Plastic Surgery and The Islamic Golden Era

Dr. Azzaam Najjaar, Plastic & Reconstructive Surgeon at Melomed Tokai Hospital
MBChB(UCT) FC Plast Surg(SA)

Plastic surgery is often associated with the glitz and glamour of the A-listers. There is more to the specialty than this. It is seen to have two main subdivisions: cosmetic and reconstructive surgery.
Many people inaccurately equate plastic surgery solely with cosmetic surgery and, although surgery for appearance forms a significant part of the speciality, even more so is the treatment and reconstruction of injuries, including burns, hand injuries, a variety of cancers and congenital deformities. As plastic surgeons, we aim to improve both function and form.
The English word “Plastic” comes from the Greek word “Plastikos” which means “to mould”. When used in the context of plastic surgery, the term has nothing to do with the use of the synthetic material that we encounter on a daily basis. The term “Plastic Surgery” was first used in 1818 by the German von Graefe in his book Rhinoplastik. This name was used again by Zeis in 1863 who published an index of literature relevant to plastic surgery from as far back 900 years BC.

In India around 600BC, criminals would be punished by way of nasal amputations. An Indian surgeon by the name of Susruta, would reconstruct the nose of these maimed faces using tissue from the forehead. This debut “nasal reconstruction” was the birthplace of reconstructive surgery. It was during the First and Second World Wars that the current modern day speciality of plastic surgery was recognised as an independent speciality and it is here that it started to flourish.

What is often forgotten and not made mention of, is the contribution of Muslims to the field of plastic surgery. It gives me great pride to mention this as I feel an intimate link to this legacy by way of my Arab bloodline. The Arabs made great progress in the House of Wisdom of Baghdad between the 8th and 12th century A.D. This was the Golden Era of Muslim academics. It was here that the core of almost all surgical specialties was developed.

I pay particular homage to the father of modern day surgery and pharmacy – Abū al-Qāsim Khalaf ibn al-‘Abbās al-Zahrāwī al-Ansari, latinised as Albucasis. Al-Zahrāwī was born in the city of Azahara in Andalusia. His heritage was from the Al-Ansar of Madinah. The surgery chapter of his famous 30 volume medical text was translated into Latin and was the standard textbook in Europe for the next five hundred years. By 1250, England had its first, now oldest, medical manuscript and according to the British Medical Journal, it has a "startling similarity" with Al Zahrawi’s encyclopaedia. The famous 14th-century French surgeon Guy de Chauliac quoted him over 200 times in his book, which was published in cities such as Venice, Basel and Oxford up until the 18th Century.

Al-Zahrāwī pioneered the use of catgut, a suture material that is still used by Plastic Surgeons today. He designed an array of surgical instruments that are still used today (see pictures). He was also known for his interest in the subject of cosmetics. He considered cosmetics a branch of medicine, which he called "Medicine of Beauty” and dedicated a chapter for it in his medical encyclopaedia.

A common procedure performed by Plastic Surgeons nowadays is removal of excess breast tissue in men (gynecomastia). Although it has evolved over the centuries, it has its basis in Al-Zahrawi’s teachings. In fact, he described one of the most common complications of the procedure and the appropriate treatment for it.

Even though the roots of this speciality run as far back as the Islamic Golden Era, Plastic Surgery continues to be a rapidly progressing, ever-evolving surgical speciality.

Modern breakthroughs in plastic surgery include the development of skin substitutes in treating burns; the development of microsurgery has resulted in more complex reconstructive procedures and the replantation of amputated parts; LASER treatments hold promising results for previously detrimental skin conditions. And so, I hold my breath as I look to the future and what the possibilities are in this, undoubtedly, most creative field of surgery.