The Life and Work of Dr. Suzanne Noël: The First Woman to Perform Aesthetic Surgery.

Abstract

Dr. Suzanne Marguerite Gros Noël, born in Laon, France, in 1878, is widely recognized as the first female aesthetic surgeon. From 1912 to 1954, at a time when women were struggling to gain a foothold in the medical profession, Noël was not only a pioneer in the field of plastic surgery but continued a distinguished career that spanned over four decades. Dr. Noël’s medical career began in 1905, when she was admitted to the Faculté de Médicine at the University of Paris.1 She placed fourth in her class on the difficult Internat des Hôpitaux de Paris examination in 1912, securing her spot as an intern for 2 years at La Pitié Hôpital.1,2 There, she practiced obstetrics and gynecology, a field that was deemed more appropriate for women at that time.3 Rejecting such conventions, she sought further training in plastic surgery and dermatology and learned surgical repairs for acid burns, correction of protuberant ears, removal of tattoos, and scar revision. Nevertheless, her training was interrupted with the onset of World War I. During the war, because many doctors were working on the front lines, Noël and other interns in Paris were permitted to practice medicine independently.1 During this time, she gained extensive experience in treating large wounds and disfiguring scars. In 1918, she received the Silver Medal of National Recognition for her contributions to the war effort.1 By this time, she had honed her surgical skills and was performing reconstructive surgery through the Association of Refugees in Aisne. In 1925, she was finally granted her medical license after submitting her thesis on the reflex of the big toe.1 Dr. Noël is most notably remembered for her rhytidectomy surgical techniques, specifically for using long elliptical incisions along the hairline.2 She was the first surgeon to combine the incisions into one longer one. Her signature operation, which she called the “petite” face lift, typically took 3 hours and was performed under local anesthetic so that she could communicate with her patient.4 Noël was very precise in her technique and placed a craniometer in the center of her patient’s forehead to ensure symmetry on the face.5 Noël’s petite operation involved only preauricular excision and traction; she used minimal undermining and sutured the skin without excising the underlying tissue.3 In contrast, her “grande,” or complete, face lifts involved preauricular and occipital incisions with wide undermining and the removal of a large segment of tissue.3 In these operations, Noël detached the earlobe to prevent downward pull or undermined large amounts of subcutaneous tissue for a more durable result.2 Lastly, she used a unique technique to eliminate horizontal neck wrinkles, making large vertical incisions down the back of the neck, removing a strip of skin, pulling the neck skin together, and primarily closing the site.1 Furthermore, she was one of the first surgeons to experiment with the Novocaine and adrenaline combination for anesthesia.1 This mixture reduced postoperative bleeding, and the procedure was easier for patients to conceal. Noël is also recognized as the first surgeon in France to use the Biesenburger technique for reduction mammaplasties.2 She later modified the technique to improve gland resection by using successive, peripheral excisions.1 She lifted the gland using plication instead of rotation to use less deep suturing.3 During World War II, Dr. Noël performed more invasive surgical procedures, including excising fat from the legs, slimming the abdomen, and removing hand rhytids by injecting a sclerosing solution into the blood vessels.2 She experimented for years to improve techniques for abdominoplasty, blepharoplasty, mammaplasty, rhytidoplasty, and thighplasty.4 Besides her aesthetic work, she frequently performed pro bono reconstructive surgery on children with severe deformities. Her book La Chirurgie Esthétique, which detailed her specific techniques and opinions on the specialty, was only the sixth book dedicated to cosmetic surgery when it was published in 1926.1 Throughout her book, she emphasized the impact of physical appearance on patients’ personalities, and self-confidence. She described them after surgery as being “again happy and courageous.” Remarkable in other professional achievements, she was instrumental in founding Soroptimist International, which became one of the largest global women’s empowerment organizations. She was far ahead of her time in exceptional patient-centered care. Her tireless efforts to destigmatize cosmetic surgery helped to empower women. Her courageous and determined spirit enabled her to overcome adversity, not only as a female surgeon, but as a feminist leader and advocate for other women through Soroptimist International. Fittingly, her legacy continues through the Dr. Suzanne Noël Scholarship fund, providing financial assistance for the pioneering female plastic surgeons of the future.