Aesthetic surgery dates back to the 1890s, when anesthesia and sanitation were finally advanced enough to warrant smoothing out or resizing a nose for purely aesthetic reasons. But surgeons had been reconstructing noses and other body parts for medical reasons for more than 2,000 years before that.

World War I drove more advances in plastic surgery than any other period. Trench warfare resulted in so many head and neck injuries that the US military appointed 30 doctors to reconstruct shattered jaws, missing ears, lips, and unrecognizable noses. World War II ushered in techniques to rebuild entire limbs, graft skin to extensive burns, and advance the field of hand surgery.

In 600 BC, Sushruta, an Indian surgeon, recorded tips for restoring damaged noses and ears. He instructed surgeons to cut skin from the cheek or forehead, press it to the severed part, and sew the ensemble back into place.

In ancient Rome, surgeons reconstructed lost ears and noses of gladiators, and medical tomes of the day included instructions for avoiding unsightly scars and the collapse of the new appendages.

In subsequent centuries, surgery fell out of favor and came back into fashion in Europe in the 15th century. A pair of Sicilian barbers reconstructed noses using upper arm flesh. In another case, Leonardo Fioravanti, an Italian military surgeon, reattached a soldier’s nose.

European interest in plastic surgery was rekindled again in the 1700s, when tales of Indian rhinoplasty traveled west. The tales inspired one British surgeon, Joseph Carpue, to test the technique on cadavers. He was able to  restore a missing nose in 15 minutes.

When anesthesia became available, surgeons no longer had to rush to spare their patients pain and the advent of germ theory led to fewer infections. By the 1890s, surgeons could argue that rhinoplasty could be performed for aesthetic reasons alone.

[www.latimes.com, June 12, 2006]