An astonishing 20 million plastic surgery procedures around the world were undertaken last year, according to new figures published this week. They included 50,000 pairs of buttocks being augmented in Brazil; 107,000 pairs of eyes being widened in South Korea – many of them to be made more ‘western’; 1.35 million Americans having their breasts enlarged and 705 British men have their moobs removed. Don’t ask about all the labiaplasty in Germany.
These statistics, published by the International Society of Aesthetic Plastic Surgery, show how far the concept of beauty has changed in the last generation, and hint at how, in many cultures, going to a cosmetic surgeon, rather than a cosmetics counter, is guaranteed way to reduce the signs of ageing.
The idea of grafting skin from one part of the body to another dates back centuries: “plastic surgery” as a term was coined in the 1830s (from the Greek, plastikos – to be moulded), decades before “plastic” became a word to describe man-made materials. But as Roger Green, archivist for the British Association of Plastic and Reconstructive Surgeons(BAPRAS), and himself a surgeon, says, the birth of modern plastic surgery can be dated to 1915.
Gillies was an ear, nose and throat surgeon, who volunteered to serve in the Red Cross in Belgium. “He saw new injuries that were pretty horrific,” says Green. Many soldiers had their faces hideously disfigured by shrapnel as they poked their heads above the parapet.
Too severe to rectify with a skin graft, Gillies developed a technique called the tube pedicle, which involved cutting a strip of flesh from a healthy part of the body – usually the chest or forehead – but leaving one end still attached. The strip of skin was then “swung” into the new area. The flap was folded in on itself, enclosing all the living tissue and blood supply, which prevented infection. The result looked bizarre, but it worked.
During the Battle of the Somme in 1917, Gillies treated 2,000 soldiers, mostly in this way.
During the Second World War, Archibald McIndoe, a pupil of Gillies, made further huge strides treating burnt airmen.
But it was not just McIndoe’s technological advances, it was his whole approach, that were novel. “While Gillies’s mantra was ‘as long as I can fix someone, that’s OK’, McIndoe was more bothered about the psychology of patients,” says Professor Tony Metcalfe, director of research at the Blond McIndoe Research Foundation. East Grinstead, where McIndoe’s hospital was based, became “the town that didn’t stare”.
This right to a “normal” life is something another pupil of Gillies has also pioneered, but for a very different type of patient. In Rio de Janeiro, Ivo Pitanguy, now 91, is called simply “maestro” for his work in helping to popularise cosmetic surgery among not just the yacht-owning classes, butslum dwellers too. Last year over 1.3 million had work done in Brazil. “Aesthetic surgery brings the desired serenity to those that suffer by being betrayed by nature,” he has said.
Pitanguy argues that cosmetic surgery heals ailments such as low self-esteem, an idea that has certainly gained traction in some cultures – in particular highly aspirational and fast-growing economies like Brazil and South Korea, where an estimated 50 per cent of all women their twenties have had work. Many Korean girls are given a facelift by their fathers as a graduation present – this is not anti-ageing, it is about transforming your features in order to improve your chances in life.
In some Seoul clinics, as part of their consultation clients are asked to complete a questionnaire. One question asks what they intend to do after successful surgery. The options? “Get a lover”, “find a job” or “upload a selfie without using Photoshop”.
This sounds shocking but is not much different from the Hollywood stars of the 1920s, including Rudolph Valentino and Gloria Swanson, who had work done to their ears, noses and faces in an effort to land more roles, in an age when looks suddenly became magnified on the silver screen.
In Britain cosmetic surgery is, mercifully, more regulated than in Korea, where it features on game shows. And after a decade of huge growth, the trend is for less invasive work – tweaks not tucks.
Indeed, breast enlargement surgery fell by 23 per cent last year in the UK, as many women were put off by the PIP scandal where many implants ruptured.
Also, the British attitude is different from South America or Asia. “Patients don’t want to look to as if they have been operated on. They want to look healthier, brighter, but not necessarily much younger,” says Paul Harris, council member of the British Association of Aesthetic Plastic Surgeons, adding that for his patients the most popular breast size is “a full C”.
Of course, for wealthy clients, the ultimate sin is to look “done” like the infamous ‘Bride of Wildenstein’, the New Yorker Jocelyn Wildenstein, who spent a rumoured $4 million looking like a terrifying plastic cat. Or indeedJennifer Grey, the Dirty Dancing actress, who bitterly regretted her rhinoplasty. “I went in the operating room a celebrity and came out anonymous,” she has said of the surgery to straighten her distinctive nose.
People in the UK no longer want change their appearance, as they might have done in the 1990s, but just “have more lustre”, says Harris. “It’s now all about being subtle.”
Like the great majority of plastic surgeons in Britain, he works both for the NHS doing reconstructive work as well as undertaking cosmetic work for private patients.
And after nearly a century of cosmetic surgeons stealing ideas from reconstructive plastic surgery, the flow of knowledge is now going the other way. Fat transfer – pumping out fat from one area of the body, typically the stomach, and injecting it into the face is a case in point. Developed by cosmetic surgeons, it is now being used to help reconstruct breasts following cancer surgery.
Fat transfers are “alchemy”, says Nigel Mercer, President of BAPRAS, but are still very risky. “The problem with fat is that it’s got millions of stem cells, I mean millions.” And with those stem cells comes a far higher chance of cancer developing once again.
100 years on, Gillies pioneering work is also still being used to help people rebuild their lives. As well as pump up their buttocks.