surgeon, began publishing papers about procedures he developed. His contemporaries Hollander and Lexer – “the fathers of the facelift” – based the procedure on women’s existing beauty hacks. And according to The Telegraph: “[…] ‘plastic surgery’ as a term was coined in the 1830s (from the Greek, plastikos – to be moulded), decades before “plastic” became a word to describe man-made materials.”

However, the true revolution for cosmetic surgery came about through the breadth and depth of facial injuries suffered by soldiers in trench warfare. “During World War I, London General Hospital established the Masks for Facial Disfigurement Department. The Tin Noses Shop, as the soldiers called it, brought together American and European doctors and sculptors who worked to create individualized metallic masks, which then covered deformed or missing jaws, eyes, lips, and noses of wounded men.”

According to Roger Green, archivist for the British Association of Plastic and Reconstructive Surgeons (BAPRAS), the field of plastic surgery officially dates back to 1915. With the large number of injured and disfigured soldiers, cosmetic surgery became more than an elective. “Facial restoration was viewed as a necessity rather than a vain indulgence, and generals, hoping to raise troop morale, heartily endorsed the practice.”

After WWI, the procedures became more mainstream, particularly as the film industry gave the opportunity for close-ups. Surgeons had likely performed or at least learned the techniques in the war effort, but the patient pool changed. Hollywood film stars like Rudolph Valentino and Gloria Swanson reportedly had work done. Actress Fanny Brice even invited onlookers to her 1923 rhinoplasty procedure in her rooms at the New York Ritz.

This landscape more closely resembles the plastic surgery industry of today, with celebrities endorsing an ideal that in turn drives the market for cosmetic work. Procedures are improved everyday, producing more subtle, natural results. Technology has added some exciting developments, like the ability to 3D print your face with proposed procedural changes, to ensure customer confidence and satisfaction.

What will the next 100 years bring? “Personalized tissue engineering” will make for easier and safer transplants. Aging – or at least the appearance of – will slow. And people will gain more control than ever before over their appearance and bodies.