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History of Plastic Surgery

Plastic surgery procedures between 1840 and 1900 boomed. Why was there this sudden surge in interest and surgical innovation? This is because of the development of Anaesthesia (no pain) in 1846 and Antisepsis (no infection) in 1867.

Introduction of Anaesthesia

Anaesthesia was introduced in 1846. William Thomas Green Morton (1819-1868) discovered ether anaesthesia that could make one sleep while the surgery was taking place. General anaesthesia was born. Because of this, surgery was more widely accepted.

By late 1880s, local anaesthesia (numb the area for the surgery) using cocaine for surgery of the eye and spinal meant that the risk of dying under general anaesthesia could be significantly reduced. Plastic surgery began to use local anaesthesia and this practice became widely used. This was one of the primary factors that encouraged the successful outcome of the patient undergoing surgery.

Antisepsis

The model of Antisepsis was discovered by Joseph Lord Lister (1827 - 1912) in 1867, which led to the reduction in infection.

By the end of the 19th Century, this model was widely accepted. It became a norm that cleansing of the patient, the surgeon, instruments and operation room be carried out before every surgical procedure. This sharply reduced the risks on patients undergoing aesthetic surgery due to decreased rates of infection.

The Enlightenment Philosophy - Happiness is the goal of Plastic Surgery

Every person could remodel him or herself so as to achieve happiness was The Enlightenment Philosophy of the 19th Century. This thinking was encouraged by the reduction or removal of pain and infection rates in plastic surgery, and the right to remake one's self to become happy with the help of a surgeon led aesthetic surgery to become a modern phenomenon.

From Pharoanic Egypt to Renaissance

Throughout historical records of medicine, there were procedures to improve the appearance of the body. A common undesirable result of surgical intervention in the body is scarring. Surgeons in the Pharoanic Egypt as early as the Edwin Smith Papyrus (ca. 1600 B.C.E) were concerned about the aesthetic results of their interventions. It was documented that the Egyptians carefully sutured the edges of facial wounds. Nose bone fractures were forced into normal positions by inserting two plugs of linen, saturated with grease into the nostrils.

In 1st Century A.D., Aulius Cornelius Celsus, the Roman Encyclopedist emphasized the importance of the beautiful suture.

Early records such as the bone oracles (14th Century B.C.E) documented illnesses of the nose in Ancient China.

Two Chinese Physicians, Bian Que (5th Century B.C.E) and Hwa Tuo (c.a. 150 - 208 A.D.) described and documented treatment of the eyes and ears of patients.

According to Chinese tradition, it was prohibited to open the body. Therefore, all forms of surgical interventions were limited until recent times. However, records of medical texts dating to the 10th Century A.D. in the Northern Tang and Gin dynasty described harelip (cleft lip) reconstructive surgery. Elsewhere, procedures were developed to improve the appearance and function of the body. For example in the 7th Century, Alexandrian physician Paulos of Aegina developed a procedure to remove male breasts in men - gynaecomastia. This procedure is common till this day. Liposuction, the "cure for obesity" was described by Piimy the Elder (23/24 A.D. - 79 A.D.) to remove excess fat from the body.

In the middle ages, all surgery was seen as a cure for disease be it physical or psychological and plastic surgery was unheard of even though body parts such as noses were lost to war, accidents and disease. This is because the body parts were still functional although deformed. Aesthetic or beauty surgery was spoken of only in the Renaissance Era.

Syphilis in the 16th Century

The rise of plastic surgery in the 16th Century was related between the outbreak of Syphilis epidemic that caused defects such as deformed noses and led to the new aesthetics of the Renaissance era.

Aesthetic surgery was a trade secret passed on from father to son. However, a knight Heinrich Von Pfalzpaint described the use of an arm flap graft to repair the nose from 1460 - a trade which he claimed to have learnt from a foreigner which earned him much money.

However, only with the Italian Renaissance and a professor of surgery at the University of bologna, Gaspare Tagliacozzi (1545 - 1599) that he found the relation between an absent or deformed nose and unhappiness of the patient and general good health. Unhappiness also stemmed from the stigma that having no nose be it due to war or accident could be a mark of disease or infection like Syphilis. In his book "De Curtorum Chirurgia" 1597, Gaspore Tagliocozzi described and illustrated the use of pedicle flap grafts to reconstruct new noses ravaged by trauma or syphilis. This became the first documented illustrated nose job.

The technique using flaps was also used in 15th Century Sicily. This graft, still attached to the arm, the loose end of the flap joined to the stump of the nose for as long as 20 days, reducing the complication of taking a graft from the cheek, leaving scars on the face. It took a total of at least 6 procedures and a span of more than a month with risks of infection, pain and a great deal of discomfort as well as inconvenience before a nose was created by this method.

First nose job in India (1794)

The Catholic Church did not like the idea that one can correct the scarring and distortion that Syphilis caused. This was because a human intervention was presented to the realm of divine punishment. Therefore, Tagliacozzi's innovations were ignored or forgotten until 1794 when the British colonial power was established in India that a detailed account of the reconstruction of a nose was published in the West. This was published in an anonymous article written in the Gentlemen's Magazine in London.

The patient named Cowsjee, in the service of the British, was a Parsi Bullock driver who was captured by a rebellious Tipu Sultan, Fath Ali, Nawab of Mysore (1753 - 1799). Cowsjee's hand and nose were amputated for working with the British - meant he was a traitor. Therefore, nose repair developed much later in Europe (and the west) written by German surgeon Eduard Zeis (1807 - 1868) in 1838 due to the destructive effects of Syphilis and not barbaric forms of punishment as seen in the east.

Berlin Surgeon Johann Friedrick Dieffenbach - The Father of Plastic Surgery

In the middle 19th Century, aesthetic surgeon from Berlin Johann Friedrick Dieffenbach (1792 - 1847) was the main figure in 19th century facial surgery. He was regarded as best in the field of nose repair or reconstruction. He encouraged reconstruction of the nose for both function and to improve one's looks. He aimed to reduce the syphilitic's isolation by reconstructing new noses for them, yet the method showing visible scars would also alert healthy people on the possibility of having contact with carriers of venereal disease. He repaired an 18 year-old Polish woman's nose whose face had been eaten away by Scrofula (Tuberculosis). He did that by using a flap graft from her upper arm. The transplant was a success and corrective procedures carried out to shape the nose in the following 6 months.

The First Tummy Tuck (1899)

Howard A. Kelly (1858 - 1943) in Baltimore removed a pendulous abdomen surgically removing fat and skin (a.k.a. tummy tuck). The belly fat removed weighed 14 - 19 pounds from a 285 pound woman. It was believed that in so doing obesity would be reduced or cured.

The First Face Lift (1901)

Eugen Hollander (1867 - 1932) undertook the first face lift on a Polish aristocrat. The patient suggested that he remove facial skin at the front of the ear, the nasolabial fold and corners of the mouth would be tightened. The woman made very specific suggestions in a drawing and persuaded him to do it her way. By doing so, Hollander was able to make small changes to the upper face that the patient was happy with, even though he found that this method was inferior.

The First eyelid surgery (1906)

Charles Conrad Miller (1850 - 1950) had developed procedures for the removal of little bags from the lower eyelid or relaxed lid (droopy eyelid) folds of skin that could impair vision. This procedure was copied by other surgeons of his day. General surgeon Johann K. G. Fricke (1790 - 1841) coined the term "Blepharoplasty" for eyelid surgery in 1829.

The First Fat Injections (1926)

Plastic surgeons of 1920's wanted to rejuvenate the ageing face rather than change the skin of the body by tightening using facelifts. In 1926, Charles Willi wrote that frown lines and naso-labial lines can be easily filled using one's own fat. A procedure that does not have pain, danger or leave scars like surgery. It remains popular till this day.

World War 1 leading to reconstructive surgery

Sir Harold Delf Gilles (1852 - 1960), a New Zealand born surgeon, described plastic surgery as to surpass normal, for example nose job to make the bridge higher. He also described reconstructive surgery as to return to normal such as trauma after a war - reconstruct a new nose. After World War 1, plastic surgery was for men damaged by war. Later on it became known, after the 1920's, as beauty surgery for women.

Breast Augmentation

H.O. Barnes medicalized the need for increasing breast sizes in his observation that decreased breast sizes caused psychological stress or unhappiness. Hence there begin a search for a cure for this - breast augmentation. Breast augmentation then became the "cult" of body beautiful from the 1950's, shifting the trend of breast reduction in the 1880's.

Initially in the 1950's, silicone was injected under the fat. Some problems arose from this method. This included migration, infection, bruising, visible lines and unusual hardening of the injected area.

In 1963, a silastic gel prosthesis invented by two surgeons from Houston, Thomas Cronin and Frank Gerow consisted of a saline filled sack. This concept came about when Gerow saw a plastic bag filled with blood used for transfusion in a form of a breast shape. The prosthesis was implanted successfully in 1962 and later models using the same concept were filled with silicone. Later on, saline filled implants reduced in popularity due to less natural feel and did not give the illusion of the breasts form and texture that the women and surgeons wanted. Today, silicone implants have overtaken saline implants in popularity because they are safe and give a much more natural feel. With cohesive/gummy bear gel filling, silicone gel implants no longer have contents that leak into the surrounding body tissues.

Modern Liposuction

Until the 1970's, methods to remove fats from various parts of the body involved removing fatty tissue and skin, then stitching the two ends together. This would however result in bad scarring.

Throughout the 1970's, different procedures were developed to solve this problem. Modern liposuction involved blunt instruments to create tunnels and was (developed in 1977 by Yves - Gerard Illouz of France), and introduced to United States in 1981. This then became the most popular method as fat was removed with little scarring and no excess skin, leaving no trace of surgery.

Plastic Surgery Today

Plastic surgery has been increasing in practice since the close of the 19th Century. In reality, plastic surgery is a classic product of the modern world. The technology arose because of the anxiety about the visibility of the diseased damaged body that needed reconstruction. Surgery from wounds of war, lesions from diseases such as syphilis to small pox and malformation of birth found the background to the start of plastic surgery from the close of 19th Century. Antisepsis (1867) and Anaesthesia (1846) made surgery more acceptable and contributed to the rise in increased cases. Interestingly, throughout the history of plastic surgery the first patients were men.

Today even though there is public anxiety about transformation of the body using commonplace procedures, more people who have had procedures claim their right to take control and change their bodies, and publicly admit this.

With more procedures arising, more people are willing to undergo procedures. This is due to the need to look better, in association with health and fitness regimes, as there is always room for improvement to enhance our looks, be it a smaller nose, fewer wrinkles, or bigger breasts.

With botox, fillers or surgery, the history of plastic surgery reflects our ability to reimagine every aspect of our bodies in a different and improved form.

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