Discover the remarkable history of cosmetic surgery and how it is inevitably linked with society’s views on health, beauty and ageing in our beauty director’s deep-dive.
Would you ever have cosmetic surgery?
It’s a question that has fascinated, scandalised, and divided people for generations – long before ageing Hollywood starlets, reality TV stars (yes, definitely the Kardashians) and Instagram filter-inspired looks made discussing plastic surgery and less invasive treatments such as injectables and laser (known as ‘tweakments’) more common in casual conversations.
In fact, while our current fixation with injectables may feel distinctly modern, the desire to alter and perfect the human form is anything but new. The history of cosmetic surgery actually stretches back thousands of years.
From the ingenious nasal reconstructions of ancient India to Hollywood starlets quietly perfecting their profiles, Citizen Femme’s beauty director Becki Murray explores how cosmetic surgery evolved from a medical necessity towards modern innovations, and why, even today, we can’t stop being enthralled by the art of transformation (and scandal) it can provide.
Read on to discover the fascinating history and cultural impact of cosmetic surgery…
Ancient Beginnings: Beauty and Status
Even in a time way before anaesthetic and where risks were a lot higher, reconstructive surgery was still being trialled in ancient times, laying the foundations for modern cosmetic surgery, even if it wasn’t yet being used for elective beautification. The Edwin Smith Papyrus, an ancient Egyptian medical text for treating trauma injuries, includes fixes for nasal injuries using splints and plugs, making it one of the first real records of a ‘nose job’.
Cosmetic nose procedures were also documented in ancient India all the way back in 600 BCE. As detailed in the Sushruta Samhita, an ancient Sanskrit medical text still studied today, physicians there were performing nasal reconstructions as a response to punitive amputations (aka the removal of noses as a punishment for certain crimes). These early rhinoplasties used skin from the cheek or forehead, a technique that continues to form the basis of modern reconstructive surgery. Similarly, the first known cleft lip repair is believed to have been carried out by 4th-century Chinese doctors and the closest thing to an eye lift (with excess skin being removed from the area) is documented by the ancient Roman encyclopedist Aulus Cornelius Celsus.
The ancient Greeks, meanwhile, saw beauty as symmetry, proportion and balance – concepts still in use during surgical consultations today. It is actually from the ancient Greeks that we get the term ‘plastic surgery’ (although it only gained popularity as a phrase in the 1800s). While in modern times, the phrase may conjure up images of fakery and plastic Barbie dolls, it is actually derived from the Greek work ‘plastikos’ which means to mould or give form. While surgical alteration was rare in Ancient Greece, medical thinkers such as Hippocrates and Galen did lay the foundations for anatomy-based medicine, reinforcing the idea that the human body could be understood – and altered – through science.
The Renaissance: Aesthetics Becomes a Science
Cosmetic surgery as a recognisable discipline began to take shape in Europe during the Renaissance period, and it was closely tied to broader cultural shifts. Advances in anatomical studies, driven by university-based dissection and the exchange of knowledge between artists and physicians, encouraged surgeons to view the face as a structure which could be governed by artistic ideals, such as harmony and balance. This subtly informed surgical thinking, elevating the perception of surgery from an individual craft to a teachable academic discipline. In 16th-century Italy, surgeon Gaspare Tagliacozzi published De Curtorum Chirurgia per Insitionem, which is widely regarded as the first comprehensive surgical text devoted to reconstructive surgery, building on the expertise of earlier practitioners.
Equally, just as modern beauty standards can influence our self esteem and drive demand for particular cosmetic enhancements, facial disfigurement carried significant social consequences during this time period. Injuries from duelling and diseases such as syphilis often resulted in the loss of the nose, which became a visible marker of dishonour or social marginalisation. It’s clear that the link between society pressures and interest in cosmetic surgery was already beginning, but it’s important to note that surgeons such as Tagliacozzi still framed their work as restorative rather than decorative, aiming to repair damage, rather than to enhance appearance purely for aesthetic reasons.
The War Years and Modern Reconstruction
In the late 1800s, skin grafting techniques were rapidly improving, partly thanks to the adaption of methods long practiced in India, and in 1895 the first documented restorative breast augmentation – although still far from a traditional ‘boob job’ – occurred by transplanting tissue from the back to the breast. However, it would be the trauma of war (as well as the development of modern germ theory and the invention of anaesthesia) that would really propel the aesthetics field forward. During the First World War, unprecedented facial injuries forced surgeons to innovate rapidly. The British surgeon Harold Gillies, who is particularly renowned for working with soldiers disfigured by shrapnel, developed groundbreaking reconstructive techniques that transformed both function and appearance. Gillies’ work, later documented in Plastic Surgery of the Face and highlighted in Lindsey Fitzharris’ brilliant book The FaceMaker, acknowledged something radical for its time: appearance matters not only physically, but psychologically, especially for men ‘lucky’ enough to survive, but certainly not returning unscathed.
World War Two continued this trend, with new plastic surgery techniques developed to treat airmen and other victims of severe burns and facial trauma. After the war, these methods migrated into civilian medicine, supported by the founding of the British Association of Plastic, Reconstructive and Aesthetic Surgeons in 1946. The reconstructive expertise honed on the battlefield laid the foundation for cosmetic surgery that people wanted, not just needed, a concept which gradually entered private practice in the decades that followed.
Hollywood Boom and the Hunt for Perfection
By the mid‑20th century, Hollywood had become both a driver for and a denier of cosmetic surgery – and probably also started the trend for everyday women saying ‘I want to look like that starlet’, which is still a common comment in aesthetic clinics today. During the Golden Age of the film industry, contracts gave studios extensive control over actors’ life and careers, including their appearance, and stars were often expected to mould themselves to a carefully crafted ideal of on-screen beauty. Executives and publicity departments oversaw not just names and wardrobes, but also dental work, makeup, hairstyling, prosthetics, and, in some cases, discreet surgical enhancements to refine features such as noses, ears, and jawlines to fit prevailing ideals.
As Elizabeth Haiken suggests in her book Venus Envy, cosmetic surgery in this period was an ‘open secret’, and many stars pursued surgical tweaks, such as nose jobs or facelifts, to correct perceived imperfections or to maintain their careers, especially as they aged. However, these changes were typically denied or kept out of the public eye. The pressure to conform to Hollywood standards of beauty helped cement a powerful paradox that still resonates today: societally acceptable beauty could be engineered if needed, but only if no one knew it had been altered. In this way, cosmetic surgery both reflected and reinforced the studio‑shaped ideal of glamour while remaining socially taboo to acknowledge publicly.
The Late 20th Century: New Possibilities
Innovation and changing perceptions collided in the later half of the 20th century. A newly created substance called silicone allowed for the first silicone breast implants in 1962, fundamentally expanding the possibilities of body contouring, while the cultural shifts of the 1980s and 1990s transformed cosmetic surgery from a guarded secret into a symbol of aspiration. As women gained greater financial independence, elective procedures became more accessible. Liposuction, breast augmentation and face-lifts surged in popularity, and by the start of the 2000s, the number of cosmetic surgery procedures performed in the US was almost double that of reconstructive procedures, according to the American Society of Plastic Surgeons.
Media and entertainment played a significant role in normalising these practices too: celebrity culture, tabloids, and television talk shows frequently featured stories about cosmetic procedures, both glamorising them and critiquing them when they went wrong (especially in the case of ageing Hollywood stars or those that chose to change their signature look, such as Jennifer Grey’s career dive after her nose job post-Dirty Dancing). Cosmetic surgery had entered the mainstream conversation with both its celebrators and its critics, but it remained a serious commitment to the everyday woman, requiring time, money, long recovery times and risks. Then came the needle…
The 21st Century: The Needle and Beyond
The early 2000s marked a quiet but seismic shift in aesthetic medicine. In 2002, the muscle relaxing Botulinum toxin A – known most commonly as Botox – received approval for cosmetic use, opening the door for minimally invasive treatments that softened lines and wrinkles without surgery. Dermal fillers soon followed, offering volume, contouring, and the ability to subtly reshape facial features with temporary, yet significant results. At the same time, energy-based devices such as laser resurfacing and IPL began to gain traction. Initially developed in the 1980s and 1990s to treat wrinkles, scarring, and pigmentation, by the early 2000s, refinements in precision, power and cooling systems reduced side effects, making treatments safer, faster, and more comfortable.
For the first time, cosmetic enhancement was not only less risky, but also more discreet, appealing to people who wanted improvements without a dramatic transformation, via treatments that could fit seamlessly into a busy lifestyle. In the UK, these minimally-invasive treatments, which sit between pampering facials and cosmetic surgery, gained a new name, popularised by the journalist Alice Hart-Davis: ‘tweakments’.
The 2010s: Social Media Booms
In the 2010s, the growth of social media platforms such as Instagram and later TikTok changed how we viewed our faces, causing massive demand, especially among younger individuals, for preventative, face ‘perfecting’ treatments that helped people ‘fit the beauty mould’, not just ‘turn back the clock’ on ageing. Social media algorithms arguably rewarded highly edited, idealised images that celebrated youthful, often exaggerated beauty standards such as plump lips, high cheekbones, sculpted jaws and smooth skin, and reality television stars and influencer culture also played a major role, normalising this very particular type of beauty enhancement. As a result, cosmetic clinics opened in their hundreds up and down the country, and there was a surge in what critics now call the “overdone” look: with overfilled lips, cheeks and lack of movement in the forehead causing striking rather than subtle changes.
2020s: A Softer, Cautious Touch
Then, the pendulum swung back again. By the 2020s (and post Covid-19 lockdown where we weren’t able to access tweakments so easily), societal viewpoints had started to shift. Growing awareness of body-image issues sparked major conversations about what ‘selfie culture’ was doing to our brains (and our faces) and the safety of certain treatments were more publicly discussed. One of the most widely reported examples involved the supermodel Linda Evangelista, who revealed that a fat‑freezing procedure she underwent in 2015 had left her, what she called, “brutally disfigured”. Equally, there’s been important steps more recently to address a significant gap in UK legislation which allows individuals without any real training to deliver treatments such as laser and dermal fillers, leading to many individuals (especially those operating on a smaller budget) to be left with potentially life-altering side effects. It has never been more important to stress that your first consideration when it comes to any cosmetic procedure is to keep yourself as safe as possible!
Luckily, as the decade continues to unfold, many patients and practitioners are increasingly advocating for more natural, individualised approaches, as well as increased transparency, and broader dialogues about wellness, and the limits of cosmetic enhancement; a cultural counterpoint to the more extreme trends of the previous era.
The Future Face
So, once whispered about behind closed doors and really only commented on publicly when something was seen to go wrong, cosmetic intervention has undergone a remarkable cultural shift over the years. Today, tweakments are not only more widely available but there’s more choice out there too, helping you get the best results should you want them. That includes an ever-increasing number of treatments promising results for key concerns such as wrinkles, dark spots and sagging without the traditionally long recovery periods of invasive procedures.
And, as aesthetic medicine continues to evolve, the future of the industry looks increasingly personalised to us as individuals. Regenerative treatments, biostimulators and AI-led facial mapping promise results that work with the body rather than against it and, most importantly, the emphasis is continuing to shift from erasing age to supporting longevity. The aim: to achieve that ‘yourself but better look’, rather than becoming just another look-alike clone.
Equally, there’s a desire to avoid pressuring individuals into these treatments unnecessarily (in the same way as the naturally grey hair movement has taken off in the last decade). Ultimately, wherever you land on the ‘would you, wouldn’t you’ debate, there’s a reframing of cosmetic surgery as a personal choice without judgement. The innovation is there if you want to dip into it, but what you do with your own face is very much up to you.
Becki Murray is Citizen Femme’s Beauty and Wellness Director. As one of the only UK journalists to hold a Distinction-grade diploma in cosmetic science, she combines her unique knowledge with an editor’s eye to help you make smarter choices about beauty, wellbeing, and aesthetics. Becki also heads up CF’s spa guide so you could say she’s an expert in the science of relaxation too…
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