First Plastic Surgery: Oct. 23, 1814

Joseph Carpue, a surgeon at Duke of York’s Hospital in Chelsea, England introduces cosmetic surgery to western medicine as he reconstructs the nose of a young soldier.  Twenty years earlier, Carpue had read a magazine article describing procedures developed in India to rebuild mutilated noses and had traveled there to learn more about the procedure. Upon returning to England, he decides to try it himself, selecting a patient whose nose had been eaten away by mercury, a treatment for some diseases at the time.

Carpue cuts a strip of skin from the young man’s forehead, twists it, folds it down over the nasal area and sews it into place. For several days, the patient, his face completely bandaged, was required to lay on his back and remain immobile. When Carpue finally removed the bandages, he is said to have exclaimed, “My God, there is a nose.”

The operation was considered a great success. Because the flap of skin for the new nose came from the patient himself, his body accepted the graft and there was little scarring.  Soon, Carpue repeated the procedure on another injured soldier and then published a book titled, “An Account of Two Successful Operations for Restoring a Lost Nose from the Integument of the Forehead.”

Two years later, in 1818—long before plastics were invented--German surgeon  Carl Von Graefe uses the word “plastic” to describe reconstructive surgery, taking it from the Greek word “plastikos,” meaning to fold or give form.

With the development of anesthesia and more sterile surgical techniques, the notion of performing surgery for purely cosmetic reason began to emerge during the 19th century and in 1891, an American doctor named John Roe performed the first nose job that wasn’t to repair injured or damaged anatomy.

The first cosmetic facelift was performed in Berlin in 1901 by German surgeon Eugen Hollander after an elderly Polish aristocrat asked him to “lift her cheeks and the corners of her mouth.” Instead of cutting out isolated pieces of skin, Hollander is believed to be the first doctor to use the technique of cutting the skin around and under the ears and “lifting” it to smooth wrinkles on the face. The first tummy tucks also were done at the turn of the 20th century, although the early version of the procedure resulted in patients losing their belly buttons.

The quality of cosmetic surgery improved dramatically after World War I, as surgeons applied practices and techniques learned through the treatment of horrific facial wounds suffered by soldiers in trench warfare.  At the same time, plastic surgeons formed professional associations and established regulations that bolstered the field’s reputation and made people less likely to associate cosmetic surgery with quackery.

World War II brought more advances.  Surgeons developed techniques to rebuild entire limbs and do extensive skin grafts, for instance. And after the war, in line with a cultural focus on staying young, plastic surgeons began marketing their skills toward particular groups—especially middle-aged women largely finished with raising families. By the 1960s, plastic surgery was fully integrated into the medical establishment.

Today, almost 200 years after Joseph Carpue introduced nose reconstruction to western medicine, an average of  350,000 Americans get nose jobs every year.