History of Plastic Surgery (Translation) Plastic surgery is the technique of reshaping the tissues of the body for reconstructive or cosmetic purposes, and has an ancient history. The word “plastic” comes from the Greek word “plastikos”, meaning “to mold”, and plastic surgery has played an important role in civilizations around the world. Some ethnic groups have a centuries-old custom of rounding lips, pulling earlobes, wrapping feet, filing teeth, and tattooing. And modern popular dramas such as “Extreme Makeover” and “Plastic Surgery (Nip/Tuck)” suggest that the influence of plastic surgery on culture has not waned. While it may be difficult to file teeth, modern men and women have a wide variety of surgical options, such as liposuction, nose jobs, eye jobs, tummy tucks, and breast augmentation and reduction. The term “plastic surgery” also includes non-surgical procedures such as Botox, microdermabrasion, collagen injections, laser hair removal, and chemical peels. Plastic surgery, which has not always been so approachable and popular, has also been shrouded in mystery, magic and pornography. Ancient Egypt: Plastic Surgery Applied to the Dead Because there is no empirical evidence of living plastic surgery in ancient Egypt, those plastic surgery skills were supposedly intended for the dead. For example, the mummy of Ramses II was treated surgically, using small bones and some kernels to fill the nose so that its most prominent features could be carried into the afterlife. the mummy of Queen Nunjmet used bandages to fill the cheeks and abdomen, in the same way that modern plastic surgeons implant silicone into the body. The Edwin Smith Papyrus shows that the Egyptians had the ability to perform analogous surgery on living bodies, but there is no record of the actual act. Most scholars support that plastic surgery was not performed on living bodies because the Egyptians believed that facial features could be carried into the afterlife and, therefore, simply found ways to maintain their original appearance after death (DiBacco 1994). Ancient India: Birthplace of Plastic Surgery Most historians agree that the first record of reconstructive plastic surgery applied to a living body is found in ancient Indian Sanskrit texts. These texts record restorative procedures for the nose and ears, whether in response to criminal punishment (e.g., adultery) or warfare is not known. The Indian physician Sushruta, working near the present-day city of Varanasi, describes the “attached flap” method of plastic surgery in his book Sushruta Samhita (600 B.C.). The procedure described for nasal reconstruction consists of cutting the skin from the face or forehead, removing and distorting this leaf-shaped skin of appropriate size from its original position, placing it in the new position and suturing it. In order to keep the breathing passages open during the rehabilitation process, two wooden smooth hard tubes are inserted into the nostrils. This is now known as the “Indian Method of Rhinoplasty” and has been unknown in India for centuries (Haiken 1997). Ancient Rome: Plastic Surgery and the Roman Baths In the first century B.C., Rome was also practicing advanced plastic surgery, perhaps as a result of the popularization of the Roman baths. Aesthetics and literature promoted nude beauty, and cultural reasons led the Romans to discover physical differences, especially in the external genitalia, with an inquisitive or even entertaining eye. Celsus also described the “breast reduction” of obese men, whose breasts were “indecent”. These men had “unsightly” and “humiliating” breasts. Roman doctors were also able to remove scars – especially back scars, which were marks of shame, signifying that a man had turned and fled in war, or worse, that he had been whipped like a slave. The poet Martial (A.D. 40-104) mentions that in his time doctors removed the marks from some slaves, but there is no detailed description of the procedure. Doctors often operated on warriors who had damaged their noses and ears abroad, so that they could be better integrated into Roman society. The Middle Ages: The Decline of Plastic Surgery In the time of Galen (A.D. 129-216), the development of plastic surgery accelerated and matured as the human body became better understood; Galen tried to treat strabismus and droopy eyelids, and also performed cosmetic rhinoplasty for purely aesthetic purposes on wealthy men and women. Unfortunately, Galen’s medical books were lost after the fall of Rome, and 20 of the 600 copies survived. Although proper dental treatment was discussed in the Middle Ages, general surgeons were considered pagans and sinners because they spilled blood on the body and were demonic in what they did to it. Renaissance: The brief rise of plastic surgery In the late Middle Ages, the translation of Galen into Western languages was like the Crusaders encountering Arabic documents. During a brief period, plastic surgery underwent a multifaceted revival, most notably in hairdressers. Two Sicilian hairdressers, a father-son team, were able to reconstruct the nose using cheek or upper arm flaps. The upper arm flap is close to the wound, but requires keeping the upper arm close to the nose against the ear for up to 20 days. In India, this procedure is a “trade secret from father to son” (Gilman 1999). Heinrich von Pfalzpaint, a knight of the Teutonic Order, kept the secret of nose surgery handed down to him by foreigners, which made him “very rich”. Many surgeons obtained skin flaps from other donors, such as a neighbor’s pig, and were baffled by the withering away of the new nose. Their theory was that the tissue was “inductive,” meaning that the graft died with the donor. Taglioacozzi believes that plastic surgery is a way for humans to seek to improve themselves, both physically and mentally. However, his reconstructed nose is still only an “insubstantial” nose, as it can fall off if pulled too hard by its owner; rhinoplasty in young women is almost sexual in nature (Gilman 1999). Tagliacozzi also wondered whether a reconstructed nose would still be a reason to end a marriage. During the European Renaissance, Tagliacozzi’s surgical innovations made it possible to reconstruct partial defects of the nose, however, Taglioacozzi’s work was lost due to the religious convictions of the opposition and its emphasis on the syphilitic nose as a justified punishment from God (Haiken 1997). Most plastic surgeons today recognize the Italian Gasparo Tagliacozzi (1546-1599) as the “father of modern plastic surgery” and the main author of the plastic surgery book De curtorum chirugiau (1957). Noting that the “frequent duels, street weapons and other armed conflicts” (Haiken 1997), which destroyed the nose as much as syphilis, created a great need for plastic surgery, Tagliacozzi experimented with tipped flaps, which were transposed to other areas to repair wounds in connection with the skin, subcutaneous tissue and vasculature of the corresponding segment. Tagliacozzi creatively transferred the skin of the upper arm to the nose in several surgical steps. The great thing about Tagliacozzi is that he did not follow the trend of interpreting the disease as a punishment, but he justified his surgical innovation with the individualized and autonomous self-remodeling created by the humanists of the Renaissance, such as Giovanni Francesco Pico della Mirandola (1463-94). Rationale. The nose civilization In 1794, plastic surgery was revived in Europe. It began when Belgian doctors witnessed an Indian mason repairing the nose of a Belgian bullock cart driver who had his nose and hand cut off for the crime of Tiu Sultan. In 1818, Karl Ferdinand Graefe (1787-1840) coined the term “plastic surgery” and described the technique in his 1818 book entitled “Rhinoplastik”. Graefe agreed with Tagliacozzi that the world needed to treat patients with nasal defects with a medical name for the disease rather than as a mark of moral guilt, and Graefe went further to remove the moral stigma of nasal reconstruction by giving it a standardized name (rhinoplasty) like other surgical procedures. The shift to a medical perspective on nasal defects was gradually accepted. At this time, however, the first famous American plastic surgeon, John Peter Mettauer of Virginia (who worked mainly on “cleft lip and palate” and “hypospadias” using tools of his own devising), was not in touch with the people living in the United States. “), has been in dispute with the American physician who lived by Dryden’s admonition (God forbid one should repair his work) (Gilman 1999). Moreover, as the 19th century passed and the colonial influence of European civilization deepened, the nose became a conspicuous racial marker, a stream of consciousness that continues to the present day, as is now known as the “Michael Jackson Factor”. The two world wars and the innovation of plastic surgery War has played a pivotal role in the history of plastic surgery. For example, World War I was filled with close combat trench warfare, which meant that the head and neck were more susceptible to injury, and the newly available airplanes were not safe enough, so pilots and passengers often suffered severe facial injuries never before seen. Injuries such as ruptured palates, impacted noses, and skull splitting wounds contributed significantly to the advancement of plastic surgery techniques and clinical trials, as well as to the development of Harold Delph. Delph. Giles (1882-1960) established the first hospital dedicated to reconstructive and plastic surgery (as cited in Backstein and Hinek 2005). Moreover, despite the medical developments after World War I, there were still no standardized standards in the field of plastic surgery, and the Victorian opposition to vanity still prevailed in a sense. Because any untrained surgeon could be called upon to perform plastic surgery, patients often suffered serious complications, such as amputation or, in the most minor cases, severe scarring. As a result, plastic surgery was associated with “quackery” in the minds of many people. However, the chaos of plastic surgery was effectively ended when a group of surgeons who had survived World War I founded the American Society of Plastic Surgeons (Hyken 1999), which was joined by the American Society of Plastic and Reconstructive Surgeons in 1931 and the American Board of Plastic Surgery in 1937 (renamed the American Society of Plastic Surgery in 1991 to avoid any association with “reconstructive” and “reconstructive” surgery). (renamed the American Society of Plastic Surgery in 1991 to avoid confusion with the historical political terms “reconstructive” and “cosmetic”). Plastic surgery was finally recognized as a separate specialty. World War II led to the development of many plastic surgery techniques, such as functional reconstruction of extremities, multiple methods of skin grafting, microsurgery, immune antibodies, and the corresponding development of knowledge about tissue cell health. A variety of factors contributed to the development of postwar plastic surgery and the break with the tradition of refusal to undergo plastic surgery. First, professional institutions and publications contributed to the further legitimization of the profession; in addition, after the war there were no more war patients, and surgeons generally targeted their surgical skills to a specific population – middle-aged, middle-class women who were wealthy and had mostly completed their families. In turn, these specific groups felt more pressure to look young and beautiful and were referred to by postwar culture as “body fanatics” (Gilman 1999). Plastic surgery became a common post-war term, incorporated into everyday processes like sewing, cleaning, and cooking. Some critics accused surgeons of coining new terms to expand the demand for plastic surgery, such as “flap deformity” (loose skin on the upper arms) and “spare tire deformity” (protruding belly). Silicone breast implants also became popular in the 1960s. Dancers were injected with liquid silicone, a substance first used in Japan during World War I for augmentation of the atrophied legs of polio. Liquid silicone often had dangerous side effects, such as mastectomy due to infection and inevitable sagging of the breasts after a woman’s 40s. Improvements in silicone breast augmentation (liquid silicone in a safety capsule) gave hope to women undergoing mastectomy (Haiken 1997). The 1990s: Continued popularity Although silicone breast implants were available for breast cancer patients in the 1990s, the FDA banned silicone breast implants from the free market in 1992 because of reports of implant leakage. Even though this could be considered a setback, it did not affect the continued growth of plastic surgery in the 1990s, with over 5,000 board-certified plastic surgeons practicing in the United States. In an important event for plastic surgeons and patients during this period, President Bill Clinton signed a bill requiring insurance coverage for post-mastectomy plastic surgery costs. Several groups were working to get reconstructive surgery for childhood deformities included in insurance entries (web info). The Future of Plastic Surgery Throughout the history of plastic surgery, it has been cultural orientations and constraints that have shaped plastic surgery by illuminating the complex connection between makeup and plastic surgery. The status quo is that many in the “Western societies” have become more open to plastic surgery advice as an alternative method of self-care – not only for women, but for men as well. Big Tent Books has even published a new picture book explaining to children why moms work so hard to get a flat tummy (Springen 2008). While critics warn that plastic surgery is creating a world that follows stereotypical beauty standards, it is now making an exciting array of technological improvements that continue to expand the boundaries of the industry. For example, new, longer-lasting fillers are being investigated, as well as new lasers that can rejuvenate the skin. They are also exploring whether cloning can be a way to rejuvenate the body, and exploring the secret of scarless growth in the uterus. Plastic surgery would not be what it is today without the imagination and accumulation of plastic surgeons and patients. Original Article: A History of Plastic Surgery Plastic surgery, the practice of reshaping body tissues for reconstructive or aesthetic purposes dates back to Derived from the Greek plastikos, meaning “to mold,” plastic surgery holds a critical place in cultures all over the world. For centuries, tribes would disc their lips, stretch their earlobes, bind their feet, file their teeth, and tattoo and scar their skin. contemporary popular series such as Extreme Makeover andNip/Tuck are any indication, plastic surgery has not lost any of its cultural power. teeth may not appeal to everyone, men and women of today still have a wide range of surgical procedures from which to choose, including liposuction, nose While filed teeth may not appeal to everyone, men and women of today still have a wide range of surgical procedures from which to choose, including liposuction, nose jobs, eyelid surgery, tummy tucks, and breast augmentation and reduction. Plastic surgery, however, was not always so readily available or varied and Plastic surgery, however, was not always so readily available or varied and was even shrouded in mystery, magic, and eroticism. the Egyptians did not practice extreme forms of plastic surgery on the living, they would often prepare their dead using principles of plastic surgery. For example, Ramses II’s mummy was surgically altered by having a small bone and a handful of seeds inserted into his nose to ensure that his most prominent The mummy of Queen Nunjmet also had bandages stuffed in her cheeks and belly in the same sense that modern The mummy of Queen Nunjmet also had bandages stuffed in her cheeks and belly in the same sense that modern plastic surgeons implant silicone into a body. While the Edwin Smith Papyrus shows that the Egyptians had skills to perform similar surgical procedures on the living, there is no solid documentation that is was actually done. Scholars suggest this reluctance to perform plastic surgery on the living was due to the Egyptian belief that one’s face remained the same in the afterlife and, therefore, should remain recognizable even after death ( DiBacco 1994). AncientIndia: The Birthplace of Plastic Surgery Most historians agree that the first recorded account of reconstructive plastic surgery on the living These texts describe procedures to repair noses and ears that were lost either as punishment for crimes (such as Hindu surgeon Sushruta, working near the modern-day city of Varanasi described the “attached flap” method of plastic surgery in his 600 B.C. The procedure involves reconstructing the nose by cutting skin from either the cheek or forehead, twisting the skin to make the nose more comfortable. The procedure involves reconstructing the nose by cutting skin from either the cheek or forehead, twisting the skin skin-side-out over a leaf of the appropriate size, and sewing the skin into place. To keep the air passages open during healing, two polished wooden tubes would be inserted into the nostrils. This method became known as the “Indian Method of Rhinoplasty ” and was kept secret for centuries inIndia (Haiken 1997). Ancient Rome: Plastic Surgery and Roman Baths By the first century B.C., Romans were also practicing advanced plastic surgery procedures, perhaps By the first century B.C., Romans were also practicing advanced plastic surgery procedures, perhaps prompted by the very public Roman baths. In a culture that praised the beauty of the naked body in both art and poetry, Romans viewed any abnormality, In a culture that praised the beauty of the naked body in both art and poetry, Romans viewed any abnormality, particularly the genitalia, with suspicion or even amusement. Consequently, one of the most popular plastic surgery procedures appeared to be circumcision removal, which is described in a rather detached way by Cornelius Celsus’s text De re medicina during the reign of Tiberius (A. D. 14-37). D. 14-37). Celsus even describes a “breast reduction” surgery on an obese man whose breasts were “unsightly Roman surgeons would also remove scars-particularly those on the back, which were marks of shame because they suggested that a man’s breasts were “unsightly” and “shameful. Roman surgeons would also remove scars-particularly those on the back, which were marks of shame because they suggested that a man had turned his back in battle or, worse, he had been whipped like a slave. The poet Martial (A.D. 40-104) suggests that some slaves during his time had their brands removed by surgeons, but he gives no details of the procedures. Surgeons would often operate on gladiators who had noses and ears chopped off and on foreigners who would try to fit into Roman society. time of Galen (A.D. 129-216), plastic surgery gained momentum and sophistication due to increased obsession with the human body. Galen attempted to cure eyes that squinted and drooped, and performed aesthetic rhinoplasty on both women and men of wealth who simply wanted a new nose, After the fall of Rome, however, many of Galen’s medical texts were lost; of his 600 books, only 20 survive. Though there were discussion of proper dental care during the Middle Ages, surgery in general was deemed to be pagan and sinful because the spilling of blood by a surgeon and the power he held over the body were akin to magic. The Renaissance: A Brief Rise in Plastic Surgery Translations of Galen re-entered Western culture during the late Middle Ages as crusaders encountered Arabic texts. For a brief time, plastic surgery experienced a rebirth of sorts, though mostly in barber shops. Two Sicilian barbers, a father and son team, would use skin flaps from the cheek or upper arm to rebuild a nose. As inIndia, such surgery was a “trade secret passed on from father to son” (Gilman 1999). (Gilman 1999). Heinrich von Pfalzpaint, a knight from the Teutonic order, also held secret the procedure of a nose job that was taught to him by a foreigner and made him “Many surgeons took skin grafts from donors, such as a neighbor’s pig, but were confused when They concluded that the flesh was “sympathetic,” meaning that the graft died when its owner died. They concluded that the flesh was “sympathetic,” meaning that the graft died when its owner died.
Most plastic surgeons today recognize Italian Gasparo Tagliacozzi (1546-1599) as the “father of modern plastic surgery” and as the first author of a plastic surgery textbook, De curtorum chirugiau (1597). Noting the need for plastic surgery due to “frequent duels, street brawls, and other clashes of armed men” (Haiken 1997) as well as a pervasive outbreak of syphilis which destroyed the nose, Taglioacozzi experimented with the use of pedicles which involves relocating a section of skin, subcutaneous tissues, and vasculature to another area to cover a wound. Specifically, Tagliacozzi would take skin grafts from the upper arm and, after several painful procedures, attach the flap onto the nose. Motivated by radical claims of autonomy present in the High Renaissance (e.g., Tagliacozzi is significant because in contrast to prevailing views that interpreted illness as a punishment, he used the vocabulary of High Renaissance humanists such as Giovanni Francesco Pico della Mirandola (1463-94), who advocated autonomous self-remaking individual as justification for his surgical innovations. For Taglioacozzi, plastic surgery was one way humankind seeks improvement of self, both physically and emotionally. Still, his reconstructed nose was still a “virtual” nose that could fall off if the user blew too hard, and young women with reconstructed noses were hardly objects of desire (Gilman 1999). Young women who lost their noses could be disowned by their fiancés because it suggested either a venereal or moral disease. However, Tagliacozzi mused whether a reconstructed nose was still grounds for terminating a marriage arrangement. For a time in Renaissance Europe, Tagliacozzi’s surgical innovations promised at least partial restoration of the nose but, due to the religious zeal of the Counterreformation and the concomitant emphasis on the syphilitic nose as a justifiable punishment from God, Tagliacozzi’s work disappeared (Haiken 1997). The Enlightened Nose Plastic surgery would reappear in Europe in 1794 when British surgeons witnessed an Indian bricklayer repaired the nose of a British cattle driver who had had his nose and hand cut off while a prisoner of Tiu Sultan. British surgeons then imported the procedure to northern Europe, where interest rapidly grew. In 1818, Karl Ferdinand Graefe (1787-1840) coined the term “plastic surgery” and described connected grafts in his 1818 text titled Rhinoplastik. Graefe, like Tagliacozzi, believed that the world needed to see the nose-less patient in medical terms rather than as a morally branded sinner. Graefe further attempted to remove the moral stigma associated with nose reconstruction by giving the procedure a classical name (rhinoplasty) similar to other surgical procedures. The move to a medical model for understanding the lost nose began to spread. However, the first notable plastic surgeon in the United States, John Peter Mettauer of Virginia (who primarily operated on cleft palates and hypospadias using tools he designed himself), still struggled with American surgeons who lived by Dryden’s admonition that “God did not make his Works for man to mend” (Gilman 1999). In addition, as the nineteenth century wore on and the European culture began its colonizing efforts in earnest, the nose became inextricably associated with race, an association that lasted until the current era, as seen in what is now called the “Michael Jackson Factor.” Two World Wars and Innovations in Plastic Surgery War has played a significant role in the history of plastic surgery. For example, WWI trench warfare meant heads and necks were more vulnerable, and pilots and passengers in the new and dangerous airplanes often suffered serious facial injuries that were unprecedented any time in history. Injuries such as shattered jaws, blown-off noses, and gaping skull wounds accelerated the techniques and experimentation of plastic surgery and prompted Harold Delf Gilles (1882-1960) to establish the first hospital devoted to reconstructive plastic surgery (Backstein and Hinek 2005). In addition, these drastic surgeries enabled surgeons to imagine that even transgender surgery could be performed. Despite medical advances after WWI, there were still no standard criteria, and something of the Victorian opposition to vanity still prevailed. Because any untrained surgeon could claim to be a plastic surgeon, patients often experience severe complications, such as amputation or at the very least severe scarring. Plastic surgery became associated in many minds with the term “quack.” However, when surgeons who had served in WWI established the American Association of Plastic Surgeons, they effectively signaled the end of unregulated plastic surgery (Haiken 1999). This first association was joined by the American Society of Plastic and Reconstructive Surgeons in 1931 (renamed American Society of Plastic Surgeons in 1991 to show the conflation of historically politically charged terms “reconstructive” and “cosmetic”) and by the American Board of Plastic Surgery in 1937. Finally, plastic surgery was achieving recognition as an independent specialty. WWII ushered in such plastic surgery techniques as rebuilding entire limbs, extensive skin grafts, microsurgery, antibodies, as well as increased knowledge about tissue health. Several factors contributed to the postwar plastic surgery boon and the breaking down of traditional reluctance to undergo plastic surgery. First, continued activity of professional organizations and publications helped further legitimize the industry. In addition, after there was no war to generate patients, surgeons consequently began a widespread trend toward marketing surgical techniques toward particularly groups-particularly middle-aged, middle-class women who were affluent and largely finished with raising families. Furthermore, this demographic felt increasing pressure to remain young in a postwar culture often dubbed the “cult of the body beautiful” (Gilman 1999). Indeed, plastic surgeons would often use the vocabulary of postwar domesticity–such as sewing, housecleaning, and cooking–to refer to their procedures. Some critics even accused surgeons of inventing new names, such as “bat wing deformity” (the flabby skin on the upper arms) or “spare tire deformity” (protrusion of the lower abdomen) to create a need for plastic surgery that might not otherwise exist (ibid). By the 1960s, plastic surgery was fully integrated into the medical establishment. Silicone breast implants also grew in popularity during the 1960s. Showgirls would inject their breasts with liquid silicon, a substance initially used inJapanin WWI to plump out legs withered by polio. Injecting liquid silicone, however, often had dangerous side effects, such as amputation of the breasts due to infection and guaranteed “pendulous” breasts by the time women were 40. Yet advances in silicone breast augmentation (which later was made available in sac), gave hope to women who had undergone a mastectomy (Haiken 1997). 1990s: Continued Popularity Though silicone breast implants would remain available for breast cancer patients throughout the 1990s, the FDA removed them from the open market in 1992 due to reports of leaking implants. Even with this setback, plastic surgery continued to grow in the 1990s, with more than 5,000 board-certified surgeons active in theU.S.alone. In an important move for both plastic surgeons and their patients, President Bill Clinton signed a bill which required insurance companies to cover the cost of plastic surgery for women who had undergone a mastectomy. Groups are still working to ensure that reconstructive surgery for children’s deformities will also be covered by insurance plans (Web site). The Future of Plastic Surgery Throughout its history, plastic surgery has been shaped by cultural priorities and pressures that illuminate the complex interplay between the cosmetic and reconstructive. The fact that many Western societies today have become more comfortable with plastic surgery suggests that they view it as another method of self-improvement-not just for women, but men as well. Big Tent Books even published a new picture book that explains to kids why mom is getting a flatter tummy (Springen 2008). While critics warn that plastic surgery is creating a world where beauty standards are brutally conformist, plastic surgeons today implement an exciting array of technological advances that continue to push the boundaries of their industry. For example, surgeons are researching new fillers that last longer and new lasers that inject “energy” into the skin. They are also exploring the potential of cloning technology as a method of body rejuvenation and are looking to the secrets of growth within the womb where scarless healing takes place. Without such imagination of plastic surgeons and their patients over the ages, plastic surgery would not be the phenomena it is today. — Posted August 31, 2008 References American Society of Plastic Surgeons. “The History of Plastic Surgery, ASPS and PSEF.” Accessed: July 20, 2008. Backstein R, and A. Hinkek. 2005. “War and Medicine: The Origins of Plastic Surgery.” University Toronto Medical Journal. 3:217-219. DiBacco, Thomas. Dec 13, 1994. “Plastic Surgeries Earliest Cases Date to Ancient Egypt, India.” Washington Post. Accessed: July 20, 2008. Haiken, Elizabeth. 1997. Venus Envy: A History of Cosmetic Surgery. Baltimore, MD: The John Hopkins University Press. Gilman, Sander L. 1999. Making the Body Beautiful: A Cultural History of Aesthetic Surgery. Princeton, NJ: Princeton University Press. Springen, Karen. April 15, 2008. “Mommy 2.0.” NewsWeek.com. Accessed: July 20, 2008.