Father of Surgery: Was Sushruta the First Plastic Surgeon in 600 B.C.?

The restoration, reconstruction, and alteration of the human body is not something that has popped up in the recent years. Cosmetic or aesthetic surgery, reconstructive surgery and the treatment of burns has its roots more than 4000-year-old in India, back to the Indus River Civilization . It is believed that plastic surgery originated in the Vedic period (5000 years B.C) and Sushruta Samhita, which is a part of Atharvaveda (one of the four Vedas) is believed to be the first surgical text.

‘Sushruta Samhita’ which translates to Sushruta’s compendium describes the ancient tradition of surgery in Indian medicine. This treatise contains detailed descriptions of teachings and practice of the great ancient surgeon Sushruta, mentioned ispub.com Website.

Considered  to be the most advanced compilation of surgical practices of its time, ‘Sushruta Samhita’ not only contains the teaching regarding plastic surgery but also the composite teachings of the surgery and all the allied branches including ‘midwifery’. Giving priority to the knowledge of both surgery and medicine, he compares a doctor not proficient in both of them to a bird with only one wing.

Sushruta said, “Anyone, who wishes to acquire a thorough knowledge of anatomy, must prepare a dead body and carefully observe and examine all its parts.” Accordingly, a body is to be submerged in water and allowed to decompose. Every stage of decomposition is meant to be studied carefully and examined, layer by layer. It is to be noted that during those times, dissection was performed without using instruments.

Sushruta Samhita. Image source: www.ancient-origins.net
Representational Image. Image source: http://www.ancient-origins.net

‘Sushruta Samhita’ was first published in Europe by Hessler in Latin and by Muller in German, in the early 19th century. The first complete English translation was done by Kaviraj Kunja Lal Bhishagratna in three volumes in 1907 at Calcutta.

The Internet Scientific Publications Website mentioned that in the book ‘Sushruta Samhita’, the insight, accuracy, and detail of the surgical descriptions are most impressive. All the 184 chapters and the 1,120 conditions listed in them, include various medical explanations and treatment procedures ranging from injuries and illnesses relating to ageing and mental illness. The compendium of Sushruta includes many chapters on the training and practice of surgeons. The Sushruta Samhita also describes over 120 surgical instruments.

The ancient surgical science was known as Salya-tantra (surgical science) embraces all processes aiming at the removal of factors responsible for producing pain or misery to the body or mind. Salya (salya-surgical instrument) denotes broken parts of an arrow /other sharp weapons while tantra denotes maneuver. Sushruta has described surgery under eight heads Chedya (excision), Lekhya (scarification), Vedhya (puncturing), Esya (exploration), Ahrya (extraction), Vsraya (evacuation) and Sivya (Suturing).

Shushruta Statue, Haridwar Image Source: Wikipedia Commons
Shushruta Statue, Haridwar Image Source: Wikipedia Commons

One of the highlights of Sushruta’s surgery is the operation of Rhinoplasty or the making of a new nose. This grabbed the attention of the medical world and brought him fame as the originator of plastic surgery. The Indian Rhinoplasty today, is just a modification of the ancient Rhinoplasty described by Sushruta in 600 B.C. Even today pedicled forehead flap is referred to as the Indian flap.

Talking about Sushruta, the eminent surgeon Allen Oldfather Whipple (1881-1963), 20th century’s major innovator in pancreatic surgery said,  “All in all, Susruta must be considered the greatest surgeon of the pre-medieval period.”

The marvels and brilliance of Sushruta is recognised by many people across the globe. His texts are reefed even today by many great minds. He is regarded as the ‘Father of Indian Surgery’ and the ‘Father of Indian Plastic Surgery’ because of his numerous seminal contributions to the science and art of surgery in India.



Hugh Hefner’s Wife Was Not Poisoned By Her Breast Implants

ASPS surgeon takes aim at claim by wife of Playboy magazine founder that her breast implants caused her to be ‘poisoned’. Jack Fisher, MD, a key figure in debunking erroneous claims that breast implants cause systemic disease, uses science to refute Crystal Hefner’s declaration that her silicone implants directly led to symptoms of disease and other complications.

Crystal Hefner, wife of Playboy entrepreneur Hugh Hefner, recently elected to have her breast implants removed because she believed that they “were slowly poisoning her.” This was after she read Internet comments from people who shared similar symptoms and said implants were the problem, and after she believed she had chronic Lyme disease.

Science is not on her side. Not even close.

It’s okay that she did it. Breast implantation is a reversible process. If the devices are no longer providing benefit, if they become a source of worry or fear, or for any reason, they can be removed, ideally by an experienced surgeon working in an approved facility. An image of Ms. Heffner recovering suggests that she did just that.

But the important question for other women who may now be concerned is this: What is the source of information that drove her to this level of concern? If she has based her decision on the unsubstantiated belief that silicone polymers are toxic to humans, then her worry and fear is unwarranted.

False assumptions about silicone in medical devices, especially breast implants causing myriad diseases (more than 200 attributed) were commonplace in the early 1990s. Fortunately, we now have the results of dozens of well-run studies, which show no causal link between silicone exposure and any of the problems that Mrs. Hefner lists: aches and pain, fatigue, allergies, thyroid dysfunction.

We are told that Mrs. Hefner sought medical advisory, and was diagnosed with Lyme Disease. Apparently this was insufficient for her or her husband, who is on board with the decision based the shabbiest of evidence— 3000 listings on Facebook by people with similar problems. This sounds ridiculous enough, but it does not mean that other women won’t follow suit.

A bigger question is: What should several million women, who have breast implants, but no problems do? And, what about hundreds of thousands who have symptoms similar to Ms. Heffner, but do not have implants?

The breast implant issue was studied thoroughly by a panel of scientists selected by the Institute of Medicine of the National Academy of Sciences. Their report in 1999 was do not waffle. It declared that all claims about carcinogenic, mutagenic, teratogenic, or immunologic effects of breast implants were invalid.

No- breast implants do not cause cancer, genetic disorders, birth defects, or autoimmune and rheumatic diseases. The events leading up to the IOM report are documented in Silicone on Trial: Breast Implants, Regulation, and the Politics of Risk.

Breast Reduction Surgery May Also Fix Your Neck & Back Pain

Breast Reduction patients are so grateful. Often patients come in for their first post-operative check-up and they say they can already tell that their back and neck pain has been relieved. It is also common for older patients ask, “Why didn’t I do this years ago!”


Pain Relief

Breast reduction surgery removes excess breast tissue and skin, and works to relieve back and neck pain related to large breasts.

The amount of breast tissue removed varies by the size of the patient and their bust. The final cup size is a happy medium – not too small and not too large, and retains the patient’s femininity.


Breast Reduction Procedure

This operation can be done as an outpatient procedure or with an over night stay at the hospital. The recovery is not too bad, usually a 7-10 days of rest off work and driving. Gentle exercise can start soon after surgery but higher level gym classes or running may be 6 weeks post surgery. The exact type of scar depends on the type of reduction, and patients consider the scar a fair tradeoff for the breast reduction gained plus the relief from their back and neck pain.


Covered by Insurance?

Breast reduction is covered by insurance plans if you have symptoms, such as neck or back pain, shoulder strap grooves and underwire irritation. There is a process of pre-approval and your Plastic Surgeon will need to submit documentation.


Breast Reduction for Teenagers

Teenagers are a special category of patients who ask for breast reduction. It is safe and effective but usually we require patients to be fully mature so recommend waiting until aged 18 years of age. Often teenagers are involved sports and are greatly hindered by the large size of their breasts. Due to the extra physical exertion and stress on their bodies they can have neck and back pain at a much younger age. Teenagers who proceed with breast reduction surgery will experience profoundly positive physical and psychological changes in their lives.


Taking Action

If you are experiencing back and neck pain, and think a breast reduction might be an option, I recommend consulting an experienced and certified Plastic Surgeon (FRACS – Plastic & Reconstructive Surgery).

Rejuvenating Your Eyelids – What You Need to Know About Blepharoplasty Surgery

Over the years, eyelids can start to sag. Not only can they make a person look older, but they may feel very heavy or start to obstruct your vision. If you are experiencing droopy lids, you may wonder if blepharoplasty, rejuvenating eyelid surgery, is right for you.

Several changes occur in our eyelids as we age. By your late 30s or early 40s, the thin skin of our eyelids starts to lose its elasticity and begins to stretch, resulting in excess folds of skin that may hang down over the edge of the upper eyelids. You may feel a heaviness in the upper lid or feel the skin sitting on your lashes. In some cases this skin may start to obscure your peripheral vision.

As we get older, the muscles beneath our skin also grow weaker, allowing fat to protrude through and cause bags, particularly in the lower eyelids. Fine wrinkle lines and creases appear in the delicate skin around the lids. The result is a tired, sleepy or sad look. These changes detract from the natural youthful beauty of the eye area.

Aging around the eyes is to a degree determined by heredity. Chances are, if a parent had saggy eyelids, you will, too. Eyelid surgery is the third most commonly performed cosmetic surgical procedure, and the number of people who undergo blepharoplasty surgery continues to grow each year. The procedure corrects drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin and muscle. It goes a long way in restoring a youthful appearance with minimal cost, risk and recovery time. Many people who undergo blepharoplasty surgery are so satisfied that they later return to have a face lift and/or neck lift performed.

These conditions are often treatable through blepharoplasty:
• Puffiness in the upper eyelids caused by excess fatty deposits
• Loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, sometimes impairing vision
• Excess skin and fine wrinkles of the lower eyelid
• Bags under the eyes
• Droopiness of the lower eyelids

A physical examination must be conducted to determine what is causing the droopy lid. If it is a downward displacement of the brow, then elevation of the brow can be performed by a brow lift, with or without surgery of the upper lid. You can not assume that all eyelid droop can be corrected by blepharoplasty.

Good candidates for the procedure are adult men and women who have healthy facial tissue and muscles, do not smoke, and have a positive outlook with realistic goals for improvement of the upper and/or lower eyelids.

Blepharoplasty should be performed in an accredited office based surgical facility or a hospital. It is a relatively low-cost procedure and recovery time is short. Under normal conditions, you should be able to return to daily activities within seven to 10 days. Initially, you may experience post eyelid surgery swelling, bruising, irritation or dry eyes and discomfort, which are controlled with medication, cold compresses and ointment.

To ensure you have both proper care and a positive experience, select your plastic surgeon carefully. Choose an experienced Plastic Surgeon who is certified (FRACS – Plastic & Reconstructive Surgery) and operates in an accredited facility.

Popular Plastic Surgery Procedures by Age

Plastic surgery is one of the most common procedures performed and the transformative power compels thousands of men and women to go under the knife every year. Unlike most surgeries, cosmetic procedures are not medically necessary which can make it hard to analyze the demographics. While each individual’s needs and wants differ when it comes to choosing a procedure, the most popular cosmetic surgeries can be broken down by age group. While trends in plastic surgery vary from year to year, the statistics show that some procedures are consistently popular with certain age groups.

Nose reshaping is widespread among 16-20 year-old patients, simply because the nose you were born with is the nose you will have for life. While other parts of the body can change given time or lifestyle habits, the shape and structure of your nose changes the least. The skin does thicken and the cartilage can lose its support, but for the most part, the defining features remain constant throughout life. Adolescents who are approaching adulthood oftentimes turn to rhinoplasty to get a new start or a fresh look as they embark on milestones such as high school graduation or the start of college.

On the other hand, breast augmentation is a popular procedure for those who are aged 20-29 years old. Breasts are typically fully formed by that age, and the size and shape are at a fixed point. Shifts in weight, pregnancy and lifestyle (sport and bra usage) may alter breast size and shape but in an unpredictable way. This is a time when image is very important to women, so they seek larger breasts in order to boost their self-confidence and balance the proportions of their new adult figures.

Once men and women reach their 30’s they notice a change in the way their bodies deposit fat even if their exercise pattern and diet have remained the same. Certain body parts store stubborn fat that is hard to lose even with healthy eating and exercise. Liposuction has traditionally been the remedy to this problem. We have seen an increase in the popularity of newer technologies that provide less invasive options for fat reduction. However, liposuction remains time honored and consistent in providing the most predictable results. A variety of techniques are available to safely remove fat and sculpt curves.

The 40’s are a time when the aging process really begins to set in. We typically start to see the earlier signs of aging around the eyes and forehead. The skin around the eye is prone to wrinkle and show redundancy. The upper eyelids and forehead can begin to droop and give a tired or sad appearance. It is no surprise then that patients between the ages of 40-54 are likely to undergo a blepharoplasty and/or brow lifting surgery in order to minimize these changes. The lower eyelids are treated by removing or tightening skin as well as treating fat pockets.

Finally, face and/or neck lift is an extremely popular procedure for those 55 and older. At this point, there are multiple parts of the face and neck that need rejuvenating. The cheeks typically fall or deflate, the corners of the mouth turn down, jowls appear, the jawline loses its contour and the neck becomes loose and droopy at times, showing bands under the chin. A facelift helps restore a youthful appearance by addressing these parts that have aged. Combinations of procedures can lift the brow, the mid face or cheek area and tighten the jaw line while treating jowls and reshaping the neck.

Of course everyone ages differently and each person’s goals are different, but these tend to be the most popular procedures by age group.

Be Sure to Choose an Accredited Plastic Surgery Centre

You have just scheduled your cosmetic surgery procedure. You were careful researching your Plastic Surgeon and procedure, making sure everything was just right.

  • Did you look into the hospital or facility where the procedure will be performed?
  • Are you sure you chose to have your surgery performed in an accredited surgical facility?

This is a detail that many people overlook, assuming the operating room will be fine. However, choosing an accredited facility is vital for a safe experience.


Why would a Plastic Surgeon consider using a non-accredited facility?

The answer is painfully obvious – the cost. An easy way for a surgeon or hospital to cut their overhead is to use the cheapest operating room possible. No respectable Plastic Surgeon would take this shortcut, so if you find out there is not an accredited surgical suite included in your surgical fee, it is time to find a new plastic surgeon. The added expense will be worth it.

The facilities that I use include my private practice procedure room, St George’s and Southern Cross Hospitals – all are accredited to New Zealand standards and are part of a continuing assessment program overseen by external auditors. This ensures that all aspects of my surgical practice are up to date with contemporary requirements, and overall this provides my patients with the best possible outcome to their plastic surgery.


Reasons Accreditation Matters:

  1. An accredited facility will monitor and report incidents of infections, complications, and other issues related to patient safety to the health ministry.
  2. Protocols for emergencies, such as emergency patient health issues or facility fires, are in place and are constantly being reviewed.
  3. Surgeon’s certifications are checked routinely, making sure no unlicensed professionals are working.
  4. Quality management ensures the best patient care standards are met.
  5. Patient care and treatment plans are reviewed and updated.
  6. Patients’ rights and responsibilities are clearly displayed.
  7. Drug and medication expiration dates have not lapsed.
  8. Surgeons serve as peer review monitors for each other, ensuring continuity and quality of care.
  9. Anesthesia standards are clearly set, and always administered by a licensed anesthesiologist.
  10. Accredited ambulatory facilities are shown to have exceptionally low rates of serious complications and low mortality rates.


Unfortunately, many cosmetic surgical tourism facilities are neither hospitals or accredited. This compromises surgical care, for example:

  • cosmetic surgery not being performed by a certified Plastic Surgeon or even the surgeon you consulted with.
  • facility nurses are not registered or trained in operating theatre practice – this compromises sterility and increases infection risk, which can cause your procedure to fail or at worst be life threatening in a foreign country with no emergency back up.
  • aftercare facilities that are not registered and may simply be a hotel room with care provided by an untrained and unregistered “nurse” – unable to provide appropriate pain relief or recognise post-operative complications such as bleeding, leg clots or infection.
  • use of expired anaesthetic or pain drugs, and even breast implants. Commonly breast implants are counterfeit copies or even different to those paid for. The complication profile of these implants are high in respect to devices bursting, infection and capsular contracture.

Overall, when seeking out a cosmetic surgical procedure it is important to have profiled your Plastic Surgeon but equally important to profile the facility where the surgery is to be performed. You will truly get what you paid for.

My Hands Make Me Look 15 Years Older!

“The Fountain of Youth” – Dr Chris Porter’s inside view of cosmetic surgery where he aims to help you to make the best possible informed choice and achieve your cosmetic surgery goals.

The top of our hands are subjected to the same aging and sun damage as the skin on our faces. As we get older our hands may develop thin skin, wrinkles, patchy brown spots and lose the cushioning fat that softens the skin. Loss of this fatty layer makes the veins and tendons more obvious giving a skeletonised appearance.

Thankfully there are some relatively simple procedures that can make your hands appear more youthful.

Patchy pigmentation, fine wrinkles and thin skin can be treated by peels, either chemical or laser or IPL. Maintenance of this improvement requires regular use of sunscreen and vitamin A cream.

To conceal obvious veins and tendons the best procedure is structural fat grafting, this will re-fill the thin fatty layer and provide a softer appearance to the skin. It has been proven also that fat grafting can improve the skins color and texture. Structural fat grafting is performed by moving fat from another part of the body, such as the tummy or buttocks, and then transplanting them to the back of the hands. The fat is inserted by a series of small injections. Fat is a better option than synthetic fillers as fat will survive permanently whereas synthetic fillers will last  maximum of 12 months.

If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: chris@breast-body.co.nz