Plastic and cosmetic surgery

Cosmetic surgery began to be practiced in the last part of the nineteenth century as surgical intervention became increasingly possible because of the development of anesthesia and sterile techniques. One of the first cases to be reported in the last part of the nineteenth century had to do with correcting what was known as saddle nose, a deep depression in the middle of the nose. There are several causes of this condition, but one of them was syphilis. This association with syphilis made those with such noses particularly willing to try to get some surgical change. Large noses were also an issue and intranasal rhinoplasty (hiding the incisions inside the nose) was first done in the 1880s.

Public knowledge of the possibility of plastic surgery came during World War I (1914-1918) as surgeons treated patients in unprecedented number with bad facial and other visible scars. The “miracles” wrought by the surgeons brought plastic surgery out of the closet, and there were enough physicians engaged in it to found the American Association of Oral Surgeons in 1921, later called the American Association of Oral and Plastic Surgeons, and still later, the American Association of Plastic Surgeons.

These early-organized plastic surgeons were cautious about their reconstructive surgery, determined to use their skills to help the maimed but not to do frivolous surgery designed to make people more “beautiful.” Not all would-be surgeons agreed with them, and a separate group popularly called “beauty surgeons” developed. These surgeons were looked down upon for their promises to improve the looks of their patients. They took shortcuts, avoiding some of the time-consuming operations involving bone and cartilage grafts. Instead, they relied upon the injection of paraffin, which for a time in the 1920s, was seen as a panacea for all soft-tissue defects. It was widely used to fill facial wrinkles. Unfortunately paraffin had a tendency to migrate to other areas, particularly if the patient spent time in the sun. That tended to disfigure the patient, who then had to go through the process again. One of the best known of these beauty surgeons was Charles C. Miller of Chicago, who wrote an early textbook entitled Cosmetic Surgery: The Correction of Featural Imperfections.

The attempt to distinguish between plastic surgery and beauty essentially failed. While surgery was still done for people whose bodily features had been altered by wounds or fires, increasingly it was used to meet personal beauty standards or to change identifiable ethnic features or to make someone appear younger by removing facial wrinkles or having eye tucks. Surgery was also done to change the contours of the body, particularly among women where breast augmentation or breast reduction became an important specialty. By 1988 breast enlargement surgery had become a $300 million business. Some urologists got into the business of penile augmentation, although this was far more controversial. One San Francisco urologist in the 1990s claimed to have done 3,500 such operations even though many urologists condemned the operations as unnecessary and potentially dangerous.

Silicone implants gave a big boost to the breast augmentation industry, and it became second only to lipo-suction (fat removal) as the most common cosmetic surgery. Some women complained that the silicone in their breast implants ruptured or leaked, causing them to have chronic fatigue, arthritis, and damage to the immune system. The result was a lawsuit that resulted in the largest fee ever negotiated in a class-action lawsuit. Dow Corning, Bristol-Myers Squibb Company, and others agreed to pay more $4 billion to 25,000 women. Breast-implant surgery grew even more prevalent, however, when the silicone was replaced by saline. Still the silicone worked better and research both before the lawsuit and after has tended to disprove the validity of the claims about the dangers of silicone. In 2003 there was an unsuccessful campaign to return to silicone as an option. The last word, however, has not been said on this issue.

While many women want to increase the size of their breasts, others want to lessen theirs, and breast reduction remains an important part of cosmetic surgery. By 1992, 40,000 women a year were having reduction surgery.

Probably the most radical of plastic or cosmetic surgery is that involved in transsexual surgery. Surgery to change males to female has changed drastically in the last 40 years, and skilled surgeons can use the penis and testicles to make functional labia and vaginas. The surgery for changing females to males is less well-developed since it has proved difficult to make a penis that can be used for both urination and sexual intercourse, but research is still continuing in the field.

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