The discipline derives its name from the Greek word “plastikos” — to mold or give form. And while the idea of perfecting yourself surgically is a relatively recent phenomenon, there is evidence of reconstructive surgery going back to antiquity.

The oldest-known procedures appear in an ancient Egyptian medical text called the “Edwin Smith Papyrus.” Thought to be an early trauma surgery textbook (and named after the American Egyptologist who purchased it in 1862), the treatise contains detailed case studies for a variety of injuries and diagnoses.

Whether these procedures can be considered types of plastic surgery is a matter of historical debate, according to Justin Yousef, whose research on the topic was recently published in the European Journal of Plastic Surgery. It is in India, in fact, that historians have found “the first description of reconstruction proper,” he said in a phone interview.

By the 6th century B.C., physicians in India were carrying out procedures not dissimilar to a modern-day cosmetic rhinoplasty. In a detailed compendium called “Sushruta Samhita,” the Indian physician Sushruta — who is sometimes called the father of plastic surgery — outlined a remarkably advanced technique for skin grafts.

As in Egypt, the procedure involved repairing noses. But according to Yousef, patients’ motives were, in a sense, cosmetic.

“In ancient India, there was a practice of having one’s nose removed as punishment for adulterous acts or (other acts that were) against the law at the time,” said Yousef, who is also a trainee surgeon at Sydney’s Royal Prince Alfred Hospital. “It was a public sign of shame — if you walked around with an absent nose, people knew that you’d done something.”

Sushruta’s technique involved constructing new noses using skin from elsewhere on patients’ faces. “There are two schools of thought,” Yousef said. “That the skin was either from the forehead or the cheek. But he basically raised the skin and the underlying fat, before transporting it to the area of the nose.”

Celsus documented a procedure whereby excess skin around patients’ eyes was surgically removed.

“Celsus described what we today would call blepharoplasty, or eyelid rejuvenation,” Yousef said. “It was used when hairs (eyelashes) became inverted and started to affect the patient’s ability to see. They were trying to shorten the eyelid so the hairs wouldn’t reach the eye.”

In the ancient world, patients were usually “seeking to replace something rather than enhance their aesthetic appeal,” Yousef said. And given the pain and risks involved, going under the knife was reserved for those most in need. “Wine was the anesthetic,” Yousef added.

The needs of war

Progress in the field was slow over the ensuing centuries. Like much of medical science, it was the development of modern germ theory and the 19th-century invention of anesthesia that began shaping the practices seen today.

As with so many innovations, however, there was another factor that accelerated plastic surgery’s progress: war.

During World War I, the sheer volume of patients with facial injuries — coupled with advances in blood transfusions and infection control — allowed doctors to experiment with innovative new techniques

At the time, the priority for military and civilian patients was improved functioning, such as chewing or breathing more easily. And the idea of using surgery to simply improve one’s appearance remained in its infancy.

Standards improved in the inter-war period, which also saw the first attempts at sex reassignment surgery. But cosmetic procedures were frowned upon by parts of the medical establishment.

“Most plastic surgeons yearned to be recognized as ‘serious surgeons’ and avoided what were considered frivolous procedures,” he added.

Entering the mainstream

The post-war period saw drastic changes for the field. Improved technology, diminished risk and increased disposable income all contributed to plastic surgery’s growing popularity — as did a surplus of doctors after the end of World War II,

By the 1960s — in the US especially — many of today’s most common cosmetic procedures, such as breast augmentation, rhinoplasty and face re-shaping, were becoming more commonplace. Innovation was still driven by the needs of trauma patients or those suffering from cancer or disfigurements. But the technology could be used to vainer ends.

Take, for instance, the emergence of Botox. Originally a treatment for strabismus, or crossed eyes, the injections were later harnessed by the cosmetics industry for their skin-smoothing properties and were approved by the US Food and Drug Administration to treat frown lines in 2002. (In recent years, innovation has benefited the medical profession once again, with Botox now used to treat migraines and spasms.

It took a plastic surgery explosion boom of the 1990s, which saw the volume of procedures in America grow tenfold, for cosmetic procedures to begin outnumber reconstructive ones. By 2005, the number of cosmetic surgery procedures performed in the US was almost double that of reconstructive procedures, according to data from the American Society of Plastic Surgeons, or ASPS. Fueled by celebrity endorsements and economies of scale, cosmetic surgery also tapped into a new aesthetic of desirability, said Ruth Holliday, a professor of gender and culture at Leeds University’s School of Sociology and Social Policy.

According ASPS data, 15.6 million cosmetic procedures were carried out in the US last year. New technology continues to drive the sector’s growth, with some 85% of these procedures (of which Botox and fillers were by far the most popular) considered “minimally invasive.”

Tastes continue to change, too. And while the Covid-19 pandemic has impacted the entire industry, with ASPS reporting a 15% drop in cosmetic procedures carried out in the US in 2020 compared to the previous year, some procedures suffered far larger falls — the number of breast augmentations was down 33% and buttock lifts were down 27%, year over year.