WEBVTT - What Does Plastic Surgery Have to Do With the Civil War? 0:00:02.600 --> 0:00:05.520 Guess what, well, what's that mango? So, have you ever 0:00:05.600 --> 0:00:06.960 heard of poker talks. 0:00:07.880 --> 0:00:11.680 Poker talks, is that like dtox for playing poker? Or what? 0:00:11.840 --> 0:00:13.920 I actually not heard of it. 0:00:13.920 --> 0:00:16.320 It's actually botox for playing poker. 0:00:16.520 --> 0:00:18.000 Oh, I get it. That's smart. Yeah. 0:00:18.520 --> 0:00:20.840 It was invented by this New York City doctor. His 0:00:20.960 --> 0:00:24.239 name is Jack Birdie, and he's also this poker player, 0:00:24.320 --> 0:00:26.720 and he realized the biggest problem for poker players is 0:00:26.760 --> 0:00:30.200 there tells like people who like fire their brows or 0:00:30.400 --> 0:00:33.040 curl their lips as they're trying to bluff, and so 0:00:33.080 --> 0:00:35.640 he basically came up with a few places to administer 0:00:35.720 --> 0:00:38.440 botox so you don't show your hand as much. 0:00:39.560 --> 0:00:41.919 Now, I'm guessing this is just for humans, or can 0:00:42.040 --> 0:00:44.080 you know those dogs that play poker? Can they also 0:00:44.120 --> 0:00:44.839 get this treatment? 0:00:45.960 --> 0:00:48.600 I love the idea of like Sharpei or one of 0:00:48.640 --> 0:00:51.320 those like super wrinkly dogs just getting all smoothed out. 0:00:51.360 --> 0:00:54.880 Think of the bowtops. I feel like it'll take so 0:00:54.880 --> 0:00:57.920 many years off the dog. But hearing about Poker Talks 0:00:57.960 --> 0:01:00.680 treatments really made us wonder, like, what what's the history 0:01:00.720 --> 0:01:03.640 of these cosmetic procedures? How long have people been getting 0:01:03.680 --> 0:01:06.120 those jobs? And why was the Civil War such a 0:01:06.160 --> 0:01:08.800 turning point for plastic surgery? So let's dive in. 0:01:30.040 --> 0:01:32.479 Hey, their podcast listeners, Welcome to Part Time Genius. I'm 0:01:32.480 --> 0:01:34.600 Will Pearson and as always I'm joined by my good 0:01:34.600 --> 0:01:36.800 friend mangesh Hot Ticketer and on the other side of 0:01:36.800 --> 0:01:40.360 the soundproof glass really feeling that burned because he's doing 0:01:40.400 --> 0:01:43.000 his daily set of Facer sizes. I don't know if 0:01:43.040 --> 0:01:45.000 you've noticed this man, he's been doing them all week. 0:01:45.600 --> 0:01:46.039 I didn't. 0:01:46.440 --> 0:01:48.800 Well, that is our friends and producer Tristan McNeil. 0:01:49.000 --> 0:01:49.200 Now. 0:01:49.240 --> 0:01:53.760 Tristan claims these exercises are a viable alternative to plastic surgery, 0:01:54.080 --> 0:01:56.880 something about how like toning your face muscles can make 0:01:56.920 --> 0:01:59.520 you look younger. So good luck to you, Tristan. You're 0:01:59.520 --> 0:02:01.520 already pretty young looking. But you know, we'll see if 0:02:01.520 --> 0:02:04.520 this makes a difference. And honestly, from here, it mostly 0:02:04.560 --> 0:02:07.160 looks like he's just kind of smushing his cheeks and 0:02:07.200 --> 0:02:09.720 making this little turtle face. It's kind of I wish 0:02:09.720 --> 0:02:11.360 everybody could see this. It's a little weird. 0:02:11.880 --> 0:02:14.040 Yeah, So he was trying to explain this to me earlier. 0:02:14.120 --> 0:02:17.000 He's been doing this old nineties exercise routine that's supposed 0:02:17.000 --> 0:02:21.160 to tighten facial muscles. And he said it's called cheek energizing, 0:02:21.280 --> 0:02:24.119 and supposedly it's part of this whole facer size program 0:02:24.400 --> 0:02:28.080 that this doctor named Carol Maggio developed like thirty years ago. 0:02:28.560 --> 0:02:32.480 It all sounds and looks pretty bizarre, and I mostly 0:02:32.520 --> 0:02:35.480 just impressed that Tristan was able to decode the written instructions. 0:02:35.800 --> 0:02:38.320 So I actually look this up, and this is a 0:02:38.320 --> 0:02:42.000 breakdown of the cheek energizer move he's been doing. Quote, 0:02:42.360 --> 0:02:46.239 place an index finger lightly on the top of each cheek. Now, 0:02:46.360 --> 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 --> 0:02:55.800 your teeth. Keep your upper and lower lips firmly pulling 0:02:55.840 --> 0:02:58.399 away from each other, and feel your cheeks move under 0:02:58.440 --> 0:03:02.560 your index fingers. Repeat this, smile and release. I mean, 0:03:02.720 --> 0:03:06.760 none of this makes any sense to mew. 0:03:07.320 --> 0:03:08.359 It feels weird. I don't know. 0:03:08.480 --> 0:03:10.000 Yeah, I'll only smile in the middle of your lip. 0:03:10.040 --> 0:03:11.679 Okay, Oh got bad. Bad. 0:03:12.240 --> 0:03:14.440 What's strange is that if we wanted, we could actually, 0:03:14.480 --> 0:03:17.079 like ask the inventor herself about how to do this. 0:03:17.160 --> 0:03:20.520 At age seventy three, she actually promotes facer size on 0:03:20.760 --> 0:03:22.680 Skype and you can do a Skype session with her 0:03:22.760 --> 0:03:24.800 and she'll walk you through it face to face. 0:03:25.280 --> 0:03:27.560 I am totally gonna do this manga. That just sounds 0:03:27.680 --> 0:03:29.440 weird enough for me to want to do it, and 0:03:29.680 --> 0:03:31.800 it does seem like it'ld be a pretty surreal experience. 0:03:31.840 --> 0:03:35.000 But as proponents of plastic surgery will tell you, most 0:03:35.040 --> 0:03:38.440 improvements from facial exercise just don't hold a candle to 0:03:38.520 --> 0:03:41.160 the results you get from a shot of botox or 0:03:41.200 --> 0:03:43.760 maybe a half hour under the knife. And when you 0:03:43.760 --> 0:03:46.480 think about it, that relative ease and the immediacy of 0:03:46.480 --> 0:03:49.600 the results, it's what makes cosmetic procedures so appealing in 0:03:49.680 --> 0:03:53.800 the first place. For instance, in twenty seventeen alone, fifteen 0:03:53.840 --> 0:03:58.280 point seven million minimally invasive cosmetic procedures were performed in 0:03:58.320 --> 0:04:01.760 the US, So we're talking about things like botox injections, 0:04:01.840 --> 0:04:06.360 chemical peels, laser hair removals. That's almost two hundred percent 0:04:06.440 --> 0:04:09.800 increase since the year two thousand. Now. Obviously a big 0:04:09.840 --> 0:04:13.280 reason for that growth is that cosmetic procedures have become easier, 0:04:13.800 --> 0:04:16.599 less invasive, you know, than they were in the year's past. 0:04:16.720 --> 0:04:19.560 But millions of people are lining up each year to 0:04:19.600 --> 0:04:22.359 have parts of their bodies nipped and tucked and shaped 0:04:22.400 --> 0:04:24.640 and plumped. But you know, whether or not that's a 0:04:24.680 --> 0:04:26.520 good thing is still kind of up in the air 0:04:26.560 --> 0:04:28.920 for many people. And so with that question of mine, 0:04:28.960 --> 0:04:31.120 we foind it be interesting to look into the history 0:04:31.120 --> 0:04:34.760 of plastic surgery, including how and why it got started 0:04:34.839 --> 0:04:37.240 and many of the ways it's changed over the years, 0:04:37.520 --> 0:04:39.359 And then a little bit later in the episode, I 0:04:39.360 --> 0:04:41.640 think we'll check out some of the more recent trends 0:04:41.680 --> 0:04:44.200 in the industry, as well as how a selfie stick 0:04:44.279 --> 0:04:47.159 might make you think twice about getting a nose job. 0:04:48.000 --> 0:04:50.080 That's right, But you know, before we get into any 0:04:50.120 --> 0:04:51.839 of that, I thought we could start by breaking down 0:04:51.880 --> 0:04:54.080 some of the terms we'll be using today, you know, 0:04:54.240 --> 0:04:56.160 just so things don't get confusing a little bit later. 0:04:56.279 --> 0:04:59.279 So in general, we refer to the term plastic surgery 0:04:59.440 --> 0:05:01.400 for a few time diferent things at once. You know, 0:05:01.440 --> 0:05:04.320 they're cosmetic surgeries, which are the ones meant to enhance 0:05:04.360 --> 0:05:08.320 a person's overall appearance and aren't considered medically necessary, so 0:05:08.520 --> 0:05:12.719 things like liposeuction or facelifts, as well as the less 0:05:12.720 --> 0:05:15.719 invasive procedures you mentioned like chemical peels and botox. But 0:05:16.080 --> 0:05:19.120 plastic surgery can also refer to reconstructive surgeries, and those 0:05:19.120 --> 0:05:21.680 are the ones performed to restore the normal function or 0:05:21.680 --> 0:05:23.960 appearance of a person's body, and for the most part, 0:05:24.160 --> 0:05:26.440 these are considered medically necessary. 0:05:26.960 --> 0:05:28.840 Yeah, I mean there are several of these types. When 0:05:28.880 --> 0:05:31.440 you think about surgeries like you know, repairing a cleft 0:05:31.480 --> 0:05:35.600 palate or the you know, unbelievable jobs that these surgeons 0:05:35.600 --> 0:05:38.400 can do when they're reconstructing a burn victim's face or 0:05:38.440 --> 0:05:41.160 their body, it's pretty remarkable how far this has come. 0:05:41.800 --> 0:05:44.120 Yeah, and I did think it was worth mentioning because 0:05:44.200 --> 0:05:46.440 there's still a ton of stigma surrounding the term, Like 0:05:46.720 --> 0:05:49.280 lots of people only associate plastic surgery with the cosmetic 0:05:49.320 --> 0:05:52.160 side of things like tummy talks and calf implants. 0:05:52.800 --> 0:05:54.919 Yeah. Well, my guess is that the stigma has a 0:05:54.920 --> 0:05:57.680 lot to do with the word plastic itself. I mean, 0:05:57.720 --> 0:06:01.200 I think it makes people think about fakeness and artificiality 0:06:01.360 --> 0:06:04.680 and all the other things we associate with plastic as 0:06:04.760 --> 0:06:07.760 a substance, Like we wrap our view of plastic as 0:06:07.800 --> 0:06:11.560 being cheap and disposable onto these surgeries that share this name, 0:06:11.880 --> 0:06:13.960 which of course is pretty unfair when you really think 0:06:13.960 --> 0:06:14.360 about it. 0:06:15.000 --> 0:06:17.560 Yeah, I mean, especially when you consider that the name 0:06:17.600 --> 0:06:20.159 doesn't have anything to do with plastic in the first place. 0:06:20.520 --> 0:06:22.640 Like I read this week that the first time the 0:06:22.640 --> 0:06:26.080 word plastic was actually used to describe a surgical technique 0:06:26.120 --> 0:06:29.960 was in eighteen thirty seven, which is so long before 0:06:30.000 --> 0:06:31.760 plastic the substance was even invented. 0:06:31.920 --> 0:06:33.839 All right, So then what did the term actually mean 0:06:33.880 --> 0:06:35.599 when it was used in eighteen thirty seven. 0:06:36.000 --> 0:06:39.440 It actually came from the Greek word plasticos, which means 0:06:39.480 --> 0:06:42.400 to mold or give form. So a plastic surgery was 0:06:42.440 --> 0:06:46.040 basically a shaping surgery, and that was pretty fitting because 0:06:46.080 --> 0:06:48.680 the earliest forms of plastic surgery were based much more 0:06:48.720 --> 0:06:51.880 in reconstruction than they were in purely cosmetic changes. 0:06:52.480 --> 0:06:54.200 You know, It's interesting. This is another one of those 0:06:54.200 --> 0:06:56.720 things that when we started looking into the history, you 0:06:56.920 --> 0:06:59.720 really don't think about how far back some of these 0:06:59.720 --> 0:07:02.880 things go. And so actually, the earliest known example of 0:07:02.920 --> 0:07:05.520 plastic surgery dates all the way back to the sixth 0:07:05.560 --> 0:07:09.560 century BCE, and it was indeed a form of reconstruction. 0:07:09.640 --> 0:07:12.320 This was a nose job. The technique was invented in 0:07:12.320 --> 0:07:15.640 ancient India by a physician and a surgeon named Soushruta. 0:07:16.160 --> 0:07:18.120 And this was at the time when you know, it 0:07:18.160 --> 0:07:20.800 was common to punish an adulter or a thief with 0:07:20.840 --> 0:07:24.120 some form of body mutilation, usually by cutting off the 0:07:24.160 --> 0:07:27.480 nose or maybe an ear. And so this physician was 0:07:27.520 --> 0:07:29.480 one of many in the region who felt that this 0:07:29.720 --> 0:07:32.760 was a kind of public shaming and was just way 0:07:32.800 --> 0:07:35.680 over the line of course, and you know, basically ensured 0:07:35.720 --> 0:07:38.120 that the criminals would be shunned for the rest of 0:07:38.160 --> 0:07:41.400 their lives. We wanted to do something to help solve 0:07:41.440 --> 0:07:43.800 this problem, and so it began looking for a way 0:07:43.840 --> 0:07:47.200 to help these people reintegrate into society by restoring their 0:07:47.200 --> 0:07:50.960 appearance as much as he possibly could. And so what 0:07:51.000 --> 0:07:53.400 he came up with was this technique where a flap 0:07:53.400 --> 0:07:56.600 of skin was removed from a patient's cheek and then 0:07:56.720 --> 0:08:01.080 molded and shaped into a new nose the nostrils by 0:08:01.080 --> 0:08:03.800 inserting these two hollow reeds, and then you'd leave them 0:08:03.800 --> 0:08:06.600 in place to make sure the nostrils didn't close up 0:08:06.640 --> 0:08:09.760 as the new nose healed. I mean, it's unbelievable that 0:08:09.840 --> 0:08:11.960 somebody could pull this off that long ago. 0:08:12.400 --> 0:08:14.960 Yeah, and it almost sounds like fantastical that anything like 0:08:15.000 --> 0:08:16.320 that could even work. 0:08:16.960 --> 0:08:18.840 Yeah, it seems to have been the consensus at the 0:08:18.880 --> 0:08:22.160 time too. But you know, once word of this method spread, 0:08:22.680 --> 0:08:26.040 other Indian surgeons began trying it for themselves, and some 0:08:26.120 --> 0:08:28.360 even put their own spin on the procedure by building 0:08:28.440 --> 0:08:31.280 the replacement nose from a flap of the patient's forehead 0:08:31.320 --> 0:08:34.280 skin rather than you know, maybe their cheek. And this 0:08:34.440 --> 0:08:37.920 early form of rhinoplasty proved so successful that it was 0:08:37.960 --> 0:08:41.440 eventually adapted throughout Europe, where it became known as the 0:08:41.520 --> 0:08:42.320 Indian method. 0:08:43.440 --> 0:08:45.680 So I had actually heard about this Indian method just 0:08:45.679 --> 0:08:48.560 because it's one of those things I feel is compulsory 0:08:48.640 --> 0:08:51.520 if you're Indian, like for an Indian pride, Like you know, 0:08:51.640 --> 0:08:53.720 India also came up with the concept of zero as 0:08:53.760 --> 0:08:57.120 a number and invented shampoo. Like these are just things 0:08:57.160 --> 0:09:00.640 we know, and you are welcome. But so apparently we 0:09:00.640 --> 0:09:02.840 weren't the only invaders there. There was also something called 0:09:02.880 --> 0:09:05.760 the Italian method, and this was emitted by a surgeon 0:09:05.840 --> 0:09:09.360 named Antonio Branca. This was in early fourteen hundreds, and 0:09:09.400 --> 0:09:11.600 the big difference was that Bronca used a flap of 0:09:11.640 --> 0:09:14.920 skin from the upper arm to build his patient's new noses, 0:09:15.040 --> 0:09:17.160 and this was considered an improvement for the most part 0:09:17.200 --> 0:09:19.720 because it left a lot less scarring than the Indian 0:09:19.760 --> 0:09:22.520 method did. The only downside was that, and this is 0:09:23.040 --> 0:09:25.080 a little strange to think about, in order for the 0:09:25.080 --> 0:09:27.840 skin to fully attach itself, patients actually had to hold 0:09:27.880 --> 0:09:31.360 their arms against their nose for like twenty straight days. 0:09:32.280 --> 0:09:34.640 Obviously seems super uncomfortable. 0:09:34.840 --> 0:09:37.680 It does sound miserable, but I guess in these cases, 0:09:37.720 --> 0:09:40.760 you know, considering the results or the payoff, I guess 0:09:40.760 --> 0:09:43.319 it was considered worth it. But yeah, let's get back 0:09:43.320 --> 0:09:46.520 to Shushruta for a minute. Because after his breakthrough, this 0:09:46.600 --> 0:09:50.400 plastic surgery continued to develop throughout Europe. So, for example, 0:09:50.480 --> 0:09:52.680 ancient Rome got in on the act sometime during the 0:09:52.720 --> 0:09:57.360 early first century, so surgeons of the era pioneered bleferoplasty, 0:09:57.480 --> 0:10:00.000 which is the adjustment of the eyelids in order to 0:10:00.120 --> 0:10:03.920 correct drooping or squinting eyes. And around the same time, 0:10:04.000 --> 0:10:08.199 the Greek physician Galen performed the very first purely cosmetic 0:10:08.280 --> 0:10:10.559 plastic surgery, so it was kind of like a nose 0:10:10.640 --> 0:10:11.720 job for the wealthy. 0:10:13.080 --> 0:10:15.560 It's kind of cool that those jobs were like first 0:10:15.679 --> 0:10:20.000 both for reconstructive and cosmetic purposes. It's kind of stunning, 0:10:20.080 --> 0:10:23.440 but you know, not everyone was happy about those breakthroughs 0:10:23.440 --> 0:10:26.720 and body modification. As Christianity began to take hold in 0:10:26.760 --> 0:10:29.319 Europe during the Middle Ages, plenty of religious leaders viewed 0:10:29.360 --> 0:10:33.960 plastic surgery as sinful or almost borderline blasphemous, and this 0:10:34.040 --> 0:10:36.400 belief gained more traction in the twelfth century when the 0:10:36.440 --> 0:10:39.000 Pope I think it's Pope Innocent the third at the time, 0:10:39.160 --> 0:10:42.560 he formally spoke out against it, and pretty soon after 0:10:42.640 --> 0:10:45.320 it became a crime to surgically alter the human body. 0:10:46.280 --> 0:10:48.839 So you see this kind of thing happen throughout history, 0:10:48.840 --> 0:10:51.959 but in this case, like what changed that perception? What 0:10:52.280 --> 0:10:55.360 made the church eventually back down from this. 0:10:55.360 --> 0:10:57.440 This is going to sound strange, but a lot of 0:10:57.480 --> 0:10:59.760 the shift was due to syphilis. 0:11:00.080 --> 0:11:01.880 Really, you know that there were a lot of things 0:11:01.920 --> 0:11:03.760 I was guessing about. Is not what I expected you 0:11:03.800 --> 0:11:04.520 to say, though. 0:11:05.040 --> 0:11:08.120 I know. So there was a really bad outbreak of 0:11:08.160 --> 0:11:11.080 this disease in Europe during the late sixteenth century, and 0:11:11.280 --> 0:11:14.360 one of the symptoms of advanced syphilis happens to be 0:11:14.920 --> 0:11:17.880 soft tissue decay, which is usually centered in the nose. 0:11:17.920 --> 0:11:20.400 I had no idea about this. But now there were 0:11:20.400 --> 0:11:24.200 all these like upper crust lords and ladies with these big, 0:11:24.320 --> 0:11:28.559 gaping holes in their faces, and suddenly this like quote 0:11:28.600 --> 0:11:31.760 sin of like crafting a false nose, it started to 0:11:31.840 --> 0:11:34.280 seem a whole lot better, you know than the alternative 0:11:34.280 --> 0:11:36.079 of having, you know, a hole in your face. 0:11:36.360 --> 0:11:38.560 Yeah, I mean that makes sense. And yeah, of course, 0:11:38.559 --> 0:11:41.920 plastic surgeries development didn't end in Europe, and the techniques 0:11:41.920 --> 0:11:44.720 eventually made their way here to the United States, with 0:11:44.840 --> 0:11:48.960 one of the earliest practitioners being doctor John Metdouer. You know, 0:11:49.000 --> 0:11:51.880 he and his sons ran this successful practice in Virginia 0:11:52.040 --> 0:11:56.120 and they were specializing and repairing genital birth effects and 0:11:56.160 --> 0:11:59.679 then later on in reconstructive surgery, and his legacy is 0:11:59.720 --> 0:12:03.599 actually really impressive. So Metour is credited with performing the 0:12:03.679 --> 0:12:06.760 first hard cleft palette repair on the Americas in eighteen 0:12:06.840 --> 0:12:10.439 twenty seven, and notably, he completed the procedure by transplanting 0:12:10.480 --> 0:12:13.480 pieces of bone rather than just skin or muscle as 0:12:13.520 --> 0:12:16.400 previous surgeons had done. And so this new technique was 0:12:16.440 --> 0:12:19.920 this huge leap forward for reconstructive surgery, and it's actually 0:12:19.920 --> 0:12:23.120 the main reason why doctor Metour is often called America's 0:12:23.120 --> 0:12:24.360 first plastic surgeon. 0:12:24.840 --> 0:12:27.440 Yeah, so it really seems like the nineteenth century is 0:12:27.480 --> 0:12:30.440 when modern plastic surgery really started to take off. And 0:12:30.640 --> 0:12:32.720 I was reading about how much of a game changer 0:12:32.840 --> 0:12:36.320 the Civil War was for battlefield medicine. I mean, you 0:12:36.320 --> 0:12:40.000 think about things like amputation techniques or more reliable forms 0:12:40.000 --> 0:12:43.840 of anesthesia, but facial reconstruction was another area that saw 0:12:43.920 --> 0:12:48.400 these major advances during America's bloodiest war, and records actually 0:12:48.400 --> 0:12:51.920 show that Union surgeons performed more than thirty successful plastic 0:12:51.960 --> 0:12:55.679 surgeries on these odd disfigured soldiers during the war, and 0:12:55.800 --> 0:12:58.640 they also pioneered new techniques that would later become standards 0:12:58.679 --> 0:13:01.320 in the field, like taking photo to track the progress 0:13:01.320 --> 0:13:04.560 of repairs and also using smaller sutures for incisions to 0:13:04.559 --> 0:13:07.200 help minimize the scarring. Yeah. 0:13:07.240 --> 0:13:10.240 You know, it's interesting how these advancements happened during war, 0:13:10.320 --> 0:13:12.679 because it actually wasn't just the Civil War where these 0:13:12.760 --> 0:13:16.280 kinds of breakthroughs happen, like both world wars actually also 0:13:16.440 --> 0:13:18.880 brought major innovations the plastic surgery as well. 0:13:19.720 --> 0:13:21.560 Yeah, I mean, that's definitely a good point, and we 0:13:21.600 --> 0:13:24.000 should spotlight a few of those advances before we talk 0:13:24.000 --> 0:13:26.720 about the state of plastic surgery today. But before we 0:13:26.760 --> 0:13:43.960 go any further, why don't we take a quick break. 0:13:44.760 --> 0:13:46.640 You're listening to Part Time Genius and we're talking about 0:13:46.679 --> 0:13:50.440 the long, surprising history of plastic surgery. Okay, well, so 0:13:50.520 --> 0:13:52.720 we're up to the twentieth century now in our timeline, 0:13:52.760 --> 0:13:55.080 and we were just about to get into World War One. 0:13:55.480 --> 0:13:57.320 Yeah, that's right. You know, as we were saying, earlier 0:13:57.520 --> 0:14:01.160 wars have certainly led to these turning points and you know, 0:14:01.240 --> 0:14:05.400 reconstruction of various kinds and facial reconstruction specifically. And there 0:14:05.400 --> 0:14:07.439 were a couple of reasons for this. I mean, if 0:14:07.440 --> 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 --> 0:14:15.280 that were being used in combat and really for the 0:14:15.320 --> 0:14:19.160 first time during World War One. And the result of this, obvious, 0:14:19.240 --> 0:14:21.920 you know, tragic result of this is that more soldiers 0:14:21.960 --> 0:14:25.280 suffered facial wounds due to bullets and shrapnel than in 0:14:25.400 --> 0:14:28.040 any of the wars before them. And you know, it's 0:14:28.080 --> 0:14:31.680 obviously awful, but the wounds were often more extensive than 0:14:31.760 --> 0:14:34.760 surgeons were used to treating. So the good news here 0:14:34.800 --> 0:14:37.440 is though, that anesthesia and the treatment of infections had 0:14:37.480 --> 0:14:41.360 definitely improved drastically by this time, so you had serious 0:14:41.400 --> 0:14:43.960 injuries that would have been fatal in the past that 0:14:44.440 --> 0:14:47.440 were now considered survivable, and that included a lot of 0:14:47.520 --> 0:14:50.120 major facial disfigurements as a result of this. 0:14:51.120 --> 0:14:53.800 Yeah, we mentioned earlier that there were some like thirty 0:14:53.840 --> 0:14:57.040 odd plastic surgeries during the Civil War, and that actually 0:14:57.080 --> 0:14:59.200 doesn't sound like that many at first, but when you 0:14:59.240 --> 0:15:01.520 consider how many soldier died just because there was no 0:15:01.560 --> 0:15:04.120 way to stave off infection, it starts to make sense 0:15:04.160 --> 0:15:05.440 why the number was so low. 0:15:06.040 --> 0:15:08.560 Yeah, And so with World War One, surgeons suddenly found 0:15:08.560 --> 0:15:11.360 themselves with a lot of chances to develop and refine 0:15:11.440 --> 0:15:14.960 new ways to deal with disfigurements. And one member of 0:15:15.000 --> 0:15:18.400 the medical community was especially helpful in this regard. His 0:15:18.520 --> 0:15:21.760 name was doctor Harold Gillies, and he was actually a nose, 0:15:21.840 --> 0:15:24.720 ear and throat specialists. He was from New Zealand and 0:15:24.760 --> 0:15:27.080 so he had joined the Royal Army Medical Corps at 0:15:27.120 --> 0:15:29.680 the start of the war, and so during his time 0:15:29.760 --> 0:15:32.680 on the Western Front, Gillies learned as much as he 0:15:32.760 --> 0:15:36.160 could about reconstructive surgery, and this was mostly by observing 0:15:36.240 --> 0:15:38.800 the dentists and the doctors that he was stationed with. 0:15:39.520 --> 0:15:41.880 So then when he returns to England, he was actually 0:15:41.880 --> 0:15:44.280 given the chance to apply what he'd learned to the 0:15:44.320 --> 0:15:47.760 newly opened Queen's Hospital in London. There were more than 0:15:47.840 --> 0:15:51.120 a thousand beds there and these were reserved for patients 0:15:51.160 --> 0:15:53.480 in need of these facial reconstructions, so it was a 0:15:53.520 --> 0:15:54.160 ton of people. 0:15:54.800 --> 0:15:56.600 Yeah, I mean it's almost hard to imagine that many 0:15:56.640 --> 0:15:59.480 people needing surgeries like that all at once. It's really 0:16:00.000 --> 0:16:01.680 it's really staggering when you think about it. 0:16:02.080 --> 0:16:04.480 Yeah, no, it really is. Actually, there was such a 0:16:04.520 --> 0:16:07.600 demand for these services that patients often had to queue 0:16:07.680 --> 0:16:11.560 up outside the hospital. So even with a thousand beds there, 0:16:11.960 --> 0:16:14.000 it just gives you a sense of how many people 0:16:14.040 --> 0:16:16.480 were affected by this. And there was this set of 0:16:16.520 --> 0:16:21.400 blue benches reserved exclusively for patients with facial disfigurements, and 0:16:21.440 --> 0:16:24.000 apparently the bright blue color was a way to warn 0:16:24.000 --> 0:16:26.320 the locals that they might want to look away when 0:16:26.400 --> 0:16:29.760 walking past the benches, and so it's just tragic to 0:16:29.840 --> 0:16:32.479 think about that, and you know, it might seem insensitive 0:16:32.520 --> 0:16:34.360 at first, but it was really as much for the 0:16:34.440 --> 0:16:37.000 patients as it was for the public, and you know, 0:16:37.040 --> 0:16:40.040 if anything, the soldiers probably appreciated the break from people 0:16:40.160 --> 0:16:41.760 staring at them all the time, I guess. 0:16:43.080 --> 0:16:46.320 So what kind of breakthroughs was Gilly's making at that time. 0:16:47.520 --> 0:16:50.120 Well, there's actually probably too many to go through here, 0:16:50.160 --> 0:16:52.120 but one of the biggest was what he called the 0:16:52.200 --> 0:16:56.280 tube pedicle or flat procedure, I guess. So basically, Gillies 0:16:56.280 --> 0:16:59.040 would cut a strip of living skin and tissue and 0:16:59.040 --> 0:17:01.200 then he would form it to this tube that was 0:17:01.240 --> 0:17:04.600 still connected to the patient at one end. Then the 0:17:04.640 --> 0:17:08.000 tube could be laid across the patient's wounded face until 0:17:08.040 --> 0:17:10.680 the skin graft actually took root. 0:17:10.600 --> 0:17:13.280 Which sounds pretty gruesome, but I'm guessing there was some 0:17:13.320 --> 0:17:14.679 sort of upside to this approach. 0:17:14.960 --> 0:17:17.600 Yeah, definitely, I mean a really big one. So before 0:17:17.640 --> 0:17:21.320 Gillies came along, reconstructive surgeries had long struggled on how 0:17:21.359 --> 0:17:24.639 to ward off infection in this open wound while they 0:17:24.640 --> 0:17:27.679 were waiting for this skin graph to take So his 0:17:27.800 --> 0:17:31.080 variation solved this problem because it ensured that blood continued 0:17:31.119 --> 0:17:34.320 to flow through the grafted area, so then once the 0:17:34.400 --> 0:17:37.399 graft had taken root, the surgeon could simply sever the 0:17:37.440 --> 0:17:40.600 tube and sculpt the remaining tissue into the patient's new 0:17:40.720 --> 0:17:43.639 nose and throat, and you know, it doesn't paint this 0:17:43.680 --> 0:17:46.800 pretty picture, but the technique was so successful that the 0:17:46.800 --> 0:17:50.399 work at Queen's Hospital continued long after the war had ended. 0:17:50.800 --> 0:17:54.200 So in total, the hospital performed more than eleven thousand 0:17:54.280 --> 0:17:58.320 operations on over five thousand patients before they finally closed 0:17:58.320 --> 0:18:01.920 their doors in nineteen twenty five. And Gillies actually received 0:18:02.040 --> 0:18:05.040 knighthood for his efforts. And when World War two began, 0:18:05.480 --> 0:18:07.960 he kept working on this new set of soldiers that 0:18:08.040 --> 0:18:09.520 were in the same kind of need. 0:18:10.640 --> 0:18:14.000 That's a tremendous legacy. But you know, we've mostly dealt 0:18:14.000 --> 0:18:16.320 with the reconstructive side of plastic surgery so far. So 0:18:16.520 --> 0:18:18.280 what do you say we switched gears and focus on 0:18:18.280 --> 0:18:19.639 the cosmetic side for a little bit. 0:18:20.400 --> 0:18:22.680 Yeah, that definitely makes sense. Actually, I'll start us off 0:18:22.720 --> 0:18:25.520 with something that I was surprised to learn this week. So, 0:18:26.080 --> 0:18:29.440 even with nearly two million cosmetic surgeries performed in the 0:18:29.560 --> 0:18:33.480 US each year, the plastic surgery industry overall has actually 0:18:33.600 --> 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 --> 0:18:44.200 guess breast augmentations and liposection. Just I mean, maybe they're 0:18:44.200 --> 0:18:45.960 not as appealing as they used to be, is that right? 0:18:46.520 --> 0:18:48.760 Yeah, I mean that those are still the top two 0:18:48.840 --> 0:18:52.360 cosmetic surgeries in the States, with roughly three hundred thousand 0:18:52.480 --> 0:18:55.480 each per year, But on the whole, there are fewer 0:18:55.520 --> 0:18:58.119 people undergoing the ninth than there were about, you know, 0:18:58.160 --> 0:19:01.160 twenty years or so ago. But the most interesting part 0:19:01.200 --> 0:19:04.160 to me, at least, was that while cosmetic surgeries are down, 0:19:04.359 --> 0:19:09.200 the number of minimally invasive cosmetic procedures like injection or 0:19:09.280 --> 0:19:12.920 laser hair removal, those numbers are only going up each year. 0:19:13.320 --> 0:19:16.080 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 0:19:19.200 --> 0:19:22.560 hundred percent since two thousand, So that's the same period 0:19:22.600 --> 0:19:25.200 that you know, these cosmetic surgeries have been declining. 0:19:25.800 --> 0:19:28.040 Sure, and I'm sure poker tox is one of the 0:19:28.040 --> 0:19:30.720 biggest reasons for all of exactly. Yeah, you know, I 0:19:31.080 --> 0:19:33.520 do wonder what's behind that downward shift, Like, is it 0:19:33.720 --> 0:19:36.639 just that the minimally invasive stuff requires less downtime than 0:19:36.680 --> 0:19:38.560 the flow on surgeries or what's going on here? 0:19:38.760 --> 0:19:40.679 Yeah, I mean I think that's part of it, you know, 0:19:40.720 --> 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 --> 0:19:48.439 I think it also doesn't hurt that there isn't as 0:19:48.520 --> 0:19:52.040 much stigma around something like microdermabrasion as there might be 0:19:52.080 --> 0:19:54.320 in getting a tummy tuck or a nose job or 0:19:54.359 --> 0:19:55.040 something like that. 0:19:55.840 --> 0:19:57.520 So I guess it kind of comes back to the 0:19:57.560 --> 0:20:00.960 idea that plastic surgery might still carry a connotation of phoniness, 0:20:01.040 --> 0:20:03.760 like and I guess these similar types of procedures are 0:20:03.960 --> 0:20:06.160 kind of a way of sidestepping that stigma while still 0:20:06.160 --> 0:20:07.160 altering your appearance. 0:20:07.720 --> 0:20:10.160