Despite its common usage as a term to mean "artificial" or "cosmetic," plastic surgery derives from the Greek πλαστικός (plastikos), which means "to mold or give form." Modern plastic surgery encompasses both cosmetic and reconstructive surgery, and has a history that goes much further back than our modern movie stars and beauty obsessions.
1. Egypt, 1200 B.C.E.: Post-Mortem Modifications
Catalogue General Antiquites Egyptiennes du Musee du Caire; The Royal Mummies. G. Elliot Smith, 1912.
The first plastic surgery wasn't done on living beings, but was considered crucial to the Egyptians who were mummified. In the afterlife, the only physical feature believed to be completely retained was the facial structure, but mummification dried the body such that the face was often unrecognizable. Ramses II was known for his elongated nose, so to ensure he would be recognized as a king in the afterlife, bone and seeds were surgically inserted under the skin of his nose after the desiccation of mummification, to restore and exaggerate its original shape.
2. India, 600 B.C.E.: Nose Reconstruction
In an era where cutting off the nose of an adulterer or crook was a common punishment, one doctor sought to encourage forgiveness and decrease public shaming of criminals. Sushruta wrote of many corrective surgeries, including the ear surgery pictured above, in Sushruta Samhita (Sushruta's compendium), but focused on nasal reconstruction. His method involved cutting a flap of skin from the cheek to cover the mutilated area. He then inserted two reeds or tubes, to ensure the nostrils didn't heal closed, rubbed the new nose with an abrasive powder, and dressed it in clean cloth, which irritated it and caused it to start healing. Later Indian surgeons used an attached skin flap from the forehead, which they then rotated down, to cover the mutilated nose.
3. Rome, 1st century B.C.E. - 5th century C.E.: Body Modification
Romans were notorious for their idolization of the perfect body, and viewed congenital and injury-based deformities with suspicion and mockery. Aulus Cornelius Celsus, in De re Medicina (14-37 C.E.), described surgeries that hid scars on the back, reduced gynecomastia (increased breast tissue in males), repaired genital deformities, and used skin flaps to fix nasal and ear-lobe injuries. Celsus' work remained the primary reference guide for plastic surgery for the next 1700 years.
4. Rome, 129-216 C.E.: Eyelid Adjustment and Early Nose Jobs
Increased obsession with the body during the time of Galen led to even more advances in plastic surgery. Blepharoplasty (adjustment of the eyelids) was used to fix persistently drooping or squinting eyes. There is also evidence that Galen performed aesthetic rhinoplasties on the wealthy, which is the first time purely cosmetic plastic surgery was described. Unfortunately, only 20 of Galen's 600 texts survive, so the procedures he used are not known, and his plastic surgery is only briefly mentioned.
Between 7th-14th century C.E., the spread of Christianity throughout Europe during the Middle Ages led to surgery being deemed "sinful" and "pagan." The power a surgeon had to spill blood and modify the body was almost akin to magic. This belief was established near the fall of the Roman empire, but was formally declared by Pope Innocent III in the 12th century. Modifying the human body was a punishable offense.
5. Sicily, 1415: The Indian Method to the Italian Method
Against the law of the church, surgeon Branca de'Branca used the "Indian method" to restore the nose of a man who lost his in a duel. His son Antonio Branca improved upon the method, using a flap of skin from the upper arm to restore the nose. Though it left less scarring, the method required holding the arm behind the head for 20 days, which was incredibly uncomfortable. Antonio's method became known as the "Italian method."
6. Turkey, 1465: Treating Facial Fractures
Şerefeddin Sabuncuoğlu published Cerrahiyyet’ül Haniyye (Imperial Medicine) at the age of 80. In addition to being the first illustrated text on pediatric surgery, many of Celsus and Galen's plastic surgery methods were included. Many of the old Greek and Roman texts made their way to the Islamic world, and were preserved despite the attempts to destroy them in Europe. Sabuncuoğlu also illustrated treatment of facial fractures to avoid deformity as they healed.
7. 1597: The Italian Method, Continued
Gaspare Tagliacozzi wrote Die Curtorum Chiurgia, detailing and illustrating the "Italian method" of nasal reconstruction developed by Antonio Branca. By this point in history, syphilis (and its "cures") had erupted as a major cause of deformity in Europe, and Tagliacozzi made a name for himself reconstructing noses and lips that were destroyed by disease or injury. However, the noses he formed from the skin of the arm did not always "take" well, and would occasionally come off if blown or struck too hard.
8. Europe, 17th-18th centuries: Early Rhinoplasty
Shortly after Tagliacozzi's death, the counterreformation came down harshly on surgery, and it was once again a punishable offense to the Catholic church. Surgery continued in the East, however, and in 1794, two British surgeons residing in India witnessed the "Indian rhinoplasty" being performed on a former prisoner who'd had his nose cut off in punishment. Shortly after continental surgeons began performing this procedure back in Europe, Karl Ferdinand von Graefe published Rhinoplastik. This was the first use of "plastic" in reference to reconstructive surgery, and the first known use of the term "rhinoplasty." Von Graefe used the Indian method for many patients, and developed a method to create a nose on the patient's arm, before transplanting it onto the face. Like Tagliacozzi's method for nasal reconstruction, this nose could come off if blown too hard.
10. Virginia, USA, 1820s-40s: Reconstructive Surgery
John Peter Mettauer and his sons established a thriving practice in Prince Edward County, VA, first specializing in repairing genital anomalies, and later working in all fields of reconstructive surgery. In 1827, John Mettauer performed the first successful hard cleft palate repair in the Americas. The use of "bone flaps" (previously only skin and muscle had been transplanted) was a significant step forward in major reconstructive surgery. The innovative techniques and tools that Dr. Mettauer devised, and a life dedicated to his craft, have led to him being considered "America's first plastic surgeon."
11. London, 1910s-1950s: Reconstructing Facial Features and Sex Change Operations
Harold Gillies and his team at The Queen's Hospital at Sidcup used skin flaps from unaffected parts of the body to reconstruct facial features on soldiers from both World Wars. Harold Gillies also performed one of the first female-to-male sex change operations in 1946, and the first modern male-to-female sex change operation in 1951, using what he learned about pedicles and flaps by reconstructing the faces of soldiers. The "flap" procedure used in the male-to-female operation was the standard for over 40 years.
Sources: National Geographic News; "History of plastic surgery in India." J Postgrad Med 2002;48:76; Aspects of the history of plastic surgery since the 16th century. J Royal Soc Med 1983;76:152 [PDF]; Berke, Andreas; Vogel, Wolfgang. Brief History of Vision and Ocular Medicine;The History of Plastic Surgery; Beautiful Body: A History of Plastic Surgery; BBC; A Sketch of Dr. John Peter Mettauer.