In the 6th Century BCE, an Indian physician named Sushruta, who was widely regarded in India as the “father of surgery”, wrote one of the world’s earliest works on medicine and surgery. The work included the method of skin grafting, which entail transplanting pieces of skin from one part of the body to another. His treatise also provides the first written record of a forehead flap rhinoplasty, a technique still used today, in which a full-thickness piece of skin from the forehead is used to reconstruct a nose. However, Sushruta was not the first inventor of plastic surgery. The first known record of plastic surgery was in 1213 BCE, when ancient Egyptians tried to preserve the nose of their dead king by surgically inserting bones and seeds into it.
For centuries, tribes would stretch their earlobes, bind their feet, file their teeth, as well as tattoo and scar their skin – these practices have not lost their cultural powers. Plastic surgery gained momentum and sophistication during the lifetime of the ancient Roman physician Galen (129-216 CE) due to increased obsession with the human body. Galen himself attempted to cure eyes that squinted and drooped. He also performed aesthetic rhinoplasty on wealthy men and women who simply wanted a new nose. However, after the fall of Rome, many of Galen’s medical texts were lost – only 20 out of his 600 books survive – and the practice of plastic surgery was in decline. In the Middle Ages, despite discussions of proper dental care, surgery in general was deemed to be pagan and sinful because the spilling of blood by a surgeon and the power he held over the body were akin to magic. Plastic surgery, therefore, has always existed and was shrouded in mystery, magic, and eroticism.
Greek legends recount the Graiai, sea god desses who lacked teeth and eyes but successfully passed one of each between them for use. On the utopian island described by Iambulus around 100 BCE were tortoises whose blood had a glue powerful enough to reattach severed body parts. In Apuleius’s circa 160 CE, Latin retelling of the Greek tale The Golden Ass, the hero’s nose and ears are removed by witches and then replaced with wax.
Also in Greek mythology, there is the story of Tantalus, king of Phrygia and son of Zeus. Tantalus was one of the few mortals invited to Mount Olympus. After getting away with some minor infractions, Tantalus thought he was immune from any punishment due to his being the son of Zeus. He then committed a heinous crime by killing his own son, Pelops, and serving him at a banquet to the Olympian gods. Enraged, Zeus hurled Tantalus to Hades to suffer eternal torture of hunger and thirst. Zeus then ordered Hermes to collect all the pieces of Pelops from the dinner table and reconstruct them together. However, the shoulder was missing as Demeter, preoccupied with her daughter Persephone’s disappearance, had accidentally eaten it. Hephaestus reconstructed the shoulder with ivory and Zeus breathed life into him. Legend has it that any one who has a birth mark on the shoulder is a descendant of Pelops.
Homer stated “One surgeon was worth an army of men” recognizing the value of a surgeon during frequent wars that raged those days. This illustrates nicely a discovery made in Abdera (Thrace), dating to the middle of the 7th century BCE where the remains of a woman were discovered with what seemed like an injury on the rear of the skull consistent with a lead shot from a sling. This injury looked like it had been successfully operated on and, judging from the recovery growth around the area, it has been estimated that the woman had lived for 20 years or so following the surgery. This gives us us an early look into early treatments to trauma injury and the care it took to cover the subsequent scarring.
By the first century BCE, perhaps prompted by the very public Roman baths, the Romans were also practicing advanced plastic surgery procedures. In a culture that praised the beauty of the naked body in both art and poetry, the ancient Romans viewed any sign of abnormality, particularly around the area of the genitalia, with both suspicion and amusement. Consequently, one of the most popular plastic surgery procedures appeared to be circumcision removal, which is described in a rather detached way by Cornelius Celsus’ text De re medicina during the reign of Tiberius (14-37 CE) where he describes a breast reduction surgery on an obese man whose breasts were “unsightly” and “shameful.”
Roman surgeons would also remove scars, particularly those on the back, which were marks of shame because they suggested that a man had turned his back in battle or, worse, he had been whipped like a slave. The poet Martial (40-104 CE) suggests that some slaves had their brands removed by surgeons during this time. Surgeons would also often operate on gladiators who had noses and ears chopped off and on foreigners who would try to fit into Roman society.