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In her article, Ellen Feldman (2004) dates the history of cosmetic surgery back 2,500 years; however, the procedure was not popular until after World War I. Surgeons first began to develop cosmetic surgery techniques in response to birth disfigurement and war caused deformities. The war injuries greatly accelerated the advancement and experimentation of plastic surgery, and the rise of plastic surgeons. According to Feldman, some surgeons limited their practices to deformities caused by birth defects and automobile and industrial accidents, but others began applying the skill and techniques they had perfected on wounded veterans to dissatisfied civilians, chiefly women (p. 61).

 A decade later the American Society of Plastic Surgeons (ASPS) merged with it and a few years after that the American Board of Plastic Surgery joined the association. (p. 62) The most popular procedure of the time was rhinoplasty (rhino meaning nose). According to Josleen Wilson (1991), Early rhinoplasties often removed too much cartilage, resulting in the characteristics scooped-out or "ski-jump" nose. Some noses were made too short and some had a pinched look (p. 85).

In the 1940's WWII brought plastic surgeons again to treat the wounded soldiers and sailors, by 1949 the ASPS had more than 150 surgeons. In response to all the new surgeons, in 1948 the Educational Foundation of ASPS, now known as the Plastic Surgery Educational Foundation (PSEF) was formed in order to support research pertaining to congenital and acquired deformities, promote high standards of training, practice and research in plastic surgery; confer scholarships and prizes; and promote lectures, seminars and medical and public meetings to educate the public in plastic surgery matters. According to the ASPS website:

The Foundation also took American plastic surgery to the rest of the world by establishing exchange and fellowship programs with physicians in other nations. The PSEF has been especially active since its inception in sending American surgeons to Third World nations to help train physicians in plastic surgery techniques and treat citizens of those countries who would not otherwise have access to advanced surgical techniques. The Foundation also sponsors educational symposia to allow surgeons to demonstrate their innovations to colleagues. (p .1)

By the 1950s, plastic surgery was fully integrated into the medical community. After the war there was more prosperity in America, and with television, there was a standard of beauty the media brought in. Fifties Actresses and Models were curvy, and the bust and hips were a bit larger than present day actresses. Marilyn Monroe, who to this day is considered one of the most beautiful women of all time, had plastic surgery on her chin and nose.

From the 1960's to the 1980's plastic surgery was mostly sought by the rich and famous. Much of the research was not available between the 1950's to the 1980's because it was not as acceptable to have the procedure done as it is today. In that time frame women often waited until their 60s or 70s to get a face lift, and most of the time it was confidential and not talked about.

In the 1990's the use of silicone implants for breast augmentations made lawsuits media events, and alleged that Dow Corning and other silicone implant manufacturers knew that their products caused cancer. The Food & Drug Administration halted the use of silicone implants except in limited cases, and today saline is the implant of choice (Workman). In their website the ASPS wrote:

A four billion dollar plus global litigation settlement was unveiled in September 1993. The settlement was created by the manufacturers of silicone breast implants to address a class action suit brought by women plaintiffs who alleged the implants caused them illness. The Federal Court gave approval to the settlement in September 1994. By the fall of 1995, however, the settlement, as originally proposed, had collapsed due to underfunding following the bankruptcy filing of Dow Corning Corp. (p. 1)

Even after the silicone scare, many women continue to get breast implants, today it is the number two cosmetic surgical procedure next to liposuction.

Unlike the past fifty years, now cosmetic procedures are widely celebrated. Younger people are now electing to have some kind of procedure done. The rich and famous now boast about the procedures that they have gone through, and reality television shows us that it is an empowering procedure for regular people. There are now many procedures that can be done, that are fast and convenient to the consumer. There is an increase in demand thanks to reality TV and the variety of price options for the procedures. Most cosmetic procedures are not covered by insurance, so many people charge it on their credit cards or there is also "convenient financing" right at the doctor's office.

Cosmetic procedures in most cases are not covered by medical insurance. Still many people are willing to pay out of pocket for the procedures. Now the procedures are more affordable and available, and the non-surgical procedures are a more affordable alternative than a surgical procedure. Some of the factors that determine the cost of cosmetic surgery include:

-          geographic location,

-           expertise of surgeon,

-          the number of areas treated,

-          amount of time and effort required of the surgeon,

-          cost of anesthesiologist's services,

-          operating room fees, and lab fees.

Shows like "Extreme Makeover" on ABC, "The Swan" on Fox, and I Want A Famous Face on MTV, have attracted all classes of people wanting to look their best. The show focuses on normal people who want to improve their appearance. The contestants may have genetic traits they want fixed like their nose, or teeth, and they all claim they have been ridiculed and had a hard life, because of their appearance. The shows makeover, generally includes liposuction, implants, and porcelain veneers for teeth. With the surgeries the contestants suddenly have a high self-esteem and a source of empowerment. According to an article by Sarah Klein (2004), she writes:

By featuring hard-luck stories of patients who have been hobbled by deformities or worn down by the harsh demands of life, Extreme Makeover persuades viewers that plastic surgery is not an exercise in vanity, but an antidote to suffering [....]. These shows have been the best thing to happen to the mainstreaming of plastic surgery. (p. 1)

Other shows that promote cosmetic procedures are the dramas Dr. 90210 on E, and Nip Tuck on FX. Due to the shows there has been a huge increase in cosmetic procedures, according to Klein, women who once have limited themselves to a tummy tuck now want the same no-holds-barred treatment that people get on the show (p. 1).

Now that cosmetic procedures are acceptable, and considered part of a beauty regiment, new medical spas are the new hot spots to get a non-surgical procedure, along with a massage and a pedicure. The spas are ran by business people or by doctors, and certain states have certain laws on what medical procedures can be done in the spas. In her article Patricia King (2004) writes:

Consumer advocates and others worry that regulation of medical spas has not kept up with the industry's growth. The U.S. Food and Drug Administration oversee the safety of the machines and skin care products used at medical day spas. But it is up to each state to figure out which practitioners can administer the treatments safely. (F.2)

California allows licensed physician assistants, nurses, and nurse parishioners to perform cosmetic medical procedures, if they operate under the supervision of a physician.

Oral Surgeons also want to perform elective cosmetic surgery on the jaw, face, and adjacent structures. According to Myrle Crossdale's (2004) article, oral surgeons are authorized to perform such surgeries in 28 states and Washington, D.C. (p. 8). The ASPS and other physician groups are opposed to allowing oral surgeon to perform cosmetic procedures claiming, "facelifts and other elective cosmetic procedures are beyond the scope of oral surgical training" (Crossdale 8). . .

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