Plastic Surgery History

The past few decades of medical research and technological development have brought enormous advances in plastic surgery. The practice of plastic surgery or the reshaping of the body for cosmetic or reconstructive purposes dates back to the beginning of human civilization. The term "plastic surgery" comes from the Greek term for mold or shape "plastikos." Cultures across the world have shaped or molded the bodies of their societies to look different. Some cultures enlarge their lips with disks, elongate their necks with rings, pierce earlobes for earrings, bind feet or waits to limit their growth, file teeth to make them sharper or different in shape or tattoo and scar their skin. Today, the second most commonly performed plastic surgery procedure in the Unites States is breast augmentation. History indicates reconstructive surgery techniques in India since 2000 B.C. Sushruta, considered the father of surgery, made important contributions to the field of plastic and cataract surgery in 6th century B.C. The translation of the medical works of both Sushruta and Charak into Arabic occurred during the Abbasid Caliphate in 750 AD. The Arabic translations made their way into Europe via intermediaries. In Italy the Branca family of Sicily and Gaspare Tagliacozzi became familiar with the techniques of Sushruta. British physicians traveled to India to see medicine men perform rhinoplasties by native methods. Physicians published reports about rhinoplasties in India performed by Kumhar Vaidya in the Gentleman's Magazine in 1794. The procedure involved reconstructing the nose by cutting skin from either the cheek or forehead, twisting the skin over a leaf of the appropriate size and sewing the skin back into place. To keep the air passages open during healing, doctors would insert of two polished wooden tubes into the nostrils. This method became the "Indian Method of Rhinoplasty." Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods. Carpue could perform the first major rhinoplasty surgery in the Western world by 1815. He described the modification of Indian instruments of Sushruta Samhita to the Western world. The ancient Egyptians and Romans also performed plastic cosmetic surgeries. The Romans acted simply by repairing damaged ears starting around the 1st century B.C. Aulus Cornelius Celsus left some surprisingly accurate anatomical descriptions; his studies on genitalia and the skeleton are of special interest to plastic surgery. In 1465 Sabuncuoglu wrote a book that contained descriptions and classifications of hypospadias, which was informative and up to date. It describes in detail the localization of urethral meatus and ambiguous genitalia. In mid-15th century Europe, Heinrich von Pfolspeundt described a process "to make a new nose for one who lacks it entirely and the dogs have devoured it" by removing skin from the back of the arm of a patient and suturing it in place on the face. However, because of the dangers associated with surgery in any form, especially that involving the head or face, it was not until the 19th and 20th centuries that such surgery became commonplace. Up until the techniques of anesthesia were established, all surgery on healthy tissues involved great pain. Sterlie techniques and disinfectants reduced infection in patients. The invention and use of antibiotics, beginning with sulfa drugs and penicillin, was another step in making elective surgery safe. In 1792, Chopart performed an operative procedure on a lip using a skin flap from the neck. In 1814, Joseph Carpue successfully performed an operation on a British military officer who had lost his nose to the toxic effects of mercury. In 1818, a German surgeon, Carl Ferdinand von Graefe, published his major work entitled "Rhinoplastik." Von Graefe modified the Italian method using a free skin graft from the arm instead of the original pedicle flap. The first American plastic surgeon was John Peter Mettauer. In 1827 he performed the first cleft palate operation with instruments of his own design. In 1845, Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty, entitled "Operative Chirurgie" and introduced the concept of re-operation to improve cosmetic appearance of a reconstructed nose. In 1891, American otorhinolaryngologist John Roe reduced a dorsal nasal hump on a young woman for cosmetic indications. In 1892, Robert Weir experimented unsuccessfully with xenografts (duck sternums) in an attempt to reconstruct sunken noses. In the late 1890s, James Israel, a urological surgeon from Germany and George Monks of the United States each described the successful use of heterogeneous free-bone grafts to reconstruct saddle nose defects. In 1898, Jacques Joseph, the German orthopedic-trained surgeon, published his first account of reduction rhinoplasty. In 1928, Jacques Joseph published "Nasenplastik und Sonstige Gesichtsplastik." During World War I, a New Zealand otolaryngologist working in London, Harold Gillies developed many of the techniques of modern plastic surgery by caring for soldiers suffering from disfiguring facial injuries. His cousin, a former student Archibald McIndoe, pioneered treatments for RAF aircrew suffering from severe burns and expanded upon Gillies' work during World War II. McIndoe's radical, experimental treatments led to the formation of the Guinea Pig Club. In 1946, Gillies carried out the first female-to-male sex reassignment surgery. Plastic surgery, as a specialty, evolved remarkably during the 20th century in the United States. One of the founders of the specialty, Vilray Blair, was the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis, Missouri. In one of his many areas of clinical expertise, Blair treated World War I soldiers with complex maxillofacial injuries and his paper on "Reconstructive Surgery of the Face" set the standard for craniofacial reconstruction. The modern and more well-known history of plastic surgery begins in the 1960s and '70s. Plastic surgeons contributed to the filed in many ways: one became Surgeon General and another won a Nobel Prize. The past few decades in the history of plastic surgery have brought enormous advances in treatment and awareness among the public.

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Personalized Medicine

Personalized medicine is a medical model emphasizing the systematic use of information about an individual patient to select or optimize that patient's preventative and therapeutic care. Personalized medicine is the products and services that leverage the science of genomics and proteomics and capitalize on the trends toward wellness and consumerism to enable tailored approaches to prevention and care. Over the past century, medical care has centered on standards of care based on epidemiological studies of large cohorts. Personalized medicine seeks to provide an objective basis for consideration of such individual differences. Traditionally, personalized medicine has been limited to the consideration of a patient's family history, social circumstances, environment, and behaviors in tailoring individual care. Personalized medicine uses new methods of molecular analysis to manage a patient’s disease or predisposition toward a disease. It aims to achieve optimal medical outcomes by helping physicians and patients choose the disease management approaches likely to work best in the context of a patient’s genetic and environmental profile. Such approaches may include genetic screening programs that more precisely diagnose diseases and their sub-types, or help physicians select the type and dose of medication best suited to a certain group of patients. Personalized medicine is an extension of traditional approaches to understanding and treating illness. Since the beginning of the study of medicine, physicians have employed evidence found through observation to make a diagnosis or to prescribe treatment. In the modern concept of personalized medicine, the tools provided to the physician are more precise, probing not just the obvious, such as a tumor on a mammogram or cells under a microscope, but the very molecular makeup of each patient. Looking at the patient on this level helps the physician get a profile of the patient’s genetic distinction, or mapping. By investigating this genetic mapping, medical professionals are then able to profile patients, and use the found information to plan a course of treatment that is much more in step with the way their body works. Genomic medicine and personalized medicine use genetic information to prevent or treat disease in adults or their children. Having a genetic map or a profile of a patient’s genetic variation can then guide the selection of drugs or treatment processes. This can minimize side effects or to create a strategy for a more successful outcome from the medical treatment. Helping the physician cover all the bases is imperative. Genetic mapping can also indicate the propensity to contract certain diseases before the patient actually shows recognizable symptoms, allowing the physician and patient to put together a plan for observation and prevention. Personalized medicine, when coupled with personal pharmacogenetics, is a unique approach that may be well suited for the health challenges we face in the new millennium. Although the medical and scientific communities, through research and discovery, got the upper hand over many of the diseases we have encountered since the advent of advanced medicine, many diseases that are more complicated. Diseases like diabetes, heart disease, cancer, and Alzheimer’s are caused by a combination of genetic and other factors. Coupled with the fact that they tend to be chronic, they place a significant burden on not only the patient, but on the healthcare system as a whole. Personalized medicine aims to provide the tools and knowledge to fight chronic diseases and treat them more effectively than ever before. Genetic profiles can help physicians to better discern subgroups of patients with various forms of cancer, in addition to other complex diseases, helping to guide doctors with accurate forms of predictive medicine and preventative medicine. With personalized medicine, the physician is intending to select the best treatment protocol or even, in many cases, avoid passing the expense and risks of unnecessary medical treatments on to the patient altogether. In addition, personalized medicine, when used correctly, aims to guide tests that detect variation in the way individual patients metabolize various pharmaceuticals. Personalized medicine is working to help determine the right dose for a patient, helping to avoid hazards based on familial history, environmental influences, and genetic variation.