The modern cosmetic surgery industry is rooted in the correction of syphilitic deformities and racialised ideas about ‘healthy’, acceptable facial features.
From facelifts, nose jobs, liposuction and breast implants, the modern body has become endlessly changeable and cosmetic surgery has very much become an accepted reality. But where did it all begin? There is a long history of people driven to painful and surgical measures to ‘correct’ their facial features and body parts, even prior to the use of anaesthesia and the discovery of antiseptic principals.
How it all began
Many historians agree that the first recorded account of reconstructive plastic surgery was documented in ancient Indian Sanskrit texts, around 500BC. Hindu author Sushruta wrote about the reconstruction of earlobes and noses using skin from other parts of the face. The first recorded “nose job” is found in ancient Indian Sanskrit texts (600 B.C)
In 16th-century Britain and Europe, “barber surgeons” were medical practitioners who, unlike many doctors at the time, performed surgery, often on the war wounded. Treating facial injuries was crucial in a culture where damaged or ugly faces were seen to reflect not only a disfigured appearance but also a disfigured inner self.
Italian Gaspare Tagliacozzi (1546-1599) is widely considered the ‘father of modern plastic surgery’. His textbook De Curtorum Chirurgia per Insitionem (‘On the Surgery of Mutilation by Grafting’) noted the need for plastic surgery due to duels and street fights, as well as a pervasive outbreak of syphilis, which destroyed the nose.
Tagliacozzi was an atypical plastic surgeon during the Renaissance because he did not view illness, such as the syphilitic nose, as divine punishment. Instead he used the vocabulary of humanists such as Giovanni Francesco Pico della Mirandola (1463-94) to justify his surgical innovations as autonomous self-remaking.
At this time cosmetic procedures were usually confined to severe and stigmatised disfigurements, such as the loss of a nose through trauma or epidemic syphilis. Purely cosmetic surgery did not become commonplace until operations were not excruciatingly painful and life threatening.
The first pedicle flap grafts to create new noses were performed in 16th-century Europe. A section of skin would be cut from the forehead, folded down and stitched, or would be harvested from the patient’s arm, which would remain attached to the face during the graft’s healing period.
The advancement of anaesthesia
Two American dental surgeons Horace Wells (1815-1848) and William Morton pioneered the use of nitrous oxide (laughing gas) and ether respectively as anaesthetics, performing the first ‘painless’ operation in 1846. The ether was administered via inhalation through either a handkerchief or bellows. Both of these were imprecise methods of delivery that could potentially cause an overdose and kill the patient.
In the 1860s English doctor Joseph Lister, also known as the ‘father of modern surgery’, removed the second major impediment to cosmetic surgery. Lister’s model of aseptic, or sterile, surgery was taken up in France, Germany, Austria and Italy, reducing the chance of infection and death, opening the way for abdominal and other intracavity surgery. The 1880s saw the further refinement of anaesthesia and, as a result, cosmetic surgery became a relatively safe and painless prospect for healthy people seeking changes to their appearance.
The cosmetic counterpart of reconstructive surgery took on a life of its own in the middle 1900s when doctors and patients realised the aesthetic or plastic cosmetic restorative methods were as much or more a part of the healing process as the corrective part of the surgeries.
Advertising cosmetic surgery and non-surgical devices
Advertisements for cosmetic surgery were rare, but did exist. In 1901 the Derma-Featural Co advertised treatments for “humped, depressed or… ill-shaped noses, protruding ears, and wrinkles (“the finger marks of time”) in the English magazine World of Dress.
However, its methods were quite disturbing. A report from a 1908 court case shows the continued use of skin harvested from (and attached to) the arm for rhinoplasties. The report also mentions the non-surgical “paraffin wax” rhinoplasty, where hot liquid wax was injected into the nose and then “moulded by the operator into the desired shape.” The wax could spread to other parts of the face and result in serious disfigurement, paraffinoma or wax cancers.
In 1924 the New York Daily Mirror ran a competition ad asking, ‘Who is the homeliest girl in New York?’ It promised the winner that a plastic surgeon would ‘make a beauty of her’ and reassured entrants that the art department would paint ‘masks’ on their photographs when they were published to save embarrassment.
Advertisements were frequently published for questionable devices promising to deliver dramatic face and body changes. For example, the patented “Ganesh” brand advertised a selection of chin and forehead straps to remove lines and wrinkles from the forehead and to reduce a double chin.
Bust reducers and hip and stomach reducers, such as the J.Z. Hygienic Beauty Belt, also promised non-surgical ways to contour and reshape the body. There were also ads for the non-surgical nose-shaper, “Trados”, worn at night to correct ill-shaped noses without operation ‘quickly, safely and permanently’. The popularity of these advertisements suggests that these devices were quite normal and socially acceptable.
The rise of racialised cosmetic surgery
The 20th century saw an increase in racialised cosmetic surgery, with the most popular cosmetic operations aiming to change facial features in order to fit in line with ‘white’ people. Features such as ears, noses and breasts were commonly ‘fixed’ if they weren’t typical for a white person.
American otolaryngologist John Orlando Roe’s discovery of a method for performing rhinoplasties inside the nose, without leaving an external scar, marked a pivotal development in the 1880s. In this case, patients could pass as being ‘white’ without anyone knowing they had undergone surgery.
Historically, the size of the breasts acted as a racial sign. Smaller, rounded breasts were viewed as youthful and sexually controlled, whereas larger breasts were viewed as ’primitive’ and therefore a deformity.
In the early 20th century, the age of the flapper, breast reductions were common. Of course, these views then shifted and in the 1950s small breasts were seen as a medical problem which made women unhappy.
Cosmetic surgical trends and the qualities we value as a culture are closely related and very much intertwined with the shifting ideas about race, health, femininity and ageing.
The sheer risks that people were willing to run in order to pass as ‘normal’ or ‘beautiful’ is a stark representation of how strongly people internalise ideas about what is beautiful.
Even in today’s world, painful (and unregulated) limb lengthening procedures are on the rise in India, to add as much as three inches to someone’s height. The procedure is often undergone in a bid to improve career and marriage prospects. Limbs can be encouraged to lengthen using pins and an Ilizarov frame, which can be slowly adjusted. The section of bone supported by the frame is surgically ‘broken’ and over subsequent weeks the frame is made longer.
From rebuilding the disfigured faces of war heroes to repairing noses destroyed by syphilis, the history of cosmetic surgery gives a remarkable insight into the revolutionary advancement of surgical intervention, as well as the ever-evolving techniques and practices that have made the cosmetic industry what it is today.
