The History of Plastic Surgery

My chosen area of specialty, Plastic Surgery, is arguably one of the best known fields of medicine, but often for all the wrong reasons. Stories of botched surgeries and overdone celebrities hit the headlines and skew popular perception of what we Plastic Surgeons do. On the whole we are a profession dedicated to relieving people of the physical and psychological effects of deformity and disfigurement, offering them the chance to enjoy the simple, normal pleasures of life, like smiling, freely moving their own body, and having rewarding relationships with others.

The profession has ancient roots with physicians attempting to reconstruct amputated noses of adulterers as far back as Egypt circa 1600BC and India circa 500BC. My personal favorite historical Plastic Surgeon was 16th Century Italian surgeon Gaspare Tagliacozzi, who experimented with reconstructive methods that remain surprisingly similar today. The popularity of dueling with rapiers during this era motivated some of the early attempts at rhinoplasty!

However it was another traumatic era that is considered to have laid the foundation of modern Plastic Surgery. The discovery of penicillin between World War I and II enabled soldiers to survive horrific injuries on the battlefield. Doctors were suddenly faced with thousands of disfiguring injuries in otherwise healthy soldiers, who felt they could not return to their former lives because of the way they looked, their fear of rejection from loved ones, and their difficulty integrating back into normal social life.

We restore, rebuild, and make whole those parts which nature hath given, but which fortune has taken away. Not so much that it may delight the eye, but that it might buoy up the spirit, and help the mind of the afflicted.
— Gaspare Tagliacozzi, Italian plastic surgeon, 1597

As is often said, “Necessity is the mother of invention.” Many doctors recognised the heart-breaking emotional and psychological impacts of this situation, and a number of surgeons took action to help these soldiers.

Two of the most famous, Harold Delf Gillies and Achibald McIndoe, were cousins who heralded from New Zealand and travelled to Britain where they were responsible for treating the wounded veterans and setting up specialist hospitals dedicated to Plastic Surgery, Gillies during World War I and McIndoe during World War II.

The foundation for many current Reconstructive Plastic Surgery techniques, in particular skin grafts and flaps, can be traced to the innovations pursued by these great surgeons during this time. I consider that we stand on the shoulders of these giants, and it is due to their dedication to innovation that we can see further around the horizon when we attempt to move the profession forward.

The spirit of innovation that underpins my profession is not restricted to healing wounds. Joseph E. Murray, Nobel Laureate, was responsible for the successful integration of microsurgery into our profession, through his work in kidney transplantation. Inter-disciplinary collaboration has yielded some of the most fruitful advances.

Click on the image to watch the video about Ladd

Click on the image to watch the video about Ladd

Anna Coleman Ladd turned her sculpture skills towards assisting affected soldiers to return to their lives after experiencing disfiguring injuries. Now she would be recognised as an anaplastologist for bringing her skills to the creation of prostheses. Her story reminds me that it is the collaborative efforts of many, working towards a shared purpose that changes people’s lives. A modern example of this would be the teams of engineers working to deliver 3D printed solutions for our patients.

(See a modern day anaplastologist at Chris O’Brien Lifehouse at work)

As a medical student I did not have the intention to pursue Plastic Surgery. But there was a moment when I realised what Reconstructive Plastic Surgery was, and I was hooked.

I was watching my now colleague Nik Lotz perform an ear reconstruction by harvesting rib from the chest wall, sculpting an ear shape framework and then implanting it under the skin. When the suction drain was applied and the beautiful natural shape of the ear emerged I said, “Wow” and a switch flipped inside me.

Operating with Nik on a 3D ear implant this year

Operating with Nik on a 3D ear implant this year

I had no idea surgeons were capable of such creative and immediately life changing techniques. I realised how fulfilling it would be to use my skills in ways that could not just remove disease, but could return to a patient a feature or faculty that most of us just take for granted, like a smile, a normal sized ear or a muscle that obeys your commands. While many of these people suffer in silence and they don’t make the headlines, take a moment to reflect on how life would be different for each of us if someone we loved suddenly had a disfiguring injury, or underwent surgery for breast cancer or if our children were born without an ear. It is not difficult to see that having the capacity to restore their “wholeness” would be our priority. This was a field that demanded my focus and I have loved every minute of it. 

I hope you have enjoyed finding out a little bit more about the history of my passion and my profession, Reconstructive Plastic Surgery.