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In 1818, German surgeon Carl Ferdinand von Graefe released his significant work entitled. Von Graefe modified the Italian approach using a free skin graft from the arm instead of the original delayed pedicle flap. The first American plastic surgeon was John Peter Mettauer, who, in 1827, carried out the first cleft palate operation with instruments that he designed himself.

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Another case of cosmetic surgery for nose reconstruction from 1884 at Bellevue Health center was described in Scientific American. In  Did you see this? , American otorhinolaryngologist John Roe presented an example of his work: a girl on whom he reduced a dorsal nasal hump for cosmetic indications. In 1892, Robert Dam experimented unsuccessfully with xenografts (duck sternum) in the restoration of sunken noses.

In 1898, Jacques Joseph, the German orthopaedic-trained surgeon, published his first account of decrease rhinoplasty. In 1928, Jacques Joseph released Nasenplastik und Sonstige Gesichtsplastik. [] Advancement of contemporary strategies [edit] The father of contemporary cosmetic surgery is typically thought about to have been Sir Harold Gillies. A New Zealand otolaryngologist working in London, he established many of the methods of contemporary facial surgery in caring for soldiers struggling with disfiguring facial injuries throughout the First World War.

After dealing with the distinguished French oral and maxillofacial cosmetic surgeon Hippolyte Morestin on skin graft, he encouraged the army's chief surgeon, Arbuthnot-Lane, to establish a facial injury ward at the Cambridge Armed Force Medical Facility, Aldershot, later upgraded to a new healthcare facility for facial repairs at Sidcup in 1917. There Gillies and his associates established numerous techniques of cosmetic surgery; more than 11,000 operations were carried out on more than 5,000 men (mainly soldiers with facial injuries, typically from gunshot injuries). [] After the war, Gillies developed a personal practice with Rainsford Mowlem, including numerous famous clients, and travelled thoroughly to promote his innovative strategies worldwide.

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When The Second World War broke out, plastic surgery provision was mainly divided in between the various services of the armed forces, and Gillies and his group were broken up. Gillies himself was sent out to Rooksdown Home near Basingstoke, which became the principal army plastic surgical treatment unit; Tommy Kilner (who had actually worked with Gillies throughout the First World War, and who now has a surgical instrument named after him, the kilner cheek retractor) went to Queen Mary's Medical facility, Roehampton; and Mowlem went to St Albans.