The History of Plastic Surgery: Interview with Prof. Dr. Suleyman Tas

The History of Plastic Surgery — An Interview for Gülümse Hayata with Açelya Akkoyun

1. When did cosmetic surgery become popular?

Answering this question really means looking at a long evolutionary process, not unlike the journey from the discovery of fire to the invention of the electric car.

When we look at history, this field actually has a fascinating story of its own:

Back in the 800s BCE, in ancient Indian society, people convicted of theft or adultery had their noses cut off, which marked them out publicly within the community.

The Indian surgeon Sushruta reconstructed noses for these people using a flap of skin taken from the forehead. This is considered the earliest known chapter in the history of plastic surgery, which is why Sushruta is regarded as the father of plastic surgery. The book he wrote has survived to this day, and the technique he developed is still used today as the forehead flap.

It then took a long time for this practice to reach Europe. In the 16th century, Gaspare Tagliacozzi described a similar technique using skin from the arm to repair noses damaged in battle.

The first rhinoplasty performed purely for cosmetic reasons was carried out by Orlando Roe in 1887.

It naturally took time for society to accept and embrace this field. At first, these procedures were mainly chosen by television personalities and wealthy people as a status symbol; by the 2000s, reality shows had made them far more widespread and popular.

In the 2010s, social media raised people's self-awareness about their appearance, and cosmetic surgery began to be seen as almost a necessity.

2. Does cosmetic surgery have limits?

Of course it does. Even though these limits are pushed further every day as science advances, we still have quite a few of them.

Everything has its limits, and to give a few examples relevant to our field: cosmetic surgery reshapes living tissue. Because of that, there's no way to guarantee a result the way you could with a mechanical product designed in a factory — many personal factors affect the final outcome. A patient's age, healing capacity, tissue firmness and elasticity, collagen content, and how well the tissue can be reshaped are just some of the variables that influence the result of surgery.

3. Is there an ideal age for cosmetic surgery?

Yes, there is, and it varies from one procedure to another. For rhinoplasty, the 18-to-45 age range tends to be the most suitable, while surgery performed at an older age can be riskier and more disappointing. That's because tissue healing capacity gradually declines with age, which can lead to unwanted shape irregularities during surgery. Before age 18, surgery isn't recommended, since it can negatively affect the body's ongoing development, and the shape given to the nose may not match the face's final, adult proportions.

4. Where is the line between cosmetic surgery and an obsession with looking beautiful? How do you recognize when a patient who comes to you has crossed into that obsession?

Everyone has the right to look and feel good about themselves, and looking better can bring a lot of positive energy along with it — more happiness, more confidence, more success. But as with anything, careful assessment matters a great deal here. That's why, for a procedure that will take two to three hours, we observe a patient who wants surgery for two to three months beforehand, meeting with them two or three times to explain the procedure thoroughly, make sure they understand what will be done, and talk openly about whether they're likely to be happy with the outcome.

Patients with an obsessive mindset tend to reveal themselves during this process. When we recognize this, we tell the patient they're likely to remain unhappy even after surgery and advise against going ahead with it.

For example, take a patient who wants rhinoplasty for a very large, humped, crooked nose with a drooping tip and breathing problems. They've lived with this nose for 35 years, and naturally, the nostrils on such a nose aren't identical — one is larger than the other, and their curves differ geometrically. If, after surgery, the nose now has a size that suits the face, the hump is gone, breathing has improved, and the tip no longer droops — but the patient says they'll still be unhappy simply because the two nostrils don't look geometrically identical from below, despite every genuine improvement — that patient shouldn't go through with the surgery.

5. When a patient comes to you and says, for instance, “lengthen my chin,” how do you proceed? Their wishes matter, of course, but where's the line, and how do you measure it?

When a patient comes to us with a request like this, we first take photographs and analyze the face. We look at facial proportions, examine how the forehead, nose, and chin relate to one another, and assess the bite. Based on this evaluation, we can determine what chin projection would be consistent with medically normal facial proportions. A simulation lets us predict what the outcome might look like. This process guides both the patient and the surgeon, helping the patient understand what change is realistically possible, how it might affect their appearance, and whether they're likely to be happy with it.

6. Cosmetic surgery is also changing how we think about beauty. Looking back, what did beauty mean 30 years ago, and how is it perceived now?

You're absolutely right. This is a very subjective subject, and it varies from society to society.

What we call “trend” simply means whatever look is popular, admired, and desired at a given time. But this shouldn't be confused with the actual concept of beauty, which stays essentially the same over time — it comes down to natural anatomical light and shadow that appeals to the eye. This holds true in both art and medicine.

Thirty years ago, a hump-free nose with a tip that looked pinched, almost as if squeezed with a clothespin, was the trend. It was later abandoned, even though it was described as an “aesthetic” look at the time, because it distorted the natural anatomy and caused serious functional problems.

Right now, for example, the Brazilian Butt Lift, or BBL, is trending — a slim waist paired with a prominent, rounded backside.

Trends like this never really end, and they never will. But in cosmetic surgery, true beauty means making a change while preserving what's natural.

7. Why do we keep seeing women on the street who look almost mass-produced, as if they came off a factory line? How did things get to this point?

As I just mentioned, procedures that become trendy for various reasons but don't respect natural anatomy are what produce this cookie-cutter, mass-produced look.

In a surgical field so strongly shaped by supply and demand, unfortunately, this is one of the results we sometimes see.

Preventing this requires raising public awareness and encouraging changes that respect natural anatomy. What's often called “pure beauty” — genuine, natural beauty — has always been the essential goal in our field. As long as we hold onto that principle, these mass-produced outcomes become far less common. I can say with confidence that this has always been a guiding principle of my own surgical philosophy and of my clinic. Our clinic's motto, registered with the Turkish Patent Institute as part of our logo, is “The Address of Natural Beauty.”

8. What are the most popular cosmetic procedures right now?

Rhinoplasty comes first. Sitting right at the center of the face and playing such an important role in personal interaction, the nose — whether for functional reasons or cosmetic ones — has always held, and continues to hold, the top spot throughout the entire history of cosmetic surgery.

Given our geographic region, humped noses with drooping tips are quite common. This shape tends to get in the way of natural facial expressions, especially when people smile, which is one reason people seek to correct it. Socially, a humped, down-turned nose can also bring to mind a rather witch-like appearance in our cultural imagination, which is another reason people choose surgery. But it's actually more complex than that: when we look closely at this nose shape, the way light concentrates toward the tip of a humped, drooping nose shifts the other person's focus, in face-to-face interaction, from the eyes toward the nose. People sense this and it affects them negatively — it raises the question, subconsciously, of why someone is looking at their nose instead of their eyes. That subconscious thought eventually leads to another question: given that this can now be changed, why not change it? And that chain of thought is often what brings a person to seek out a surgeon.

This same logic actually applies to other cosmetic procedures as well. Enlarging the breasts increases the light they catch and reflect; the same effect comes from enlarging the buttocks or the lips.

Wrinkle treatment is a separate matter. Since wrinkles, which weren't there in youth, are associated with aging, people who don't want to age or look older turn to these treatments too — again as a way to reflect more light and, in turn, draw more positive energy from those around them.

9. Are there any areas you think people will start getting treated in the future that they don't today?

Honestly, almost every area of the body already has some form of cosmetic procedure available for it. There's hardly a region left untouched. In my view, the future isn't about some new area to treat. Since gene mapping made phenotype prediction possible, we're moving toward being able to determine a child's facial features while still in the womb, or even before conception. What may be waiting for us is a world where, instead of correcting a humped, drooping nose later in life, a child's facial shape is determined through simulation before birth, making these procedures unnecessary altogether.

10. Does social media fuel an obsession with beauty and the urge to get cosmetic surgery? What's your view?

Social media has created a space where people interact with each other constantly, often spending more time there — and being influenced by it more — than by their closest friends or family during the day. Because existing on social media largely means existing through photos and videos, and because making a strong visual impression matters so much for engagement, it inevitably triggers people to judge their own appearance more critically.

11. How do you handle someone who wants to look exactly like a celebrity they saw on social media — or do you even try to talk them out of it?

This isn't unique to social media — even before it existed, patients came in wanting to look like a celebrity they'd seen on television, and it doesn't have to be a celebrity at all; wanting to look like someone else entirely isn't a good basis for cosmetic surgery, and this has always been understood in plastic surgery. Patients like this aren't accepted for surgery. Every face is unique, so for these procedures you need to describe specific concerns to your surgeon; your doctor reviews those concerns and builds a plan around them. But wanting to look like someone else isn't realistic, and it often points to underlying psychological issues that need to be addressed first — so medically, it isn't considered appropriate.

12. Taking selfies seems to have increased the need to look impeccable — what do you think?

Absolutely right. To give you an example from my own life, before phone cameras made what we now call selfies possible, I only ever went to a photographer for school registration or a passport application. The quality and resolution of those old-fashioned ID photos, even at their sharpest and clearest, don't come close to the clarity and depth captured today by an ordinary phone's front camera. On top of that, people now share these photos on their social media accounts, essentially putting themselves up for others to judge. As a result, things that would never have been an issue before have now turned into shape irregularities that people feel are essential to fix.

You could call this self-awareness, though in a way it isn't quite that either — mirrors existed back then just as they do now, but no one talks about an irregularity they notice in the mirror; they talk about one they see in photos. So really, the desire to look good in photos has become the number one reason people seek cosmetic surgery today.

13. Doesn't the constant pursuit of looking young wear people out, in your opinion?

Any pursuit takes effort and energy. But it shouldn't be approached as a competition — if looking young genuinely helps someone stay active and useful to society the way a younger person would, and makes them happier and more energetic, then looking young is actually paying off. Otherwise, you're right: there's so much involved in looking younger than your age — from exercise to diet to various treatments — that if the only goal is hearing a friend say “wow, you look so young,” it will wear you out.

14. Cosmetic surgery is also used a great deal for actual healing — burn patients, for example. Isn't it really about reconstruction and repair too? (Facial deformities, cleft lip, jaw and tissue trauma, absence of a breast, and so on…)

Absolutely right. The full name of our specialty is Plastic, Reconstructive, and Aesthetic Surgery. The word “plastic” comes from the Latin “plasticus,” meaning to give shape. “Reconstructive” means to rebuild. “Aesthetic” means to improve the appearance of an existing shape. So the name of our specialty really covers both correcting the shape of something that already exists and creating something that doesn't exist yet.

That's why, in one way or another, shape-related conditions across every branch of medicine eventually fall within the scope of plastic surgery.