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Cosmetic surgery is concerned with the “maintenance, restoration or enhancement of one’s physical appearance through surgical and medical techniques” (7). The American Society for Aesthetic Plastic Surgery reported an increase of 446% in cosmetic procedures since 1997 and an overall increase of 8% in 2007, with a 17% increase in men undertaking cosmetic surgery (8). This increase is similar in the United Kingdom. The British Association of Plastic Surgeons recorded a 35% increase in procedures performed by its members from 2004 to 2005 (9). With the increased prevalence, accessibility and evolution of cosmetic surgery in Western society, it is becoming increasingly relevant to explore the various internal and external factors that motivate people to undergo cosmetic surgery. Sarwer et al (10) attribute this recent increase to the availability of plastic surgeons, the influence of the media, evolutionary interests and personal factors relating to the patient. The technological advances in cosmetic surgery have made it safer and less invasive, with a faster recovery time, as well as lowering the cost of procedures. Thus, people have become less anxious, and more willing to consider and accept cosmetic surgery as a possible option for altering their physical appearance (11). The decision to seek out plastic surgery has recently attracted a significant amount of attention (12–14). Studies have focused on evolutionary, psychosocial and health behavioural covariates of those who have undergone cosmetic surgery (15), as well as more attitudinal and belief system factors such as life satisfaction, self-esteem and body image (16). A comprehensive review by Ching et al (17) found a patient’s body image and perceived quality of life to be the strongest and most consistent determinants of aesthetic surgery outcomes. The present study focused on two factors previously disregarded in this literature: media consumption and religious beliefs. Markey and Markey (18) recently examined young American women’s interest in obtaining cosmetic surgery. They found that all four factors they investigated – namely, body dissatisfaction, physical appearance, teasing (being teased about 11 different body parts) and media influence (feeling pressured to appear like people in the media) – were related to the desire to have cosmetic surgery. The best predictor of their interest in obtaining cosmetic surgery was body dissatisfaction, which has been investigated extensively. The majority of studies exploring the reasons one may have for undertaking cosmetic surgery have focused on patient samples. There is a noticeable lack of research focusing on nonpatient samples. Delinsky (13) found that media exposure and vicarious experience predicted a greater likelihood of undergoing cosmetic surgery. Similarly, Brown et al (5) found that vicarious experience of cosmetic surgery increased the likelihood of undergoing cosmetic surgery for women. Their results also suggested that women are more likely to undergo cosmetic surgery than men, and that older men report less desire to undergo cosmetic surgery than younger men. background and education. The future of this specialty is bright and will continue to progress because of students like you who choose to enter this special field. Students interested in plastic surgery can find more information from the following: 1) Nagarkar P, Pulikkottil B, Patel A, Rohrich R. So, you want to be a plastic surgeon? What you need to do and know to get into a plastic surgery residency. Plast Reconstr Surg. 2013;131(2):19-22. 2) http://acaplasticsurgeons.org/residency-resources/ 8 ADDITIONAL RESOURCES ON THE SPECIALTY OF PLASTIC SURGERY I. American Society of Plastic Surgeons www.plasticsurgery.org www.facebook.com/PlasticSurgeryASPS II. Plastic Surgery Research Council www.ps-rc.org III. American Council of Academic Plastic Surgeons www.acapsplasticsurgeons.org IV. Plastic Surgery Education Network www.psenetwork.org 9 CHAPTER 3 HISTORY OF PLASTIC SURGERY Rajendra Sawh-Martinez MD, MHS and Ash Patel, MBChB, FACS “We restore, rebuild, and make whole those parts which nature hath given, but which fortune has taken away. Not so much that it may delight the eye, but that it might buoy up the spirit, and help the mind of the afflicted.” Gaspare Tagliacozzi (1545–1597) The origins of Plastic Surgery as a distinct field follows the history of scientific advancements, influenced by the scourge of need from social influences and wartime atrocities. Key historical figures and milestones are described in the long and illustrious history of the development of the modern innovative field of Plastic Surgery. I. PLASTIC SURGERY ORIGINS IN ANTIQUITY A. The term “plastic” in plastic surgery comes from the Greek “plastikos” which translates to “moldable”. B. Ancient plastic surgery has its origins in the management of wounds, with historical reference to sewing wound edges with fibers or wound edges approximated with insect mandibles. C. References in the Edwin Smyth Papyrus (~3000 to 2500 BC) to plastic surgery cases include descriptions of treating fractures, wounds, dislocations, sores and tumors. 1. Early wound healing remedies included use of grease, honey, linen and swabs. D. The first semblance to modern reconstruction is found in India with nasal reconstruction. 1. Ancient cultures often punished adulterers, thieves and prisoners of war by mutilating their noses as a way of public shaming. E. Famed Indian surgeon Sushruta wrote in the Ayurvedam (Indian sacred book of medical knowledge) descriptions of transposed flaps for nasal reconstruction (~600 BC). 1. He is often credited with descriptions of the first forehead flap for nasal reconstruction, but this is controversial and unknown as the first published report of the forehead flap appears to be in 1794 (figure 1). F. Greek medical influence is grounded in the writings of Hippocrates in the Corpus Hippocraticum (~460 BC) where descriptions of cauterization of raw surfaces, reduction of displaced fractures and trephination for hematoma evacuation are described. G. Roman influence in plastic surgery can be found in the famous volumes De Medicina (~30AD) by Aulus Cornelius Celsus with descriptions of vessel ligature, lip flap reconstruction and wound closure by an advancement flap. 10 H. Writings by Claudius Galen (~129-201 AD) are famed for their intricate anatomical descriptions of muscles and cranial nerves. Figure 1. First reports of the forehead flap for nasal reconstruction From BL. Letter to the editor. Gentleman’s Magazine 1794;64:891–892. II. PLASTIC SURGERY IN THE MIDDLE AGES A. Series of medical texts written by Oribasius (325-403AD) titled Synagogae Medicae describe reconstructive procedures aimed at rebuilding the cheek, nose, ears and eyebrows. B. The middle ages brought about the first independent surgical treatise in the form of Al Tasrif – On Surgery, written by Abu-l-Qasim or Albucasis (~936-1013AD) in which surgical instruments, cautery, and the first description of a syringe with a piston was given. C. The middle ages also brought about the advent of western universities which ushered anatomical classes and cadaver dissections, and anatomists as surgeons. 1. The advent of the printing press (1440AD) also allowed for the widespread dissemination of medical texts and exchange of ideas. 11 III. PLASTIC SURGERY AND THE RENAISSANCE A. Andreas Vesalius publishes his anatomical treatise De Humani Corporis Fabrica (1543). B. French surgeon Ambrose Pare (1510-1590) compiled his works in Les Oeuvers, in which are described repair of cleft lip and cleft palate, in addition to disputing the practice of “wound cleansing” by hot cautery and pouring boiling oil into wounds. C. Gaspare Tagliacozzi (1544-1599) is widely considered the founder of plastic surgery as a distinct discipline. 1. He is credited with systematizing surgical approaches to nasal reconstruction. 2. His book De Curtorum Chirurgia per Insitionem (On the Surgery of Injuries by Grafting) in 1597 provided step by step guidance and illustration to perform nasal repairs. (Figure 2) D. After these landmark achievements, there were limited new advances until the 19th Century. Figure 2. Nasal reconstruction with the arm flap From Tagliacozzi G. De Curtorum Chirurgia per Insitionem. Venice: Bindoni, 1597. IV. GOLDEN AGE OF PLASTIC SURGERY A. English surgeon, Joseph Carpue composed in 1794 a letter to the editor which first
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