Exactly how long people have been interested in cosmetic surgery is not known. Interest in creating a more youthful appearance, however, goes back a long way. An Egyptian hieroglyphic document from 1600 B.C. describes an ointment:

"Anoint a man therewith. It is a remover of wrinkles from the head. When the flesh is smeared therewith it becomes a beautifier of the skin, a remover of blemishes, of all disfigurements, of all signs of age, of all weaknesses which are in the flesh. Found effective myriads of times."

The precise makeup of this preparation is apparently unavailable, perhaps in part because the chief ingredient is the hemayet fruit, which is, at present, unidentified.

Evidently, interest in looking one's best and in reversing the effects of aging are not recent phenomena.

Through the ages many different "remedies" and interventions have been proposed to alter the appearance of specific body parts. Hemlock could supposedly prevent excessive breast growth (1558), and redundant eyelid skin could seemingly be removed by tightening metal screw-clamps and letting the skin fall off (1583). A century ago, a U.S. patent was issued for a device that purported to remove excess fat by rocking the offending portion of the body on the floor after the patient was strapped into a large metal contraption. A seven-screwed metal clamp called the Nose Shaper Model Trados 25 was advertised as being able to produce the "Successful Correction of Ill-Shaped Noses for Men and Women."

Although the first breast reduction may have been performed as early as 650 A.D., modern cosmetic surgery is generally felt to have emerged toward the end of the nineteenth century. The development of anesthesia (first general anesthesia, then local) made much of this possible. Many of the earliest surgeons were in or from Germany, including Erich Lexer (1867-1937), who pioneered modern breast reduction surgery. Experience with severe facial injuries during the First World War led to greater familiarity with surgery of the head and neck. Facial reconstructive procedures evolved into cosmetic surgery of the nose and the face. Among the earliest surgeons in this arena were Jacques Joseph and Gustave Aufricht, who helped develop nasal surgery, and Sir Harold Gillies, a British surgeon who described facial reconstruction by repositioning facial skin, later adapting it for use in cosmetic surgery.

Contrary to popular belief, the name "plastic surgery" does not come from the use of plastics in the surgery. While plastic materials (such as the silicone in breast implants) are used, the term plastic surgery was in use long before implants made of plastic were developed. Instead, plastic surgery refers to the strict definition of the word "plastic" -- "capable of being molded or of receiving form."5 "Plastic" is used in the sense of changing the position of skin, moving skin and tissue from one part of the body to another, stretching things out and shaping them. This meaning of "plastic" came to be used for the class of moldable, changeable materials that we now normally refer to as plastics, not the other way around.

The first breast implants in the modern era were developed in the 1950s. Silicone implants were reported by Thomas Cronin, in 1962. Many different materials have been used to increase the size of the breasts. In Asia, for example, women underwent injections of paraffin, often with disastrous results. The quest for the perfect breast implant material continues, which is discussed in subsequent chapters. Liposuction was developed in the 1960s and 1970s by, among others, a French gynecologist and surgeon, Yves Gerard Illouz, who adapted and improved techniques that had been introduced about fifty years earlier.

Regardless of its origins, plastic surgery is now firmly entrenched in o ur collective psyche. This is evidenced by a short trip to a newsstand or bookstore, or by "surfing" through television or radio stations. The pervasiveness of plastic surgery was underscored by an incident I inadvertently participated in several years ago.

On a hot August day I was walking through a department store. It was during a heat wave -- the type where everyone is advised to stay indoors and seek shelter in a shopping mall if air conditioning is not available. As I headed for the exit I passed through the Cosmetics department. Walking toward me was a woman in her 40s and a girl, presumably her daughter, about 15 years old. As they approached, I saw that the girl was becoming a bit wobbly on her feet. I moved nearer to them just as her eyes rolled back and she started to faint. I jumped forward, caught her as she was falling, and lowered her onto the ground. Her mother became hysterical and blurted out that her daughter hadn't eaten a thing for lunch. After determining that the girl had simply fainted and would be okay, I reassured her mother. I asked for some water. A store employee brought out an atomizer of designer water, which I sprayed onto the girl's face. She opened her eyes and looked up at the ceiling. Her mother, now calmed, turned to me and, noticing my beeper, asked if I was a doctor. I nodded. Next she asked what kind of doctor I was. "Actually," I said, "I'm a plastic surgeon." At that point the girl, apparently revived but still lying flat on her back, lifted her head up sharply and asked, "Oh wow! Do you do liposuction?" The mere mention of plastic surgery appears to have spurred her recovery.

Plastic surgery has also gained acceptance by men, a fact noted by, among others, The Wall Street Journal.6 Men now constitute about 15-20% of plastic surgery patients (and more in some practices), which is about double what it was fifteen years ago. Increasingly, men seem to have concluded that a more youthful appearance may increase their likelihood of success in the highly competitive business world, as well as benefit them personally. This is reflected in their interest in cosmetic surgery.

Despite its benefits, plastic surgery is not for everyone. Some people are plastic surgery "enthusiasts" and some aren't. Time has a way of changing one's perspective, however. More than one person nearing or in her 40s has confided that after years of insisting that she would never have plastic surgery things might be different now It's not necessarily a questions of looking a decade or so younger (even though that might be nice) but, rather, of looking as good as one reasonably can.

Plastic surgery is a dynamic field. New developments appear on a regular basis and what is accurate now may not be so in the future. Better results can be produced using smaller incisions than ever before. Today's most popular procedures were essentially unknown several decades ago. This seems only fair: A field that is defined by "capable of being molded" should be expected to be modified itself on a regular basis.