History of Cosmetic Surgery

Since the dawn of ancient civilization and perhaps even before that, mankind has sought and invented methods of improving one’s beauty and appearance, which include ancient examples of cosmetic surgery. As early as 800 B.C., Indian practitioners would employ techniques to reconstruct the noses of persons who had lost them by way of punishment. There exist various accounts of the Romans performing simple ear reconstruction around 1 B.C., and descriptions by European doctors of rhinoplasty and other primitive surgical procedures in the 15th century. However, it would not be until the late 18th and early 19th century that advances in anesthesia and antibiotics made cosmetic surgery a viable option. Several doctors in Europe achieved substantial breakthroughs during this period. These include Joseph Carpue, who in 1814 successfully restored the nose of a military officer who had lost it as a result of toxic mercury treatments; and Carl Ferdinand Von Graefe, who pushed rhinoplasty forward by introducing the use of a free skin graft from the arm to reconstruct the nose, and published a book on the subject in 1818.

The first American cosmetic surgeon of significant renown was one Dr. John Peter Mettauer, who performed the first operation on a cleft palate in 1827 using self-designed instruments. It would not be until the late 19th century, however, until the United States would begin to embrace cosmetic surgery as a collective society. As with most other scientific advancements, cosmetic surgery was propelled forward by its military applications, and in particular, during the conflict in World War I. The first World War created unprecedented forms of injury, terrible burns and wounds that could only now be inflicted on individuals due to the modern weaponry that had only become available during this period. As weapons became ever more devastating, so too did doctors have to adapt their medical technologies to repair and heal the damage that they caused. Many of the techniques employed to assist soldiers who suffered facial disfigurements were developed by one Sir Harold Gillies, an otolaryngologist from New Zealand. His cousin and former student, one Archibald McIndoe, expanded on his work to develop revolutionary treatments of air force servicemen who were severely burned. Soon enough, surgeons realized that these restorative techniques could be employed to surgeries performed for aesthetic purposes. American doctor Vilray Blair, the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis, Missouri, developed methods for the treatment of soldiers with complex facial injuries, and a paper he wrote on the subject, “Reconstructive Surgery of the Face”, became the definitive work for procedures of this type.

In spite of the cosmetic surgery milestones that were taking place in the United States, organized efforts at improving the overall quality of cosmetic surgery were practically non-existent until 1931, with the formation of the American Society of Plastic and Reconstructive Surgeons (ASPRS). The ASPRS was instrumental in the development of cosmetic surgery in the country, which included such events of note as the recognition by the American Board of Surgeons of the progress, history and importance of cosmetic surgery and its methods. The ASPRS also created the first qualifying exam for cosmetic surgeons in the United States, which further improved the legitimacy of this branch of surgery and set a minimum standard of skill and quality for its practitioners that would instill confidence in patients who sought what they could provide.

Modern plastic surgery is now safer and more sophisticated than ever, with such advances as endoscopic and laparoscopic instruments and surgical robotics making cosmetic surgery less invasive and traumatic than it was just a couple of decades ago. It is certain that technology and beauty will continue to stride together into our future.