WEBVTT - What does Plastic Surgery have to do with the Civil War? 0:00:02.480 --> 0:00:05.200 I guess what, well, what's that mango? So, have you 0:00:05.240 --> 0:00:09.440 ever heard of Poker Talks? Poker talks? Is that? Is 0:00:09.480 --> 0:00:12.280 that like detox for playing poker or what? I actually 0:00:12.280 --> 0:00:16.680 have not heard of it. It's actually botox for playing poker. Oh, 0:00:16.720 --> 0:00:19.640 I get it. That's smart. Yeah. It was invented by 0:00:19.640 --> 0:00:22.880 this New York City doctor. His name's Jack Birdie, and 0:00:23.040 --> 0:00:25.400 he's also this poker player, and he realized the biggest 0:00:25.400 --> 0:00:28.240 problem for poker players is their tells, like people who 0:00:28.360 --> 0:00:31.240 like far with their brows or curl their lips as 0:00:31.240 --> 0:00:34.040 they're trying to bluff, and so he basically came up 0:00:34.040 --> 0:00:37.280 with a few places to administer botox so you don't 0:00:37.320 --> 0:00:40.680 show your hand as much. Now, I'm guessing this is 0:00:40.720 --> 0:00:42.800 just for humans or can you know those dogs that 0:00:42.840 --> 0:00:46.440 play poker? Can they also get this treatment? I love 0:00:46.520 --> 0:00:48.800 the idea of like a sharpay or one of those 0:00:48.840 --> 0:00:51.600 like super wrinkly dogs just getting all smoothed out, because 0:00:51.640 --> 0:00:55.040 the boats I feel like it will take so many 0:00:55.080 --> 0:00:58.400 years off the dog. But hearing about Poker Talks treatments 0:00:58.480 --> 0:01:00.959 really made us wonder, like, what the history of these 0:01:01.000 --> 0:01:03.880 cosmetic procedures. How long have people have been getting those 0:01:04.000 --> 0:01:06.400 jobs and why was the Civil War such a turning 0:01:06.400 --> 0:01:31.160 point for plastic surgery. So let's dive in their podcast. Listeners, 0:01:31.160 --> 0:01:33.320 Welcome to Part Time Genius. I'm Will Pearson and as 0:01:33.360 --> 0:01:36.120 always I'm joined by my good friend Mangesh Ticketer and 0:01:36.160 --> 0:01:38.920 on the other side of the soundproof glass. Really feeling 0:01:38.959 --> 0:01:42.560 that burn because he's doing his daily set of Facer sizes. 0:01:42.560 --> 0:01:44.160 I don't know if you've noticed this man, he's been 0:01:44.200 --> 0:01:47.039 doing them all week. I didn't. Well, that is our 0:01:47.080 --> 0:01:51.120 friend and producer Tristan McNeil. Now. Tristan claims these exercises 0:01:51.120 --> 0:01:54.760 are a viable alternative to plastic surgery, something about how 0:01:54.840 --> 0:01:57.840 like toning your face muscles can make you look younger. 0:01:57.960 --> 0:02:00.639 So good luck to you, Tristan. You already pretty young looking. 0:02:00.680 --> 0:02:02.480 But you know, we'll see if this makes a difference. 0:02:02.840 --> 0:02:05.480 And honestly, from here, it mostly looks like he's just 0:02:05.560 --> 0:02:08.840 kind of smushing his cheeks and making this little turtle face. 0:02:08.960 --> 0:02:10.720 It's kind of I wish everybody could see this. It's 0:02:10.720 --> 0:02:13.400 a little weird. Yeah, So he was trying to explain 0:02:13.400 --> 0:02:15.600 this to me earlier. He's been doing this old nineties 0:02:15.639 --> 0:02:19.040 exercise routine that's supposed to tighten facial muscles, and he 0:02:19.200 --> 0:02:22.280 said it's called cheek energizing, and supposedly as part of 0:02:22.320 --> 0:02:25.480 this whole face of size program that this doctor named 0:02:25.520 --> 0:02:29.760 Carol Maggio developed like thirty years ago. It all sounds 0:02:29.919 --> 0:02:33.079 and looks pretty bizarre, and I'm mostly just impressed that 0:02:33.120 --> 0:02:36.240 Tristan was able to decode the written instructions. So I 0:02:36.280 --> 0:02:38.799 actually looked this up and this is a breakdown to 0:02:38.880 --> 0:02:42.840 the cheek energizer move he's been doing. Quote, place an 0:02:42.840 --> 0:02:46.240 index finger lightly on the top of each cheek. Now, 0:02:46.320 --> 0:02:48.919 smile with the middle of your upper lip while thinking 0:02:48.960 --> 0:02:52.680 about the expression you pulling the top lip flat against 0:02:52.720 --> 0:02:55.799 your teeth. Keep your upper and lower lips firmly pulling 0:02:55.800 --> 0:02:58.400 away from each other, and feel your cheeks move under 0:02:58.400 --> 0:03:02.480 your index fingers. Repeat this, smile and release. I mean, 0:03:02.720 --> 0:03:07.240 none of this makes any sense to me. Trying it feels, 0:03:07.320 --> 0:03:11.680 it feels weird. I don't know the middle of your lip, Okay. 0:03:12.240 --> 0:03:14.400 What's strange is that if we wanted, we can actually, 0:03:14.400 --> 0:03:17.040 like ask the inventor herself about how to do this. 0:03:17.120 --> 0:03:21.120 At age seventy three, she actually promotes facer size on Skype, 0:03:21.160 --> 0:03:22.840 and you can do a skype session with her and 0:03:22.919 --> 0:03:25.560 she'll walk you through it face to face. I am 0:03:25.600 --> 0:03:27.960 totally going to do this manga that she sounds weird 0:03:28.080 --> 0:03:29.720 enough for me to want to do it, and it 0:03:29.800 --> 0:03:31.920 does seem like could be a pretty surreal experience. But 0:03:32.160 --> 0:03:35.560 as proponents of plastic surgery will tell you, most improvements 0:03:35.600 --> 0:03:38.560 from facial exercise just don't hold a candle to the 0:03:38.600 --> 0:03:41.440 results you get from a shot of botox or maybe 0:03:41.440 --> 0:03:43.880 a half hour under the knife. And when you think 0:03:43.920 --> 0:03:46.960 about it, that relative ease and the immediacy of the results, 0:03:47.160 --> 0:03:50.400 it's what makes cosmetic procedures so appealing in the first place. 0:03:51.080 --> 0:03:54.440 For instance, in two thousand seventeen alone, fifteen point seven 0:03:54.520 --> 0:03:58.800 million minimally invasive cosmetic procedures were performed in the US, 0:03:59.120 --> 0:04:02.760 So we're talking about things like botox injections, chemical peels, 0:04:02.880 --> 0:04:07.560 laser hair removals. That's almost two increase since the year 0:04:07.640 --> 0:04:11.200 two thousand. Obviously, big reason for that growth is that 0:04:11.240 --> 0:04:15.120 cosmetic procedures have become easier, less invasive, you know, than 0:04:15.160 --> 0:04:18.200 they were in the years past. But millions of people 0:04:18.240 --> 0:04:20.360 are lining up each year to have parts of their 0:04:20.400 --> 0:04:23.719 bodies nipped and tucked and shaped and plumped, but you know, 0:04:23.760 --> 0:04:25.720 whether or not that's a good thing is still kind 0:04:25.720 --> 0:04:27.840 of up in the air for many people. And so 0:04:27.880 --> 0:04:30.000 with that question of mind, we've got to be interesting 0:04:30.040 --> 0:04:33.560 to look into the history of plastic surgery, including how 0:04:33.600 --> 0:04:35.839 and why it got started and many of the ways 0:04:35.880 --> 0:04:38.080 it's changed over the years. And then a little bit 0:04:38.200 --> 0:04:40.240 later in the episode, I think we'll check out some 0:04:40.279 --> 0:04:43.040 of the more recent trends in the industry, as well 0:04:43.080 --> 0:04:45.440 as how a selfie stick might make you think twice 0:04:45.480 --> 0:04:49.120 about getting a nose job. That's right, But you know, 0:04:49.200 --> 0:04:50.680 before we get into any of that, I thought we 0:04:50.680 --> 0:04:52.600 could start by breaking down some of the terms will 0:04:52.640 --> 0:04:55.000 be using today, you know, just so things don't get 0:04:55.040 --> 0:04:57.559 confusing a little bit later. So in general, we refer 0:04:57.680 --> 0:05:00.479 to the term plastic surgery for a few for things 0:05:00.480 --> 0:05:03.320 at once. You know, they're cosmetic surgeries, which are the 0:05:03.320 --> 0:05:06.640 ones meant to enhance a person's overall appearance and aren't 0:05:06.640 --> 0:05:11.560 considered medically necessary, so things like liposuction or or facelifts, 0:05:11.960 --> 0:05:14.160 as well as the less invasive procedures you mentioned, like 0:05:14.240 --> 0:05:17.440 chemical peels and botox. But plastic surgery can also refer 0:05:17.480 --> 0:05:20.200 to reconstructive surgeries and those are the ones performed to 0:05:20.279 --> 0:05:23.000 restore the normal function or appearance of a person's body, 0:05:23.200 --> 0:05:27.120 and for the most part, these are considered medically necessary. Yeah, 0:05:27.120 --> 0:05:28.919 I mean there are several of these types. When you 0:05:28.920 --> 0:05:31.800 think about surgeries like you know, repairing a cleft palate, 0:05:32.120 --> 0:05:36.000 or the unbelievable jobs that the surgeons can do when 0:05:36.000 --> 0:05:39.160 they're reconstructing a burn victim's face or their body, it's 0:05:39.160 --> 0:05:42.440 pretty remarkable how far this has come. Yeah, and I 0:05:42.480 --> 0:05:44.760 did think it was worth mentioning because there's still a 0:05:44.760 --> 0:05:47.200 ton of stigma surrounding the term, Like lots of people 0:05:47.240 --> 0:05:49.960 only associate plastic surgery with the cosmetic side of things 0:05:50.000 --> 0:05:53.560 like tummy toks and calf implants. Yeah. Well, and my 0:05:53.680 --> 0:05:55.440 guess is that the stigma has a lot to do 0:05:55.520 --> 0:05:58.000 with the word plastic itself. I mean, I think it 0:05:58.040 --> 0:06:02.200 makes people think about fakeness, artificiality, and all the other 0:06:02.360 --> 0:06:06.280 things we associate with plastic as a substance. Like we 0:06:06.279 --> 0:06:09.240 wrap our view of plastic as being cheap and disposable 0:06:09.279 --> 0:06:12.360 onto these surgeries that share this name, which of course 0:06:12.440 --> 0:06:15.159 is pretty unfair when you really think about it. Yeah, 0:06:15.240 --> 0:06:17.840 I mean, especially when you consider that the name doesn't 0:06:17.880 --> 0:06:20.159 have anything to do with plastic in the first place. 0:06:20.520 --> 0:06:22.599 Like I read this week that the first time the 0:06:22.640 --> 0:06:25.960 word plastic was actually used to describe a surgical technique 0:06:26.080 --> 0:06:29.960 was an eighteen thirty seven, which is so long before 0:06:29.960 --> 0:06:32.480 plastic the substance was even invented, all right, So then 0:06:32.520 --> 0:06:34.479 what did the term actually mean when it was used 0:06:34.480 --> 0:06:37.360 in eighteen thirty seven. It actually came from the Greek 0:06:37.400 --> 0:06:40.839 word plastic coast, which means to mold or give form. 0:06:40.960 --> 0:06:44.760 So a plastic surgery was basically a shaping surgery, and 0:06:44.960 --> 0:06:47.200 that was pretty fitting because the earliest forms of plastic 0:06:47.200 --> 0:06:50.080 surgery were based much more in reconstruction than they were 0:06:50.360 --> 0:06:53.760 purely cosmetic changes. You know, it's interesting. This is another 0:06:53.800 --> 0:06:55.600 one of those things that when we started looking into 0:06:55.600 --> 0:06:59.159 the history, you really don't think about how far back 0:06:59.240 --> 0:07:02.120 some of these things go. And so actually the earliest 0:07:02.120 --> 0:07:04.760 known example of plastic surgery dates all the way back 0:07:04.800 --> 0:07:08.359 to the sixth century BC, and it was indeed a 0:07:08.400 --> 0:07:11.720 form of reconstruction. This was a nose job. The technique 0:07:11.720 --> 0:07:14.280 was invented in ancient India by a physician and a 0:07:14.320 --> 0:07:17.440 surgeon named sush Ruta. And this was at the time 0:07:17.520 --> 0:07:19.920 when you know it was common to punish an adulterer 0:07:20.040 --> 0:07:23.200 or a thief with some form of body mutilation, usually 0:07:23.200 --> 0:07:26.480 by cutting off the nose or maybe an ear. And 0:07:26.520 --> 0:07:28.680 so this physician was one of many in the region 0:07:28.720 --> 0:07:31.880 who felt that this was kind of public shaming and 0:07:32.040 --> 0:07:34.120 it was just way over the line, of course, and 0:07:34.480 --> 0:07:37.280 you know, basically ensured that the criminals would be shunned 0:07:37.280 --> 0:07:39.920 for the rest of their lives. So we wanted to 0:07:39.920 --> 0:07:42.720 do something to help solve this problem, and so we 0:07:42.760 --> 0:07:45.440 began looking for a way to help these people reintegrate 0:07:45.480 --> 0:07:49.080 into society by restoring their appearance as much as he 0:07:49.120 --> 0:07:51.880 possibly could. And so what he came up with was 0:07:51.920 --> 0:07:54.720 this technique where a flap of skin was removed from 0:07:54.720 --> 0:07:58.400 a patient's cheek and then molded and shaped into a 0:07:58.440 --> 0:08:01.520 new nose. And so he warm the nostrils by inserting 0:08:01.560 --> 0:08:03.880 these two hollow reads and then you leave them in 0:08:03.920 --> 0:08:06.760 place to make sure the nostrils didn't close up as 0:08:06.800 --> 0:08:10.160 the new nose healed. I mean, it's unbelievable that somebody 0:08:10.160 --> 0:08:12.960 could pull this off that long ago. Yeah, and it 0:08:12.960 --> 0:08:17.160 almost sounds like fantastical to anything like that could even work. Yeah, 0:08:17.200 --> 0:08:19.600 it seems to have been the consensus at the time too. 0:08:19.640 --> 0:08:22.880 But you know, once word of this method spread, other 0:08:22.960 --> 0:08:26.280 Indian surgeons began trying it for themselves, and some even 0:08:26.360 --> 0:08:28.480 put their own spin on the procedure by building the 0:08:28.520 --> 0:08:31.520 replacement nose from a flap of the patient's forehead skin 0:08:31.720 --> 0:08:34.760 rather than you know, maybe their cheek. And this early 0:08:34.840 --> 0:08:38.440 form of rhinoplasty proved so successful that it was eventually 0:08:38.440 --> 0:08:42.280 adapted throughout Europe, where it became known as the Indian method. 0:08:43.440 --> 0:08:45.640 So I had actually heard about this Indian method just 0:08:45.679 --> 0:08:48.520 because it's one of those things I feel is compulsory 0:08:48.640 --> 0:08:51.480 if you're Indian, like for Indian pride, Like, uh, you know, 0:08:51.600 --> 0:08:53.680 India also came up with the concept of zero as 0:08:53.720 --> 0:08:57.080 a number and invented shampoo. Like these are just things 0:08:58.120 --> 0:09:01.160 and you're welcome. But uh, apparently we weren't the only 0:09:01.200 --> 0:09:04.559 innovators there. There's also something called the Italian method, and 0:09:04.640 --> 0:09:07.720 this was invented by a surgeon named Antonio Bronca. This 0:09:07.760 --> 0:09:10.360 was in early four hundreds and the big difference was 0:09:10.400 --> 0:09:12.600 that Branco used a flap of skin from the upper 0:09:12.720 --> 0:09:15.440 arm to build his patient's new noses, and this was 0:09:15.480 --> 0:09:18.040 considered an improvement for the most part because it left 0:09:18.040 --> 0:09:21.080 a lot less scarring than Indian method did. The only 0:09:21.120 --> 0:09:23.760 downside was that, and this is a little strange to 0:09:23.760 --> 0:09:26.480 think about, in order for the skin to fully attach itself, 0:09:26.679 --> 0:09:29.560 patients actually to hold their arms against their nose for 0:09:29.640 --> 0:09:35.240 like twenty straight days. Obviously seems super uncomfortable. It does 0:09:35.360 --> 0:09:37.880 sound miserable, but I guess in these cases, you know, 0:09:38.040 --> 0:09:40.959 considering the results for the payoff, I guess it was 0:09:41.000 --> 0:09:44.160 considered worth it. But let's get back to Sushruta for 0:09:44.160 --> 0:09:47.960 a minute. Because after his breakthrough, this plastic surgery continued 0:09:48.000 --> 0:09:51.360 to develop throughout Europe. So, for example, ancient Rome got 0:09:51.360 --> 0:09:53.960 in on the act sometime during the early first century, 0:09:54.480 --> 0:09:57.760 so surgeons of the Arab pioneered bluffero plastic, which is 0:09:57.800 --> 0:10:00.960 the adjustment of the eyelids in order to correct drooping 0:10:01.120 --> 0:10:04.360 or squinting eyes. And around the same time, the Greek 0:10:04.360 --> 0:10:09.200 physician Galen performed the very first purely cosmetic plastic surgery. 0:10:09.280 --> 0:10:11.720 So it's kind of like a nose job for the wealthy. 0:10:13.080 --> 0:10:15.600 It's kind of cool that nose jobs were like first, 0:10:15.679 --> 0:10:20.000 both for reconstructive and cosmetic purposes. Is it's kind of stunning, 0:10:20.040 --> 0:10:23.400 But you know, not everyone was happy about those breakthroughs 0:10:23.400 --> 0:10:27.080 embody modification. As Christianity began to take hold in Europe 0:10:27.120 --> 0:10:29.680 during the Middle Ages, plenty of religious leaders viewed plastic 0:10:29.720 --> 0:10:34.360 surgery as sinful or almost borderlined blasphemous, and this belief 0:10:34.400 --> 0:10:37.000 gained more traction in the twelfth century when the Pope 0:10:37.040 --> 0:10:38.960 I think it's Pope Innocent, the third at the time, 0:10:39.120 --> 0:10:42.560 he formally spoke out against it, and pretty soon after 0:10:42.600 --> 0:10:45.760 it became a crime to surgically alter the human body. 0:10:46.280 --> 0:10:48.800 So you see, this kind of thing happened throughout history, 0:10:48.800 --> 0:10:52.079 but in this case, like what changed that perception? What 0:10:52.080 --> 0:10:55.440 what made the church eventually backed down from this. This 0:10:55.520 --> 0:10:57.920 is gonna sound strange, but a lot of the shift 0:10:58.080 --> 0:11:01.480 was due to syphilis. Really, you know that there were 0:11:01.480 --> 0:11:02.880 a lot of things I was guessing about. Is not 0:11:02.920 --> 0:11:05.760 what I expected you to say, though, I know. So 0:11:06.240 --> 0:11:08.760 there was a really bad outbreak of this disease in 0:11:08.800 --> 0:11:11.640 Europe during the late sixteenth century, and one of the 0:11:11.720 --> 0:11:15.839 symptoms of advance syphilis happens to be soft tissue, to 0:11:16.320 --> 0:11:18.200 which is usually centered in the nose. I had no 0:11:18.240 --> 0:11:20.880 idea about this, but now there were all these like 0:11:21.040 --> 0:11:25.040 upper crusts, lords and ladies with these big gaping holes 0:11:25.080 --> 0:11:29.440 in their faces, and suddenly this like quote sin of 0:11:29.480 --> 0:11:32.200 like crafting a false nose, it started to seem a 0:11:32.240 --> 0:11:34.679 whole lot better, you know than the alternative of having, 0:11:34.960 --> 0:11:36.800 you know, a hole in your face. Yeah, I mean 0:11:36.840 --> 0:11:40.079 that makes sense. And of course plastic surgeries development didn't 0:11:40.200 --> 0:11:43.040 end in Europe, and the techniques eventually made their way 0:11:43.120 --> 0:11:45.720 here to the United States, with one of the earliest 0:11:45.720 --> 0:11:49.400 practitioners being Dr John Medhour. You know, he and his 0:11:49.440 --> 0:11:52.920 sons ran this successful practice in Virginia, and they were 0:11:52.960 --> 0:11:56.800 specializing in repairing genital birth effects and then later on 0:11:56.880 --> 0:12:01.320 in reconstructive surgery, and his legacy is actually really impressive. 0:12:01.440 --> 0:12:04.360 So met Hour is credited with performing the first hard 0:12:04.440 --> 0:12:08.600 cleft palate repair on the America's in eighteen seven, and notably, 0:12:08.640 --> 0:12:11.800 he completed the procedure by transplanting pieces of bone rather 0:12:11.880 --> 0:12:14.880 than just skin or muscle as previous surgeons had done. 0:12:15.240 --> 0:12:17.720 And so this new technique was this huge leap forward 0:12:17.760 --> 0:12:20.920 for reconstructive surgery, and it's actually the main reason why 0:12:21.000 --> 0:12:25.000 Dr Metour is often called America's first plastic surgeon. Yeah, 0:12:25.040 --> 0:12:27.680 So it really seems like the nineteenth century is when 0:12:27.760 --> 0:12:30.720 modern plastic surgery really started to take off, and I 0:12:30.760 --> 0:12:32.880 was reading about how much of a game changer the 0:12:32.960 --> 0:12:36.440 Civil War was for battlefield medicine. I mean, you think 0:12:36.480 --> 0:12:40.720 about things like amputation techniques or more reliable forms of anesthesia, 0:12:41.120 --> 0:12:44.480 but facial reconstruction was another area that saw these major 0:12:44.520 --> 0:12:48.680 advances during America's bloodiest war, and records actually show that 0:12:48.840 --> 0:12:52.560 Union surgeons perform more than thirty successful plastic surgeries on 0:12:52.640 --> 0:12:56.800 these disfigured soldiers during the war, and they also pioneered 0:12:56.880 --> 0:12:59.080 new techniques that would later become standards in the field, 0:12:59.160 --> 0:13:01.920 like taking photo us to track the progress of repairs 0:13:02.000 --> 0:13:04.719 and and also using smaller sutures for incisions to help 0:13:04.800 --> 0:13:08.480 minimize the scarring. Yeah, you know, it's interesting how these 0:13:08.520 --> 0:13:11.640 advancements happened during war, because it actually wasn't just the 0:13:11.679 --> 0:13:14.720 Civil War where these kinds of breakthroughs happening, like both 0:13:14.760 --> 0:13:18.480 world wars actually also brought major innovations the plastic surgery 0:13:18.520 --> 0:13:21.240 as well. Yeah, I mean that that's definitely a good point, 0:13:21.360 --> 0:13:23.720 and we should spotlight a few of those advances before 0:13:23.760 --> 0:13:25.880 we talk about the state of plastic surgery today. But 0:13:26.240 --> 0:13:28.000 before we go any further, why don't we take a 0:13:28.080 --> 0:13:46.199 quick break. You're listening to Part Time Genius and we're 0:13:46.200 --> 0:13:50.280 talking about the long, surprising history of plastic surgery. Okay, well, 0:13:50.320 --> 0:13:52.720 so we're up to the twentieth century now in our timeline, 0:13:52.720 --> 0:13:55.680 and we were just about to get into World War One. Yeah, 0:13:55.679 --> 0:13:57.880 that's right. You know, as we were saying, earlier wars 0:13:57.920 --> 0:14:01.120 have certainly led to these turning points, and you know, 0:14:01.200 --> 0:14:05.400 reconstruction of various kinds and facial reconstruction specifically. And there 0:14:05.400 --> 0:14:07.400 were a couple of reasons for this. I mean, if 0:14:07.400 --> 0:14:10.040 you think about what was advanced in terms of warfare 0:14:10.080 --> 0:14:12.640 at that time, you had machine guns and aerial bombers 0:14:12.640 --> 0:14:15.080 that were being used in combat and and really for 0:14:15.120 --> 0:14:18.320 the first time during World War One. And the result 0:14:18.400 --> 0:14:20.920 of this, obvious, you know, tragic result of this is 0:14:20.920 --> 0:14:23.960 that more soldiers suffered facial wounds due to bullets and 0:14:24.000 --> 0:14:27.600 shrapnel than in any of the wars before them. And 0:14:27.640 --> 0:14:30.720 you know, it's obviously awful, but the wounds were often 0:14:30.760 --> 0:14:34.160 more extensive than surgeons were used to treating. So the 0:14:34.160 --> 0:14:36.520 good news here is though, that anesthesia and the treatment 0:14:36.520 --> 0:14:40.720 of infections had definitely improved drastically by this time, So 0:14:40.720 --> 0:14:43.240 you had serious injuries that would have been fatal in 0:14:43.280 --> 0:14:46.960 the past that we're now considered survivable, and that included 0:14:46.960 --> 0:14:51.280 a lot of major facial disfigurements as a result of this. Yeah. 0:14:51.440 --> 0:14:54.120 We mentioned earlier that there were some like thirty odd 0:14:54.120 --> 0:14:57.360 plastic surgeries during the Civil War, and that actually doesn't 0:14:57.360 --> 0:14:59.560 sound like that many at first, but when you consider 0:14:59.600 --> 0:15:01.680 how many soldiers died just because there was no way 0:15:01.720 --> 0:15:04.360 to stave off infection, it starts to make sense why 0:15:04.400 --> 0:15:07.040 the number was so low. Yeah, And so with World 0:15:07.040 --> 0:15:09.520 War One, surgeons suddenly found themselves with a lot of 0:15:09.640 --> 0:15:13.720 chances to develop and refine new ways to deal with disfigurements. 0:15:14.240 --> 0:15:17.120 And one member of the medical community was especially helpful 0:15:17.200 --> 0:15:20.400 in this regard. His name was doctor Harold Gillies, and 0:15:20.520 --> 0:15:23.200 he was actually a nose, ear and throat specialists. He 0:15:23.280 --> 0:15:25.440 was from New Zealand and so he had joined the 0:15:25.480 --> 0:15:27.880 Royal Army Medical Corps at the start of the war, 0:15:28.400 --> 0:15:31.720 and so during his time on the Western Front, Gilly's 0:15:31.800 --> 0:15:34.840 learned as much as he could about reconstructive surgery, and 0:15:34.880 --> 0:15:37.560 this was mostly by observing the dentist and the doctors 0:15:37.640 --> 0:15:40.720 that he was stationed with. So then when he returns 0:15:40.760 --> 0:15:43.160 to England, he was actually given the chance to apply 0:15:43.280 --> 0:15:46.640 what he learned to the newly opened Queens Hospital in London. 0:15:47.080 --> 0:15:49.360 There were more than a thousand beds there and these 0:15:49.360 --> 0:15:53.040 were reserved for patients in need of these facial reconstruction, 0:15:53.080 --> 0:15:55.200 so it was a ton of people. Yeah, I mean, 0:15:55.240 --> 0:15:57.640 it's almost hard to imagine that many people needing surgeries 0:15:57.680 --> 0:16:00.840 like that all at once. It's really it's really staggering 0:16:00.840 --> 0:16:03.840 when you think about it. Yeah, no, it really is. Actually, 0:16:03.840 --> 0:16:06.520 there was such a demand for these services that patients 0:16:06.600 --> 0:16:09.760 often had to queue up outside the hospital. So even 0:16:09.800 --> 0:16:12.640 with a thousand beds there, it just gives you a 0:16:12.640 --> 0:16:15.320 sense of how many people were affected by this. And 0:16:15.720 --> 0:16:18.720 there was this set of blue benches reserved exclusively for 0:16:18.840 --> 0:16:22.960 patients with facial disfigurements, and apparently the bright blue color 0:16:23.120 --> 0:16:25.080 was a way to warn the locals that they might 0:16:25.160 --> 0:16:28.000 want to look away when walking past the benches, and 0:16:28.080 --> 0:16:31.320 so it's just tragic to think about that, and you know, 0:16:31.320 --> 0:16:33.640 it might seem insensitive at first, but it was really 0:16:33.680 --> 0:16:36.320 as much for the patients as it was for the public. 0:16:36.360 --> 0:16:39.240 And you know, if anything, the soldiers probably appreciated the 0:16:39.280 --> 0:16:41.760 break from people staring at them all the time. I guess. 0:16:43.040 --> 0:16:47.640 So what kind of breakthroughs was Gilly's making at that time. Well, 0:16:47.680 --> 0:16:50.240 there's actually probably too many to go through here, but 0:16:50.360 --> 0:16:52.400 one of the biggest was what he called the two 0:16:52.520 --> 0:16:56.520 pedicle or flat procedure, I guess. So basically, Gillies would 0:16:56.520 --> 0:16:59.160 cut a strip of living skin and tissue and then 0:16:59.200 --> 0:17:01.520 he would form it to this tube that was still 0:17:01.560 --> 0:17:04.959 connected to the patient at one end. Then the tube 0:17:05.000 --> 0:17:08.119 could be laid across the patient's wounded face until the 0:17:08.200 --> 0:17:12.199 skin graft actually took root. Which sounds pretty gruesome, but 0:17:12.200 --> 0:17:15.520 I'm guessing there was some sort of upside to this approach. Yeah, definitely, 0:17:15.560 --> 0:17:18.560 I mean a really big one. So before Gillies came along, 0:17:18.640 --> 0:17:22.000 reconstructive surgeries had long struggled on how to ward off 0:17:22.119 --> 0:17:25.280 infection in this open wound while they were waiting for 0:17:25.320 --> 0:17:28.879 this skin graft to take So his variation solved this 0:17:28.920 --> 0:17:32.040 problem because it ensured that blood continued to flow through 0:17:32.080 --> 0:17:35.520 the grafted area. So then once the graft had taken root, 0:17:35.840 --> 0:17:38.480 the surgeon could simply sever the tube and sculpt the 0:17:38.480 --> 0:17:42.440 remaining tissue into the patient's new nose and throat. And 0:17:42.480 --> 0:17:44.520 you know, it doesn't paint this pretty picture but the 0:17:44.560 --> 0:17:47.920 technique was so successful that the work at Queen's Hospital 0:17:47.960 --> 0:17:51.600 continued long after the war had ended. So in total, 0:17:51.680 --> 0:17:55.439 the hospital performed more than eleven thousand operations on over 0:17:55.480 --> 0:17:58.879 five thousand patients before they finally closed their doors in 0:17:59.000 --> 0:18:03.400 nine five. And Gilly's actually received knighthood for his efforts. 0:18:03.680 --> 0:18:06.479 And when World War two began, he kept working on 0:18:06.520 --> 0:18:08.840 this new set of soldiers that were in the same 0:18:08.920 --> 0:18:12.879 kind of need. That's a tremendous legacy. But you know, 0:18:13.119 --> 0:18:15.520 we we mostly dealt with the reconstructive side of plastic 0:18:15.560 --> 0:18:17.320 surgery so far. So what do you say we switched 0:18:17.359 --> 0:18:20.640 gears and focus on the cosmetic side for a little bit. Yeah, 0:18:20.640 --> 0:18:22.760 that definitely makes sense. Actually, I'll start us off with 0:18:22.880 --> 0:18:25.560 something that I was surprised to learn this week. So, 0:18:26.040 --> 0:18:29.439 even with nearly two million cosmetic surgeries performed in the 0:18:29.520 --> 0:18:33.520 US each year, the plastic surgery industry overall has actually 0:18:33.560 --> 0:18:36.639 shrunk by about twelve percent since the year two thousand. 0:18:37.680 --> 0:18:40.159 That's strange. I wouldn't have guessed that. I mean, I 0:18:40.160 --> 0:18:44.160 guess breast augmentations and liposuction just I mean, maybe they're 0:18:44.200 --> 0:18:46.760 not as appealing as they used to be. Is that right, Yeah, 0:18:46.760 --> 0:18:49.320 I mean that those are still the top two cosmetic 0:18:49.359 --> 0:18:52.760 surgeries in the States, with roughly three hundred thousand each 0:18:52.920 --> 0:18:55.800 per year. But on the whole, there are fewer people 0:18:55.920 --> 0:18:58.480 undergoing the knife than there were about, you know, twenty 0:18:58.560 --> 0:19:01.359 years or so ago. But the most interesting part to me, 0:19:01.400 --> 0:19:04.399 at least, was that while cosmetic surgeries are down, the 0:19:04.520 --> 0:19:09.639 number of minimally invasive cosmetic procedures like injection or laser 0:19:09.680 --> 0:19:12.920 hair removal, those numbers are only going up each year. 0:19:13.320 --> 0:19:16.040 So in fact, the American Society of Plastic Surgeons reports 0:19:16.080 --> 0:19:19.040 that the number of these procedures has grown nearly two 0:19:19.160 --> 0:19:22.600 hundred percent since two thousand, so that's the same period 0:19:22.600 --> 0:19:26.080 that you know, these cosmetic surgeries have been declining. Sure, 0:19:26.160 --> 0:19:28.000 and and I'm sure poker talks is one of the 0:19:28.000 --> 0:19:31.159 biggest reasons for all of exactly. You know, I do 0:19:31.240 --> 0:19:33.719 wonder what's behind that downward shift, Like, is it just 0:19:33.840 --> 0:19:36.639 that the minimally invasive stuff requires less downtime than than 0:19:36.720 --> 0:19:38.920 the full on surgeries or what's going on here? Yeah, 0:19:39.000 --> 0:19:40.679 I mean I think that's part of it, you know, 0:19:40.680 --> 0:19:43.520 plus the fact that these procedures are cheaper, they're faster. 0:19:43.760 --> 0:19:46.640 Of course, you know, less invasive, like you mentioned. And 0:19:46.680 --> 0:19:48.399 I think it also doesn't hurt that there isn't as 0:19:48.520 --> 0:19:51.920 much stigma around something like microderm abrasion as there might 0:19:51.920 --> 0:19:54.160 be in getting a tummy tuck or a nose job 0:19:54.240 --> 0:19:56.919 or something like that. So I guess it kind of 0:19:56.920 --> 0:19:59.080 comes back to the idea that plastic surgery might still 0:19:59.080 --> 0:20:02.440 carry a connotation of phoniness like and I guess these 0:20:02.440 --> 0:20:04.360 similar types of procedures are a kind of a way 0:20:04.359 --> 0:20:07.920 of sidestepping that stigma while still altering your appearance. Yeah, 0:20:08.040 --> 0:20:10.240 And you know, actually, just in looking this up, I 0:20:10.240 --> 0:20:13.280 think that desire for a more natural look as something 0:20:13.320 --> 0:20:15.880 that came up a lot. And there's a really good 0:20:15.960 --> 0:20:18.879 article about this and allure this past month, which is 0:20:19.080 --> 0:20:21.080 a sentence I never really thought i'd be saying, but 0:20:21.840 --> 0:20:24.240 I did want to share a quote from it really quickly. 0:20:24.280 --> 0:20:27.119 The author is Caitlyn Clark, and here's what she writes. 0:20:27.760 --> 0:20:32.520 Disproportionate breast enhancement, overfilled lips, and exaggerated cosmetic procedures in 0:20:32.600 --> 0:20:36.320 general are all trends on their way out. Now. A 0:20:36.359 --> 0:20:40.760 successful plastic surgery or cosmetic procedure should no longer be obvious. 0:20:41.160 --> 0:20:44.960 Patients are increasingly wanting to maintain their general facial structure, 0:20:45.119 --> 0:20:49.520 inherited family traits, and just generally wanting to look like themselves, 0:20:49.560 --> 0:20:53.240 but with a few refined tweaks, which definitely tracks with 0:20:53.320 --> 0:20:56.520 these so called tweakments I read about last week. So um, 0:20:56.640 --> 0:20:59.320 there's this new skin tightening treatment that's supposed to take 0:20:59.359 --> 0:21:02.480 off this year. It's a face tight and it actually 0:21:02.600 --> 0:21:05.520 uses this radio frequency energy to tighten and sculpt the 0:21:05.520 --> 0:21:08.960 skin around your neck and joline. It's it's totally non surgical, 0:21:09.040 --> 0:21:11.480 and the effects supposedly last up to five years, which 0:21:11.520 --> 0:21:14.320 is kind of amazing. And even on the surgical side, 0:21:14.320 --> 0:21:17.240