India is one of the top countries preferred by patients for plastic surgery. Beyond affordability and accessibility, one of the key reasons for this is our skillful doctors. This competence can be attributed to their knowledge and rigorous training. But history tells us that this finesse in plastic surgery is buttressed in our roots. To learn more about that, let us get into the history of plastic surgery.

This article ^[1] says that the concept of plastic surgery could be dated back to 1600 BC in Egyptian papyrus. It is also known that the Romans also practiced minor cosmetic surgery techniques for a long time. Yet, the techniques and nuances of plastic surgery were served on a platter to the upcoming surgeons by this Indian doctor, Sushruta, in 600 BC. 

Who is Sushruta?

Sushruta is a renowned Indian doctor who used surgical techniques to treat ailments in 600 BC. ^[2] He preached and practiced healing through surgery in ancient India. His surgical expertise covered a broad range of topics, including:

• Reconstructive plastic surgery

• Hernias and other intestinal surgical procedures

• Urological procedures like prostate gland removal, bladder stone removal, and urethral stricture dilatation.

• Cesarean section

• Fracture management

• Treating eye disorders and cataract surgery.

He documented his surgical expertise in his thesis, called Sushruta Samhita. This thesis included all his teachings, including the procedures, tools, and surgical techniques used.  Not only is he known for his skills, but also for his dedication to medicine, which earned him the name: Hippocrates of the sixth century ^[3]. This is attested by the story that he asked his students to take a solemn oath before they started their training, where they had to practice the incisions on melons and gourds. 

Of all the accolades, the most illustrious one is his contribution to the field of plastic surgery in 600 BC, which earned him the name—The Father of Plastic Surgery.

What did Sushruta do in plastic surgery in 600 BC?

We might have read in Indian folktales that the nose was considered to be a dignified organ. And that it was a common practice to amputate the nose as a payback for punishment or vengeance. Sushruta gave their noses back to such unfortunate people. 

He described the procedure of rhinoplasty using a skin graft taken from the cheek or the forehead. The graft was not entirely separated from the cheek, leaving a small pedicle attached to it. Then the flap is rotated to cover the nose area. This technique of using a pedicled skin graft is practiced even in modern plastic surgery. Such grafts are named the Indian flap ^[2]. 

In addition to nose jobs, Sushruta also did several other plastic surgery procedures, like repair of mutilated or torn ear lobes, lip injuries, and even congenital cleft lip ^[2].

However, this era of Indian surgical excellence came down in the Buddha period, from 500 to 400 BC. The Buddhist teachings considered surgery to be polluting and prohibited surgeons. ^[4]

Then who showcased these Indian plastic surgery techniques to the world?

After Buddhism brought it down, these surgical practices were given to people of lower castes. These people preserved the practice in their families, passing it from father to son ^[4]. 

In the 4th century AD

Though the original scripts were lost, the practices were carried out and documented by his followers. It is believed that the current one descended from Vasubandhu, a Buddhist scholar, who wrote a revised version of it in the fourth century AD. ^[2]

From 8th to 15th century AD

The first translation of Sushruta Samhita was done in Arabic under the orders of Caliph Mansur, the then ruler of Baghdad, in the period of 753–774 AD. ^[5] These Arabic translations made their way to the Middle East and the Mediterranean region. 

Through these Arabic translations, plastic surgery spread throughout Europe in the 15th century. An Italian surgeon, Gustavo Branca, and his son, Antonio, introduced the forehead flap in Western Europe. However, being concerned about the facial scar, they decided to take the graft from the arm instead. For this, the arm had to be attached to the face for 10 days! ^[1,6]

In the 19th century:

In the early 1800s, Hessler translated Sushruta Samhita into Latin and German by Muller ^[2]. The first complete English translation was done by Kaviraj Kunja Lal Bhishagratna in 1907 in Calcutta. 

Who named it “plastic surgery” when the skin was used to graft?

In the 19th century, a German surgeon, Karl Ferdinand von Graefe, combined the above-mentioned Italian method of nasal reconstruction with Sushruta’s Indian techniques and published his work as Rhinoplastik. Graefe derived the term plastik from the Latin word plasticus and the Greek word plastikos, both meaning “able to be molded” ^[7] 

Great surgeons like Carpue in London and Warren and Keegan in the United States brought the techniques of nasal reconstruction to their respective places. Beyond rhinoplasty, other reconstructive procedures were developed and practiced in this period and the first breast augmentation surgery was done in 1895.

From the 20th century until today: 

With the advent of World War I and II, the field of plastic surgery flourished even more. The patients with burns and traumatic wounds were treated with plastic surgical techniques. New techniques were employed to rebuild the entire limb, including extensive skin grafting over a severe burn wound and microsurgery.

Eventually, plastic surgery became more accepted by people to achieve their desired looks. Today, with innovations and technology, novel approaches like scarless surgery and laser treatments have become even more popular.