Tuesday 16 January 2018

100 years of plastic surgery

Invented to deal with injuries on the bloody ­battlefields of Flanders, Harold Gillies' creation has grown into a multibillion dollar ­industry that extends far beyond helping those 'betrayed by ­nature'.

Last year alone, a record number of Irish women got breast implants, which remain the country's most popular procedures
Last year alone, a record number of Irish women got breast implants, which remain the country's most popular procedures
Plastic Surgeon Sir Archibald McIndoe

John Costello

A staggering 20 million plastic surgery procedures were performed last year, according to new figures published this week by the International Society of Aesthetic Plastic Surgery. This included 50,000 Brazilians who had their bottoms beautified, a whopping 300,000 Americans who gave their boobs a boost, and almost 800 French men who had the odd inch or two added to their manhood.

This news would no doubt have horrified Harold Gillies, who 100 years ago, amid the bloody battlefields of Flanders in World War I, invented the phenomenon of modern plastic surgery.

The concept of taking a skin graft from one part of the body to heal another is centuries old. Indeed, the term "plastic surgery" was coined in the 1930s from the Greek word plastikos, which means to be moulded. However, Gillies, an ear, nose and throat surgeon, who volunteered to serve in the Red Cross in Belgium, knew the monstrous wounds being inflicted during the Great War were way beyond what a simple skin graft could heal.

Soldiers had their faces hideously disfigured by shrapnel to an extent never seen before and new injuries were frequently being encountered thanks to the rise of modern warfare. Knowing the wounds were beyond what any traditional surgical procedure could repair, Gillies developed a technique called the tube pedicle. This involved cutting a strip of flesh from a healthy part of the body, such as the chest or forehead, and leaving one end still attached. The strip of skin was then placed over the damaged area while remaining attached to the healthy part of the body to ensure the connection to living tissue would mean continued blood supply and the ability to ward off infection.

While the results looked bizarre - think Elephant Man and not George Clooney - they proved so successful, Gillies performed the surgery on 2,000 soldiers during the Battle of the Somme in 1916. When he returned to the UK, he was able to develop his techniques through carrying out more than 11,000 operations on 5,000 men.

It did not take long for news of Gillies' successful surgeries to filter through to Hollywood and silent movie actor Rudolph Valentino, whose "ears stuck out like a wild elephants", had them pinned back in 1920. Soon afterwards, Gloria Swanson became the first big Hollywood star to have a facelift. But despite some early successes, the facelift of film star Mary Pickford during the 1930s highlighted how such surgery was still in its infancy. The crude procedure she endured, however, left her not only with deep regrets but the inability to smile.

While it may have taken World War I to invent modern plastic surgery, it took World War II to perfect it. And the Battle of Britain afforded one of Gillies' former pupils, Archibald McIndoe, the perfect opportunity to make huge strides in the field while treating burnt airmen. And while his teacher's mantra had always been "as long as I can fix someone, that is OK", McIndoe became more concerned about how patients looked after the surgery. This was after he became aware of the potential psychological impact a disfigured face could have on a patient's well-being.

McIndoe, however, was not the only of Gillies' former pupils with an eye for the aesthetic. After Brazilian Ivo Pitanguy completed his training in the UK, he returned to Rio de Janeiro where his skill as a cosmetic surgeon soon had him being hailed as the "Michelangelo of the scalpel".

When he was asked why he chose to become a plastic surgeon, he replied: "Aesthetic surgery brings the desired serenity to those that suffer by being betrayed by nature."

These words quickly became his motto. He argued cosmetic surgery could heal ailments such as low self-esteem and is one of the reasons why last year in Brazil alone there were almost 1.5 million cosmetic surgery procedures carried out.

But even the Brazilians cannot match the South Koreans, where an estimated 50pc of women in their twenties have had work. Surgeries undertaken last year included 107,000 pairs of eyes being widened so they can look more Western. Even more disturbing, it is something of a cultural norm for fathers to give their daughters a facelift as a graduation present. This is intended to not only improve their prospects in love and enhance their career opportunities, but obviously also to give them the ability to take a selfie without the need for Photoshop.

While cosmetic surgery is thankfully much more regulated in Ireland, business is still booming. Indeed, despite a dip at the height of the recession, plastic surgery has experienced astounding growth over the past decade. Current estimates say the market here is worth €50m and is expected to continue to grow over the coming years.

Last year alone, a record number of women got breast implants, which remain the country's most popular cosmetic procedures, according to figures released by private healthcare search engine WhatClinic.com.

Almost 10,000 people looked up clinics that carry out the bust-boosting procedure in Ireland in 2014, a 215pc increase on the previous year - despite the price tag of almost €4,500.

But it is not just Irish women who are looking to reshape their chests. The figures revealed that almost 2,000 men sought to mop up their moobs by seeking out male breast reduction procedures.

"Ireland's fascination with cosmetic surgery shows no sign of abating," says Emily Ross, director of WhatClinic.com. "While the greatest increases are for surgical treatments, this still only reflects a small fraction of the overall market, and with ever-increasing choice and much lower prices, non-surgical treatments continue to grow in popularity as well," adds Ross.

However, while boobs and botox continue to be the mainstays of the cosmetic-surgery market in Ireland, we appear to be getting a tad more adventurous. Brow lifts and neck lifts are now the fastest growing surgical trends of 2015 with demand up 345pc and 340pc respectively already this year.

But while Gillies may have been highly disturbed by the industry his groundbreaking work sparked 100 years ago, it appears cosmetic surgery is finally giving something back to the medical profession.

Fat transfer, which was developed by cosmetic surgeons to use fat from one area of the body, typically the stomach, to inject into the face to help plump up pouts and fill out cheeks, is now being used to reconstruct breasts following cancer surgery.

So while cosmetic surgery is helping enhance Brazilian behinds and French sausages, its techniques are also being used to rebuild people's lives. And surely Gillies would be proud of that.

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