MILESTONES IN HISTORY OF COSMETIC SURGERY

     Cosmetic surgery is not exactly a 20th century vanity. Although many of its innovations are the product of only the last two decades, as a field of medical practice cosmetic surgery dates far, far back - to the times of the Indian surgical wiz, Sushruta, in fact. That's the seventh century B.C. and the Sushrut Samhita tells how he used a flap of skin from the cheek and forehead to restructure a nose lost through accident or punishment.

      What's new about cosmetic surgery is its current popular image. No longer are nose jobs and tummy tucks a preserve of the affluent set or the glamour professions. Today, not just movie stars and top-drawer models, but also company executives, housewives and college students see the aesthetic ideal as one worth pursuing without apology or guilt. An aesthetically pleasing appearance is today considered a vital component of self-esteem, social image, even job-worthiness! Television, slick advertising, the year-long whirl of beauty pageants, even health considerations… all have contributed to creating a new but expanding global community of body-worshippers.

      In India, the process has been nudged along by several specific social trends. While, in earlier times, the joint family used to offer a haven to those who were disabled or who suffered from a congenital abnormality that compromised their chances in the social, job and marriage arenas, today this familial crutch has all but disappeared. And in so doing, it has provided the impetus for those whose physical impediments might have stood as lifelong barriers to acceptance, to do something about their defects of appearance. Cleft palates, jutting jaws, bulbous noses, scar-pocked faces… all these and many more imperfections can be dramatically transformed today with a deft scalpel. And more and more Indians are thinking, why not?

      A totally different kind of impetus has come from the promise and possibilities held out by the burgeoning glamour industry. Thus, the series of Indian triumphs on the international beauty stage in recent years has proved to be a major fillip as thousands of wanna-be queens look to cosmetic surgeons to create for them those 'winning' looks and figures!

      The virtual run on cosmetic-surgery clinics that has been brought on by these and other pulls and trends is however a relatively recent phenomenon. For long centuries, the field of cosmetic surgery lay in dormant neglect. The pioneering steps that led to its modern avatar can, in fact, be traced to less than a century ago…

• The first medical paper on cosmetic surgery was published in 1906 by Miller, an American surgeon. It described the "excision of bag-like folds of skin from the region about the eyes". Miller also published another paper which carried the first photograph showing the line of surgical incision.      However, Miller has been described as an unethical practitioner, and in fact many operations in those days were carried out by unscrupulous surgeons who used newspaper advertisements to recruit their patients.

• In 1911, Kolle, another American surgeon, wrote a book titled, "Plastic and Cosmetic Surgery", incorporating descriptive procedures.

• In 1919, Bonguet, an ophthalmologist, described the small crescentric or angular type of incisions used in blepharoplasty.
In the same year, Passot published a paper describing the various types of excisions and incisions used in the removal of specific areas of skin excess.

• In 1920, the surgeon, Bettmen, also presented a paper on the facelift procedure, including "before" and "after" photographs of a patient who had been operated upon.

• In 1926, Hunt and Noel published books on cosmetic surgery in which Noel emphasised the psychological aspects of cosmetic surgery.
Operations to correct nasal deformities had become more quickly accepted because many of these deformities were associated with functional problems, such as difficulty in breathing, which called for correction for health reasons.
     Still, some surgeons of these early decades of the 19th century were unqualified; and the procedures themselves often risky. Paraffin, injected sub-cutaneously, was used until the late 1920s to smooth out face wrinkles though it resulted in endless complications such as the migration of the inorganic material and the occurrence of paraffinomas.

• In 1932, the German surgeon, Hollander, described the face-lift surgery that he had performed in 1901. In contrast to the earlier practice of excising isolated pieces of skin, Hollander claimed his technique was the first to use what has now become the classic "around-and-under-and-above-the-ears" incision that 'lifts' virtually the entire facial skin off its base!
     Meanwhile, other surgeons were performing remarkable transformations with World War I soldiers who had been facially disfigured. The War, in fact, marked a turning point in this field: 'reconstructive' surgery was leading inevitably to what we know today as 'aesthetic' surgery.

• In 1973, Rees and Woodsmith reviewed the history of cosmetic surgery in considerable detail.

• In 1979, Anthony Erian of England opted to practice aesthetic surgery as an independent and exclusive speciality. He mastered the art of rhinoplasty; and he used a revolutionary laser technique for his face-lifts.

• During this same time, Dieter Schimitz of Germany, and Julius Newman, Larry Shenlock, Richard Caleel and James Farber of the U.S., also opted to specialise exclusively in cosmetic surgery.

• In 1987, the Cosmetic Surgery Center of India was started in Bombay by Dr Vijay Sharma as a speciality clinic. Currently, it continues to offer only aesthetic surgery procedures, including the face-lift, eyelid surgery, nasal surgery, facial contouring, ear correction, double-chin correction, liposuction, lipectomy, breast implants, breast uplift, breast reduction and several more.
     The advanced computer simulation procedure helps to design the future look on the computer screen to match the emotional requirement of the patient with the post surgical results, before the actual operation.

• In 1997, the Center also started Sculptography, which uses a Plaster of Paris cast to obtain a mould that provides a three-dimensional view of a patient's face; this helps the patient get more involved at the planning stage of the surgery.

• Worldwide, cosmetic surgery constitutes about 20 to 70 per cent of the practice of renowned plastic surgeons. India is no exception, and in terms of aesthetic sense Indian surgeons are on par with those anywhere else in the world. On the basis of 10 years of a thriving independent practice, I can confidently state that the time is overdue for young plastic surgeons to opt for cosmetic surgery as an independent speciality.