The History of Aesthetic Medicine and Surgery
July 2013 | Volume 12 | Issue 7 | Original Article | 737 | Copyright © 2013
Nils Krueger PhD,a Stefanie Luebberding MSc,a Gerhard Sattler MD,b C. William Hanke MD,c
Macrene Alexiades-Armenakas MD,d and Neil Sadick MDe
aDivision of Cosmetic Science, University of Hamburg, Germany
bRosenparkklinik, Darmstadt, Germany
cIndiana University School of Medicine, Indianapolis, IN
dDepartment of Dermatology, Yale University, New Haven, CT
eWeill Medical College, Cornell University, NY
The history of beauty is as old as mankind itself - throughout history people have tried to improve their attractiveness and to enhance their beauty. The technical basis for many of nowadays procedures like lipoplasty, breast augmentation or rhinoplasty was thereby initiated more than a hundred years ago and evolved to the modern standards of today. The aim of this article is to recall the early days of aesthetic medicine and show the swift progress up to the highly specialized medical discipline of our modern time. Combining the past, present and future of aesthetic medicine, allows to incorporate this perspective and ultimately to delivery better patient care.
J Drugs Dermatol. 2013;12(7):737-742.
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The history of beauty is as old as mankind itself - throughout history people have tried to improve their attractiveness and to enhance their beauty. The ancient Egyptians had already been using animal oils, salt, alabaster, and sour milk to aesthetically improve the skin.1 Although philosophers such as Plato or Imanuel Kant tried to define the term ‘beauty’, a universally valid definition remains elusive. Nowadays, study results show that key properties, such as clarity, symmetry, harmony and vivid color, are elements of an attractive and beautiful appearance.2 However, appearance is the most public part of the self and therefore men and women both try to improve their (apparent) imperfections with the intention to increase their self-perception and quality of life.3
The market for cosmetic surgery and aesthetic treatments is booming. According to the American Society for Aesthetic Plastic Surgery (ASAPS) the overall number of cosmetic procedures has increased by 197 percent since the tracking of the statistics first began in 1997 through 2011.4 In 2011 in the US, almost 9.2 million cosmetic surgical and nonsurgical procedures were performed.2 The technical basis for many of these procedures like lipoplasty, breast augmentation or rhinoplasty was initiated more than a hundred years ago and evolved to the modern standards of today.
The aim of this article is to recall the early days of aesthetic medicine and to show the swift progress up to a highly specialized medical discipline of our modern time. Therefore, a comprehensive literature review was conducted to identify the first published articles for pioneering aesthetic treatments from the beginning of the 19th century down to present day.
Up Until the 19th Century
The history of cosmetic surgery has a long tradition. Originating in India over 2000 years ago the forehead flap for reconstruction for noses mutilated by war and criminal punishment is the oldest known procedure in aesthetic medicine.5 Throughout history the technique has been modified and adjusted by many different surgeons and has evolved to become a popular way of repairing nasal defects.6 In 1845, the Prussian surgeon Johann F. Differbach started publishing several monographs about facial reconstruction, where he mentioned the term “rhinoplasty” for cosmetic reason for the first time.7,8 With the development of the antiseptic surgery in 1867, the British surgeon Josef Lister laid the foundation for reducing post-operative infections by using carbolic acid to sterilize surgical instruments and to clean wounds. With increased safety for patients, the cosmetic surgery saw a boom with many inventions at the end of the 19th Century.9
In 1871, Tilbury Fox described the use of 20% phenol in order to lighten the skin, which became the first chemical peel, a technique that Paul G. Unna refined in 1882 when he described the properties of salicylic acid, resorcinol, phenol and trichloroacetic acid (TCA).1 In 1881, Robert T. Ely described the first otoplasty for protruding ears,10 and six years later, in 1887, John O. Roe took an important step forward in the development of cosmetic surgery when he performed the first subcutaneous rhinoplasty.11
The first injections for tissue augmentation were described in the last decade of the 19th century. In 1893, Franz Neuber was the first physician who used autologous fat as filler material.12 Robert Gersuny recommended the use of paraffin 6 years later, in 1899.13,14 Paraffin became a very common material for augmentation for several years. As shown later, the choice was a mistake, as a foreign-body reaction to the exogenous paraffin lead to granulomas. At the end of the 19th century, Vincent Czerny introduced the first augmentation mammoplasty. He successfully transplanted a lipoma from the back of a patient into the patient’s breast to correct a defect that was left from the removal of a breast adenoma.14,15