The science of Plastic Surgery has been in the process of improvement for over four centuries now. This area of medicine is a specialty practice, and focuses today on two main areas: reconstructive and cosmetic improvements. Most people are unaware that the term “plastic” does not have anything at all to do with plastic, but is a word derived from the work “plastikos” of the Greek language, which means to shape or to mold.

Plastic surgery developed out of necessity, rather than vanity, to repair damage caused by punishments and battles. In recent years, there is a popular trend towards cosmetic improvements.

In our opinion these are 10 of the most important developments in the field:

1. First reconstructive surgery, India 2000 BC and early developments.
Although it seems amazing that plastic surgery may have begun this long ago, remember there were many talented, surgeons on earth, even then. In India, 2000 BC, some of the first surgeries for reconstruction were done. It was a time when a common punishment was amputation of the nose . Repairs were done using skin from the shoulder. It is not clear what was used then for pain and suffering, perhaps herbs, alcohol or opium.
Later, but still ancient at the time dating to the 6th Century BC, medical work in this field was done on plastic and cataract surgeries. Records of the work were later (759 AD) translated into Arabic, and were sent into Europe where Italian and British physicians caught light of the techniques. They traveled to India to discover more about procedures such as rhinoplasty. Published reports in 1794 induced a physician named Carpue to embark upon 20 years of studying in India. He then returned to perform the first plastic procedure in the West in 1815. Ancient instruments used in those Indian surgeries have been modified for use in more modern times.
Wars were another factor that prompted development of plastic surgery, as the early Romans (1st Century BC) repaired ears. Egyptians began to perform cosmetic surgery around the mid 1400’s AD. By the mid-1500’s, in Europe, physicians also worked on nose repair. However, major work around the head and face was not done until the 19th and 20th centuries, due to the extreme dangers.
Concurrently with this, the study of medicine developed over the passing centuries, as the body was studied intensively, and treatment for illness and disease was sought out. Scientists and physicians studied anatomy and physiology and learned by working on actual corpses in addition to live patients.

2. 1700’s reconstructive techniques studied in India.
The detailed study of reconstructive plastic surgery techniques in India in the 1700’s is what really sparked interest and development of plastic and cosmetic surgery worldwide. These early discoveries and experiments were recorded and transmitted to other countries. British physicians visited the country of India, and spent time learning Rhinoplasty techniques, which they then brought back to the Western world. They looked at the ancient instruments used in the surgeries, and copied them and made improvements and new instruments. The boom in scientific discovery following the Middle Ages also improved all types of physical treatments and bodily repair techniques. This was a major step forward in plastic surgery and cosmetic surgery.

3. 1800’s instrument development.
Plastic and cosmetic surgery required special instruments, and this was begun by the British physicians in the mid 1800’s. As these physicians continued to perform surgeries, they improvised and created new and better instruments specifically designed for particular tasks of plastic surgery. Nose surgery was performed in 1814, and a major book, Rhinoplastik, was published in Germany in 1818. More writing appeared in 1845, which encouraged re-operation to improve the cosmetic looks of a nose that had been reconstructed. Other types of nasal cosmetic surgeries were performed, including a reduction of a female’s dorsal nasal hump. It could be said that the 1800’s were the century of nose improvements and replacements. In 1827, in America, the first plastic surgeon, Dr. John Peter Mettauer, designed his own instruments in order to perform the first operation to repair a cleft palate.
The development of new instruments was helped by changes and improvements in manufacturing, metals, and industrial innovations. Increased communications and publication of surgical success stories helped spread the word about plastic surgery, and its cosmetic effects. The devotion to plastic surgery by many physicians helped document improvements in procedures, and also sparked the need for improvements in instrumentation. The early instruments laid the foundation for creation of today’s fine selection of surgical instruments for plastic surgery.

4. Anesthesia and penicillin for pain relief.
One problem with any type of surgery is pain. Until techniques of anesthesia were developed, mostly during the 1800s, any type of surgery meant great pain would result. The other component danger to surgery was infection. With the advent of disinfectants and sterile procedures, the risks of infection were decreased. In the early 1900’s, penicillin was discovered. The first cure using penicillin was documented in 1930. It was very helpful in reducing infections and amputations during World War II. The discovery of antibiotics and their use, starting with sulfa drugs and penicillin, went a long way to making surgery less painful. It also helped to make a choice to have elective surgery possible.
Today, plastic and cosmetic surgery can be conducted with relatively little or no pain, and the risks of infections and disease transmission are very much decreased. This is another reason why many people are deciding to have this type of elective, appearance improving, surgery done. Many people opt to have multiple plastic surgeries.

5. WWI & WWII disfiguring wounds.
Disfiguring wounds that were common during the great World War I and World War II further encouraged the development of new techniques, and procedures for cosmetic surgery to improve the damages incurred by many wounded soldiers.
War wounds frequently included disfigurement of the face, and burns. Work on these areas was done during World War I by Sir Harold Gillies, an Otolaryngologist from New Zealand who was then working in the London area. His work set the foundation for much of today’s modern cosmetic surgery. During World War II, a cousin of Sir Gillies, Archibald McIndoe, worked with the RAF in treating severe burns. His work was so revolutionary and radical that his patients formed the Guinea Pig Club.
The techniques and instruments developed during these World Wars have led to today’s modern plastic surgery procedures. There are still war victims, and although the process of repair can be lengthy and involve some pain, the results can be astounding and life changing for the veterans.

6. 1951 sex change from male to female.
Sir Gillies continued his work, and in 1951, he performed the very first operation to change a male to a female. Sex change operations are part of a long, involved process today, that include psychological counseling and follow up counseling. The decision to change one’s sex is not a simple, nor an easy decision, and there are many factors involved. But, this is definitely one of the major milestones in the history of plastic surgery.
Today, the sex change operations can go either way, male to female, or female to male. A surgical penis or vagina can be created, and with hormone treatments, secondary sex characteristics can also be changed. The Adam’s Apple can be reduced, breasts or male genitalia can be removed, and hair can be removed or treated to slow growth. Some of these surgeries are generated by a genetic mix-up in sexual imprinting. A person may be born with physical attributes of one sex, yet have the internal genetic make up of the opposite sex. An internal and mental trauma can occur until the problem is discovered and remedied.
Some of the transgender surgeries have received some major publicity, but most remain quiet and personal. Publicity has helped people understand the problem better, and to know more reasons why a person would want to surgically alter their sex identification. It is, however, one of the most major of plastic surgery procedures, with life long aftereffects.

7. 20th century medical improvements.
What makes the specialty of Plastic Surgery and Cosmetic Surgery the benefit it is today, has evolved mostly during the 20th century. As technology improved, along with the development of computer technology, scientific research, antibiotics, and a general boom in information, this specialty has grown and spread around the world. Since there are always wars happening somewhere, there will always be innocent victims and soldiers to help. An American surgeon, Dr. Vilray Blair, set the standard that is still in effect today, for treating drastic maxillofacial injuries. Although his work was done during World War I, his writing on “Reconstructive Surgery of the Face” still is the standard for excellence for craniofacial reconstruction.
While earlier plastic surgery focused on repairing damaged areas of the body, the specialty moved more towards cosmetic improvements during the second half of the 1900s. This grew from many factors, including improved communications. A growing movie industry, followed by the development of a broad television entertainment industry also helped inform the public about this medical specialty, and create a growing demand for elective cosmetic improvements through surgical techniques.
Finely crafted instruments add precision to surgery, and new materials such as silicon, Botox, collagen, and natural fat repositioning belong to this modern era of plastic surgery. New techniques for growing skin, transplantation from living persons and cadavers have also meant that more surgeries can be successful. Advances in anesthesia and infection treatment and prevention have brought better peace of mind and safety to patients undergoing plastic or cosmetic surgery in this century and helped to make many procedures commonplace.
In the year 2007, over 12 million plastic surgeries were performed, following over 11 million in 2006. The industry is a multi-billion dollar industry worldwide, reaching over 2 billion dollars annually in Europe alone, which is second in line behind the United States for plastic surgery procedures. The most common elective plastic surgeries are: breast augmentation, nasal surgery, abdominoplasty, eyelid surgery, and liposuction. Obviously, the desires of the patients are to look thinner, younger, and smoother. The trend can be carried to extremes, as in the case of Michael Jackson, or the several women who had multiple surgeries (while setting world records for plastic surgery procedures) to look like the Barbie doll. However, for most people, a bit of plastic surgery goes a long way to satisfy their desire for improvements or change in looks.
Advances in surgical techniques have helped improve plastic surgery results. The innovative microsurgery techniques allow for reattachment of tiny vessels, nerves, and skin for wonderful results.

8. Joan Rivers and celebrities – women.
Starting in the 1950’s, celebrities began to admit what speculators had been saying, that they had been having some cosmetic procedures done. The name Joan Rivers is all but synonymous with plastic surgery. The comedienne has readily admitted and blatantly publicized her many procedures, along with her reasons for having plastic surgery done. Today, at 76 years of age, she still has her smooth good looks, and because of her publicity along the years, she has single handedly done a great deal to make plastic surgery for cosmetic effect not only acceptable, but normal.
In the 1990’s, the television show Baywatch brought Pamela Anderson into view, and also began a craze among women for breast implants. The buxom blonde also had lip enhancement to create very pouty lips, another attribute that many women chose to copy. The breast implants and lip fullness are easy to spot on female celebrities. Angelia Jolie’s full lips were another inspiration to many to undergo injections of collagen or Botox. Liposuction is another cosmetic procedure that many women choose for getting rid of love handles and excess fat in other places. Famous male actors that have admitted to having some type of cosmetic procedures done include Michael Douglas and Simon Cowell.
The most common female plastic surgeries include: liposuction, rhinoplasty, breast augmentation, eyelid surgery, tummy tuck, face lift, breast lift, dermabrasion, forehead lift, hair transplantion. Other surgeries are for ear surgery, lip augmentation, breast implant removal, and breast reduction. There were some problems with breast implants leaking, and many women have since either had their implants removed or changed. There are many minor procedures also, including mole removal, hair removal, eyeliner and eyebrow tattooing, and minor skin repairs for cosmetic improvement. The quest for more beauty is never ending, and in the thoughts of Joan Rivers, if you don’t like it, fix it!

9. Sarkozy effect – men.
Beyond the usual traumatic injuries incurred in wars that require plastic surgery repair, men have also been having plastic surgery for some time in the modern years, for cosmetic appeal. Recently, the much publicized surgeries of pop star and celebrity Michael Jackson over the past few decades unfortunately gave plastic surgery some negative press, as his results were visibly almost scary. However, around 2008, when the President of the French Republic, Nicolas Sarkozy, managed to hook up with a sexy model 13 years his junior, it inspired many other men to move to cosmetic surgery. It has not been confirmed that Sarkozy ever had any cosmetic procedures. Perhaps it was the sight of his lovely second bride by his side that influenced the men, but plastic surgery among men rose to such numbers, up about 50% following the Sarkozy match up with former supermodel Carla Bruni, whom he later married. This increase in male cosmetic surgery was even called the Sarkozy effect.
The types of surgery that men are opting for include Botox, breast reduction, chin lifts, microdermabrasions, blepharoplasty (removal of eye bags), and face lifts. Botox injections are up almost 60% for men. Many other male celebrities have undergone some cosmetic procedures, including Simon Cowell, and Michael Douglas, both of whom have teamed up with considerably younger women.
Pressures on men in the workplace have also led men towards plastic surgery. Looking younger and more fit is a benefit helpful to getting, and keeping their high paying jobs, especially if they are in the eye of the public. There is no stigma to getting plastic surgery for cosmetic improvements anymore. It fits right into the other aspects of being fit, including exercise, diet, and general healthcare for men. Hair transplants, liposuction, and breast reduction are other popular plastic surgeries for men. There is even a new glossary of words relating to male body parts to be adjusted, such as “moobs” for man boobs, “mandles” for male love handles, and “Boytox” for Botox.
Another reason for males wanting cosmetic surgery is the economic hard times and job losses. The men feel if they look better and younger, they will have a better chance of finding a new job. The feeling that you must look young and fit is so strong that otherwise healthy and fit men will gravitate towards the ultimate measures of having cosmetic improvements performed.

10. Full facial transplant – 2009.
Plastic surgery history was made recently, when a woman who had been shot in the face by her husband received the world’s first full facial transplant, in the United States, from a cadaver, successfully. Immediate results following surgery showed a puffy, distorted face, those problems will go away, and already the woman looks far better than before surgery. The use of masks by those persons who have major facial disfigurement is normal, especially when the damages are very severe. There have been face replants and partial face transplants in recent history, from 1994, 1997, 2005 and 2006. Full facial transplants are new, but may offer some relief to those who are struggling with this type of disfigurement.
One of the inherent problems with donor transplants is the natural rejection of foreign tissue by the body. There are drugs to help overcome this problem, but they occasionally also have side effects. Without the drugs, the body would reject any transplanted tissue, and the project would fail.