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In 1818, German cosmetic surgeon Carl Ferdinand von Graefe published his major work entitled Rhinoplastik. Von Graefe modified the Italian approach using a totally free skin graft from the arm instead of the initial delayed pedicle flap. The first American plastic cosmetic surgeon was John Peter Mettauer, who, in 1827, performed the first cleft taste buds operation with instruments that he created himself.

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In 1891, American otorhinolaryngologist John Roe presented an example of his work: a young woman on whom he decreased a dorsal nasal hump for cosmetic signs. In  Solution Can Be Seen Here , Robert Dam experimented unsuccessfully with xenografts (duck sternum) in the reconstruction of sunken noses. In 1896, James Israel, a urological cosmetic surgeon from Germany, and in 1889 George Monks of the United States each described the successful usage of heterogeneous free-bone grafting to rebuild saddle nose flaws.

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In 1928, Jacques Joseph released Nasenplastik und Sonstige Gesichtsplastik. The father of modern cosmetic surgery is generally thought about to have been Sir Harold Gillies. A New Zealand otolaryngologist operating in London, he developed much of the techniques of modern facial surgery in taking care of soldiers struggling with injuring facial injuries throughout the First World War.

After dealing with the popular French oral and maxillofacial cosmetic surgeon Hippolyte Morestin on skin graft, he convinced the army's chief surgeon, Arbuthnot-Lane, to establish a facial injury ward at the Cambridge Armed Force Hospital, Aldershot, later updated to a new hospital for facial repair work at Sidcup in 1917. There Gillies and his coworkers developed many strategies of plastic surgery; more than 11,000 operations were performed on more than 5,000 males (mostly soldiers with facial injuries, typically from gunshot injuries). [] After the war, Gillies established a private practice with Rainsford Mowlem, consisting of numerous well-known clients, and travelled thoroughly to promote his sophisticated strategies worldwide.

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When The Second World War broke out, plastic surgical treatment provision was mostly divided between the various services of the armed forces, and Gillies and his group were broken up. Gillies himself was sent to Rooksdown House near Basingstoke, which became the principal army plastic surgical treatment unit; Tommy Kilner (who had dealt 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 Healthcare facility, Roehampton; and Mowlem went to St Albans.