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The History of Plastic Surgery

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Updated March 10, 2009

An Ancient Healing Art

Perhaps since the beginning of time, human beings have been actively engaged in the pursuit of self-improvement. Therefore, it should come as no surprise that plastic surgery may be one of the world's oldest healing arts. In fact, there is documentation of the use of surgical means for correcting facial injuries dating back more than 4,000 years ago.

Physicians in ancient India were utilizing skin grafts for reconstructive work as early as 800 B.C. Later, in European countries, plastic surgery advances were slow in coming. However, eastern medicine took more readily to plastic surgery, and there are many recorded incidents of skin grafts and reconstructive surgery throughout history in that part of the world.

Overall progress in plastic surgery, like most of medicine, was slow over the next few thousand years, as techniques used in India were introduced to the West and then subsequently refined and adapted for new applications. However, there was progress made in medicine during the Greco-Roman period, and that progress was documented in ancient texts which were disseminated over time throughout civilization.

It was during this period that Roman medical writer Aulus Cornelius Celsus wrote "De Medicina", which layed out surgical methods for reconstructing ears, lips, and noses. Then during the early Byzantine period, Oribasius compiled a compete medical encyclopedia entitled "Synagogue Medicae". This 70-volume work contained numerous passages dedicated to reconstructive techniques to repair facial defects.

The Middle Ages & The Renaissance

Though the practice of reconstructive surgery continued throughout the early Middle Ages, further significant developments came to a relative standstill thanks to the fall of Rome and the spread of Christianity. In large part, science gave way to mysticism and religion. In fact, at one point during this time period, Pope Innocent III declared that surgery in any form was expressly prohibited by Church law.

For the most part, the pursuit of scientific knowledge had been replaced by a focus on more personal and spiritual concerns. In addition, the safety of surgical patients was further compromised by the lack of standards for hygiene and cleanliness. However, some minor advances were made, including the tenth century development of a procedure to repair a cleft lip.

During the Renaissance, there were more significant advances in science and technology, which resulted in the development of safer and more effective surgical techniques. A fifteenth century Islamic text entitled "Imperial Surgery" was written by Serafeddin Sabuncuoglu, and included material on maxillofacial surgery and eyelid surgery, as well as a protocol for the treatment of gynecomastia which is believed to be the foundation for the modern method of surgical breast reduction.

Progress Born of War

During the seventeeth century, plastic surgery was again on the decline, but by the late eighteenth century, the pendulum had swung in the other direction once more. However, the next major advances in plastic surgery weren’t to be until the 20th century, when the casualties of war made reconstructive plastic surgery a necessity for many soldiers. In fact, it was World War I that brought plastic surgery to a new level within the medical establishment.

Military physicians were required to treat many extensive facial and head injuries caused by modern weaponry, the likes of which had scarcely been seen before. These grave injuries necessitated brave new innovations in reconstructive surgical procedures. Some of Europe’s most skilled surgeons dedicated their practices to restoring their countries’ soldiers to wholeness during and after the war.

It was in fact around this time that surgeons began to fully realize the potential influence that one's personal appearance could exert upon the degree of success experienced in his or her life. Because of this understanding, aesthetic surgery began to take its place as a somewhat more respected aspect of plastic surgery.

This progress also brought with it a greater understanding of anesthesia and infection prevention, allowing surgeons to 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.

History of Plastic Surgery in The United States

While many of these medical advances originated in Europe, there were other surgical strides being made in the U.S., including the first cleft palate operation in 1827, which was performed by Dr. John Peter Mettauer using surgical instruments of his own design. However, it was not until the early 20th century that modern plastic surgery was to be recognized as its own medical specialty.

In 1907, Dr Charles Miller penned the first text specifically written on cosmetic surgery, entitled “The Correction of Featural Imperfections”. The text, while ahead of its time in some respects, was nonetheless criticized and denounced as “quackery” by many general surgeons. Unfortunately, this attitude was prevalent among the medical community, who largely tended to view cosmetic surgeons in general, including Dr. Miller, as charlatans or “quacks”.

Other U.S. surgeons of note during this time included Dr. Vilray P. Blair, Dr. William Luckett, and Dr. Frederick Strange Kolle. Dr Blair performed the first closed ramisection of the mandible in 1909 and published "Surgery and Diseases of the Mouth and Jaw" in 1912, while Dr. Luckett described a correction for protruding ears in 1910, and Dr. Kolle published his text, "Plastic and Cosmetic Surgery", one year later in 1911.

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