The Story Of Plastic Surgery (five): The world's first written record of a plastic surgery operation dates back to India 3,000 years ago when the cost of being caught committing adultery was to have your nose cut off.

Those bearing this mark of shame were eager to repair the damage, leading to a surgeon called Sutra (you may know his sexually active cousin Kama) developed a method to replace the absent organ of smell.

The Story Of Plastic Surgery gleefully reported that his description related the process of skin grafting in excruciating detail. That was only the start of a very gory documentary featuring grisly wounds and even more gruesome operations, as when surgeons in Renaissance Italy patched up nasty facial wounds inflicted in sword duels.

"Losing a nose became common," was an observation that made you glad you didn't live in those times. Replacing the human snout was done taking skin from the upper arm, grafting it on to the face, and shaping it into a nose.

The First World War brought horrific new types of head and facial injuries, caused by shrapnel. At first, surgeons just sewed up the gaping holes, leaving the injured to hide their disfigurement under masks. Then surgeon Harold Gillies, heading a special unit to help disfigured war victims, did much to develop techniques to rebuild faces, aided by advances in anaesthetics.

He discovered - and, if you're eating, you skip the next bit - that filling in shrapnel holes with healthy skin from other parts of the body helped repair the damage, and a skin graft was more successful if you rolled the skin inwards. As Gillies made a film record of his work, we were able to view the work of "the father of plastic surgery" in glorious detail.

There was less need for these skills in peacetime, so surgeons began performing cosmetic surgery. Big ears and large noses, they claimed, were deformities and psychologically traumatising. They saw themselves as psychiatrists with a scalpel.

Howard Crum toured the country giving public performances of plastic surgery. You can hear him now: "Tonight, Matthew, I'm going to turn Susan into Dolly Parton". After he performed a facelift on a character actress before an audience in a hotel ballroom, one observer notes surgery seemed as simple as peeling a banana (though not as nutritious).

Crum believed he could reform a female convict's personality by remoulding her face. Others, such as gangster John Dillinger, used face-changing surgery to evade the law. In 1930s Germany, Dr Jack Joseph operated on Jews to disguise their origins, and his methods of performing nose jobs are still used today.

Since the Second World War, reconstruction plastic surgery has been eclipsed by cosmetic operations, mostly on women with facelifts, boob jobs and silicone implants. The most recently invented plastic surgery procedure, liposuction, is already the most popular as it gives instant weight loss without scarring.

These days the so-called perfect body is available to everyone (who can afford it) at the slice of the surgeon's knife. Instead, wouldn't it be more sensible and less risky to alter the mindset of a society that promotes the idea that everyone has to be thin, beautiful and wrinkle-free. Variety, after all, is supposed to be the spice of life.

Published: 26/08/2003