Blood and guts: a history of surgery. Part 4, Fixing faces.

The third in a 5-part series in which Michael Mosley traces the evolution of surgery as it progressed, in his words, from butchery to brilliance. This part features plastic surgery. Mosley travels back in time to India 500-600 years ago where plastic surgery was first used to repair an unfaithful woman's nose. In 16th century Bologna, Gaspare Tagliacozzi developed a technique in which skin from the arm could be transplanted onto noses destroyed by syphilis; Mosley undergoes an imaginary nasal reconstruction from this period. Until the 19th century all plastic surgery was reconstructive, but in the mid-19th century cosmetic surgery appeared. One of the earliest techniques was to inject liquid paraffin into the area to be changed, then moulded while still warm, then finally allowed to dry, however the wax did not stay in place but moved around and often led to open sores in the face - a condition that became known as paraffinoma or wax cancer. Mosley tries out the modern equivalent - botox. During the 1st world war 2000 000 men came home with serious injuries, many of which involved the face; the work of both Harold Gillies and Archibald McIndoe is covered in detail. Gillies went on to become a very famous Harley Street cosmetic surgeon who performed the first sexual reassignment surgery. We see, in comparison, present day surgery to replace a woman's jaw bone and the possibility ofwhole facial transplants is discussed.