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100 years of plastic surgery

An astonishing 20 million plastic surgery procedures around the world were undertaken last year, according to new figures published this week. They included 50,000 pairs of buttocks being augmented in Brazil; 107,000 pairs of eyes being widened in South Korea – many of them to be made more ‘western’; 1.35 million Americans having their breasts enlarged and 705 British men have their moobs removed. Don’t ask about all the labiaplasty in Germany.

These statistics, published by the International Society of Aesthetic Plastic Surgery, show how far the concept of beauty has changed in the last generation, and hint at how, in many cultures, going to a cosmetic surgeon, rather than a cosmetics counter, is guaranteed way to reduce the signs of ageing.

The figures would horrify Harold Gillies, who 100 years ago started a field of medicine forged in the bloody trenches of Flanders: modern plastic surgery.

The idea of grafting skin from one part of the body to another dates back centuries: “plastic surgery” as a term was coined in the 1830s (from the Greek, plastikos – to be moulded), decades before “plastic” became a word to describe man-made materials. But as Roger Green, archivist for the British Association of Plastic and Reconstructive Surgeons (BAPRAS), and himself a surgeon, says, the birth of modern plastic surgery can be dated to 1915.

Gillies was an ear, nose and throat surgeon, who volunteered to serve in the Red Cross in Belgium. “He saw new injuries that were pretty horrific,” says Green. Many soldiers had their faces hideously disfigured by shrapnel as they poked their heads above the parapet.

Too severe to rectify with a skin graft, Gillies developed a technique called the tube pedicle, which involved cutting a strip of flesh from a healthy part of the body – usually the chest or forehead – but leaving one end still attached. The strip of skin was then “swung” into the new area. The flap was folded in on itself, enclosing all the living tissue and blood supply, which prevented infection. The result looked bizarre, but it worked.

During the Battle of the Somme in 1917, Gillies treated 2,000 soldiers, mostly in this way.

During the Second World War, Archibald McIndoe, a pupil of Gillies, made further huge strides treating burnt airmen.

 

But it was not just McIndoe’s technological advances, it was his whole approach, that were novel. “While Gillies’s mantra was ‘as long as I can fix someone, that’s OK’, McIndoe was more bothered about the psychology of patients,” says Professor Tony Metcalfe, director of research at the Blond McIndoe Research Foundation. East Grinstead, where McIndoe’s hospital was based, became “the town that didn’t stare”.

William M. Spreckley, Gillies’ 132nd patient. His nose was treated using a tube pedicle

William M. Spreckley, Gillies’ 132nd patient. His nose was treated using a tube pedicle

This right to a “normal” life is something another pupil of Gillies has also pioneered, but for a very different type of patient. In Rio de Janeiro, Ivo Pitanguy, now 91, is called simply “maestro” for his work in helping to popularise cosmetic surgery among not just the yacht-owning classes, but slum dwellers too. Last year over 1.3 million had work done in Brazil. “Aesthetic surgery brings the desired serenity to those that suffer by being betrayed by nature,” he has said.

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