Plastic Surgery History
Although many people think of plastic and cosmetic surgery as a relatively recent innovation, the practice of surgically enhancing or restoring parts of the body actually has its beginnings more than 4000 years ago.
In many ways, the evolution of cosmetic surgery has followed the same path that most technology has taken throughout the ages, moving forward in a series of hesitant steps and confident leaps to arrive at its current form.
Ancient Near and Far East
The oldest cosmetic surgery practices may date back to Egypt in the third millennia B.C., where early accounts describe rudimentary surgical procedures performed to repair facial trauma, including mandibular and nasal fractures. True reconstruction would later enter the historical record by way of a Sanskrit text entitled Sushruta Samhita. This encyclopedic volume (samhita is Sanskrit for encyclopedia) was written by an Indian physician named Sushruta, who lived sometime between 600 and 400 B.C. The text provides thorough descriptions of examinations, diagnoses, treatments, and procedures involving a variety of ailments. Sushruta's text also outlines procedures for reconstructing an earlobe using skin grafted from the cheek, as well as the process for repairing the nose by utilizing a pedicle flap from cheek or forehead tissue as the source for reconstruction.
By studying ancient papyrus texts, archaeologists have discovered that, in ancient India, reconstructions were often conducted to repair features damaged in battle and that amputations were performed as penalties for various crimes.
Greco-Roman and Byzantine
The rise of the Greek city-states and spread of the Roman Empire led to increasingly sophisticated surgical practices. Techniques used in ancient India were introduced to the West, where they were refined and ultimately improved upon.
It is unclear to what degree the Western world interacted with the ancient Indians prior to Alexander the Great's invasion of the sub-continent in 327 B.C. It is believed that the sharing of medical knowledge between the two cultures was likely, though such an exchange cannot be confirmed through evidence.
During the height of the Greco-Roman period, great progress was made in medicine, and knowledge was collected and disseminated throughout the ancient world in books and scrolls. These texts contained advanced knowledge regarding blood circulation, tissue health, and bone reconstruction.
In his De medicina, the great Roman medical writer Aulus Cornelius Celsus discussed methods for reconstructing mutilated ears, lips, and noses that were similar to techniques used by the Indians.
During the early Byzantine period, royal physician Oribasius compiled the sum of Roman and Hellenistic medical knowledge in his comprehensive, 70-volume medical encyclopedia, Synagogue Medicae. This sprawling text demonstrates a firm grasp of basic reconstruction principles and includes passages devoted to repairing facial defects, the use of tensionless suture lines, and the importance of cartilage as an underlying support for the ear and nose.
The Middle Ages
Throughout the early Middle Ages, the practice of facial reconstruction continued. It is believed that Byzantine Emperor Justinian II underwent nose reconstruction after he was overthrown and his nose was mutilated so that his disfigurement would prevent him from reclaiming his title. He would eventually return to power.
Though reconstructive surgery continued to be performed, the fall of Rome in the fifth century, followed by the spread of barbarian tribes and Christianity, effectively prevented further significant developments in surgical techniques or procedures. Aside from minor advancements, such as a procedure to repair a cleft lip described in early tenth-century literature, the firm scientific foundations found in Greek, Roman, and Byzantine medicine had given way to mysticism. In the thirteenth century, Pope Innocent III went so far as to declare that all surgical procedures were prohibited by Church law.
While little progress was made in reconstructive surgery during this time, the principles and techniques learned from the early Indian and Greco-Roman pioneers continued to be passed from generation to generation. When Muslims conquered India in the tenth century, it is likely that Indian knowledge of facial reconstruction was brought back to Arabic culture and, from there, spread throughout Europe with the capture of Sicily during the ninth through twelfth centuries.
For the most part, however, this Dark Age had devolved into a stagnant period wrought with superstition, fear, and outright barbarism. The pursuit of knowledge that had characterized classical-era civilizations had been replaced with a middle-age emphasis 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.
The Renaissance and the Age of Rediscovery
The Renaissance represented a rebirth of interest in antiquity, accompanied by a rediscovery of and newfound appreciation for the art and philosophy from the height of classical Greek and Roman civilization.
Building on the knowledge passed down from ancient scientists and physicians, medicine during the Renaissance benefited from tremendous advances in science and technology, resulting in surgeries that were safer and more consistently successful.
In the 15th century, an illustrated Turkish-Islamic text entitled Imperial Surgery by Serafeddin Sabuncuoglu presented such procedures as maxillofacial surgery, eyelid surgery, and treatment for gynecomastia. In fact, his method for correcting gynecomastia is considered the foundation for modern reduction mammoplasty.
Unfortunately, the resurgence of interest in Greek and Roman civilization was short-lived and not enough to prevent another lull in medical advancement. Reconstructive surgery experienced another period of decline during the 17th century. One hypothesis attributes this decline to the fallacious belief in the "sympathetic theory," which held that tissues transplanted from one person to another could only survive as long as the donor. The death of the donor meant the death of the donor tissues.
By the end of the 18th century, interest in reconstructive surgery enjoyed yet another revival, leading to further great advances in the 19th century. Perhaps the single most important impetus behind this was a letter by a British surgeon describing the reconstruction of a man's nose by a member of the brickmaker caste in India. The surgery was witnessed by two British surgeons, and popular opinion in the West followed the line of thought that if an Indian brickmaker could perform such a procedure, then certainly British surgeons would be able to improve upon that success.
The progress of the 19th century made possible a broader understanding of anesthesia, the different bodily systems, and antiseptic conditions. This understanding allowed surgeons to perform a wider variety of procedures of increasing complexity - cleft lip repair, true skin grafts, and the first recorded instances of aesthetic nose reconstruction and breast augmentation.
The 20th Century and Beyond
Advancements continued into the 20th century. As in ancient Egypt and India, war presented the opportunity for surgeons to perfect their techniques, as they strove to repair the bodies of injured soldiers.
Today, reconstructive surgery continues to progress and thrive. Although the spotlight of popular media may be cast more frequently on aesthetic plastic surgery, advancements reconstructive surgery are being made at an ever-increasing pace.
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