By Plastic Surgeon Dr Dirk Kremer. 

The early days of cosmetic surgery

Ancient India and rhinoplasty

Plastic surgery has existed for centuries, although it wasn't called 'plastic surgery' or 'aesthetic surgery' at the time, and cosmetic surgeons didn't call themselves by this term. Rhinoplasty was undoubtedly the most important procedure performed by early plastic surgeons in Ancient India (one text from 600 B.C. mentions nose jobs). At the time, and for centuries after this, people would use skin from the cheek, forehead or arm to place where the nose should have been. People who underwent surgery usually didn’t have a nose at all, so to be honest it was more about getting something less conspicuous than a hole in the middle of your face rather than making yourself pretty.

Ancient Rome and the naked body

In Ancient Rome where people would go to Roman baths naked, surgeons would be sought to erase any abnormality, especially where genitalia was concerned. Although we don’t have many details about how aesthetic surgeons would proceed, texts mention the removal of scars and even gynaecomastia, along with surgery on gladiators who would have lost an ear or their nose in the arena.

Evolution of Plastic surgery: ending the moral stigma

Medicine went through a dark period during the Middle Ages, which explains why aesthetic surgery was mostly forgotten until Renaissance.

Gaspare Tagliacozzi, one of the fathers of modern cosmetic surgery

Gaspare Tagliacozzi, born in the XVI century, was the first to write a textbook for fellow/future cosmetic surgeons. He worked mainly on rhinoplasty, which at the time was extremely painful and required patients to stay put with their arm close to their new noses for days. Indeed, a flap of skin was taken from the upper arm and sewn on the nose, but the flap was kept attached to the arm so the skin would not die. Those were the days when you risked losing your nose when you blew it...! Thankfully procedures have now evolved, but it is still very impressive for the XVI century!

Most importantly, Tagliacozzi believed that losing your nose (often due to venereal diseases…) wasn’t punishment for your sins, and he saw plastic surgery as a means for mankind to improve itself.

Karl Ferdinand von Graefe, “plastic surgeon”

This German cosmetic surgeon born in 1787 is the one who coined reconstructive surgery “plastic surgery”. Just like Tagliacozzi he worked to get rid of the moral stigma behind physical malformations. Von Graefe can be considered as the founder of German rhinoplasty, and he was a pioneer in eyelid surgery (maybe that’s why the Turn Back Time Eyelift is one of my favourite procedures!)

Jacques Joseph and innovative aesthetic surgery

Jacques Joseph is also a German plastic surgeon, author of what can be considered a milestone in aesthetic surgery: “Nasal Plastic Surgery and Other Facial Reconstructive Procedures, with an Appendix on Reconstructive Breast Surgery and Some Other Procedures in the Area of External Plastic Surgery.” The plastic surgeon is a pioneer in terms of aesthetic surgery and an innovator who developed new cosmetic surgery methods, especially for rhinoplasty. He believed that cosmetic surgery, even when undergone without a physical necessity, was beneficial thanks to the positive impact it had on a patient’s spirit and personality. In the 1920s-1930s he practised cosmetic rhinoplasty on many members of the Jewish community of Berlin, to which he belonged.

Dr Harold Gillies, plastic surgeon during the Great War

Innovative plastic surgery was practically born during the First and Second World Wars. Never before had so many people be injured and disfigured and survived. With better surgeons and medicine (antiseptics for instance) many injured soldiers lived on after losing their noses, part of their faces and limbs. But getting back to a normal life with broken faces wasn’t easy, and that’s where Dr Gillies played an important role as a pioneer aesthetic surgeon, who opened the first plastic surgery ward in the UK, at Queen Mary’s Hospital, in Kent. Even if the results obtained at the time aren’t beautiful, it allowed injured young soldiers to feel more normal and not be looked at in horror.

Sir Archibald McIntoe, cosmetic surgeon during World War II

Sir McIntoe was actually the cousin of Dr Gillies and he continued his cousin’s pioneering work with the soldiers injured during the Second World War. He worked in particular on RAF soldiers who had been deeply burnt (often with loss of eyelids) and who nicknamed themselves the ‘Guinea Pig Club’. Indeed, Sir McIntoe was innovating with procedures almost never performed before, with injuries almost never seen before… This amazing pioneer gave many young pilots their lives back, and developed techniques that definitely helped plastic surgery become what it is today. Sir McIntoe, who received many honours for his work (British knighthood, French Légion d’Honneur…), is also one of the founders of the British Association of Plastic Surgeons.

Many doctors and surgeons have played a role in creating and improving plastic surgery, and plastic surgeons will often have their “favourites”, but the gentlemen mentioned above did an amazing job at fighting social stigma and innovating in surgery. Sure, today men and women who undergo plastic surgery still face judgemental attitudes, but if someone loses their nose for any reason, no one (or no one in their right mind) will tell them they deserved it. Nowadays there is no more stigma in having plastic surgery to get a normal life.

To me, the role of a plastic surgeon today is to make sure everyone gets the freedom to undergo aesthetic surgery for the right reasons, without anyone judging them. I also believe it is important to keep innovating in order to offer new procedures that are less painful and have better recovery times, such as my e-lipo signature procedure.

Is there any plastic surgeon you think should be mentioned here? Please let me know in the comments below or on Twitter, Facebook or Google +!