The Name of Song Ruyao

A pioneer of plastic surgery in China, Song Ruyao (1914-2003) was known for his achievements aiding others who suffered; few at Penn knew what he endured in his own life.

By S.I. Rosenbaum

Every morning, he would arrive at Penn Tower—a blocky former hotel, converted to medical offices across the street from the Hospital of the University of Pennsylvania—and take the elevator to the tenth floor.

Penn medical students and residents in the plastic surgery division were aware that Dr. Song was something of a legend: a man who had studied at Penn in the 1940s and gone on to become a pioneer of plastic surgery in China. Warm and dignified, he was also a resource for young doctors, a living link with history.

“Just having that presence was a good thing,” recalled Linton Whitaker, MD, at the time the chief of the division. “Residents could stop by and talk with him, fellows and post-graduates in training could talk to him.”

But few knew what he’d endured. His younger second wife, Chen Nanping, was popular and much-loved by staff and students alike, but Song did not speak of the fate that had befallen his first wife, or what obstacles he’d faced in the process of establishing plastic surgery as a Chinese discipline.

“He’d been through a tremendous amount,” Whitaker said.

Now Song had returned after half a century to the campus that had given him his education, where all he wanted to do was write his memoirs. Whitaker had given him a desk in an alcove on the tenth floor. Each day Song would settle in, open a notebook, and begin to write, in long columns of Chinese characters, the story of his long and tumultuous life.

Sites of Suffering

Everywhere else, the war would be called World War II. But China would remember it as the Anti-Japanese War. And it was marked by the horror of the survivors’ injuries.

Many soldiers shipped home from the front were horrifically maimed: noses blown off, jaws torn open. Song Ruyao was a young dental surgeon in Chengdu, and he never forgot the helplessness he felt. “Everyone just stared blankly at these anti-Japanese soldiers with malformed faces, unable to speak, unable to eat, suffering psychological and biological agony,” he recalled many years later.

It was not the first time Song had seen extreme human suffering. When he was 12 years old, refugees from a famine had huddled outside the gates of his city, Haicheng, in Liaoning province. Many were sick with typhoid fever and officials refused to let them in. But Song’s father, a practitioner of traditional medicine, went out to treat the sick. Song watched his father die of typhoid not long after.

 

After that, life was difficult for Song. While his widowed mother struggled to save pennies, he excelled at the local school—until it was closed after the Japanese occupied the area in 1931. Song was 16. He traveled to Jinan as a student exile and enrolled in medical school there with only his high school degree, then transferred the next year to a dental university in Chengdu, where the cost of living was lower. Even so, he could hardly afford pencils and paper. Once, he recalled years later, he broke a pen while studying, and had to tie it back together since he couldn’t afford another one.

But he persevered and practiced making careful drawings to aid his education. This artwork so impressed one fellow dental student, Wang Qiaozhang, that she married him. After graduation, Song became a surgeon and teacher at Huxai University, where he was much admired for the careful sketches and watercolors he still made of each operation, which he hung up in his office.

Soon, Song found himself promoted to chair of Surgery. Yet despite being at the top of his field, he was powerless to help the wounded soldiers lying in agony before him. Some had gunshot wounds to the face, others terrible burns. There was no known surgical treatment in China that could repair such damage. 

As the war continued, however, something happened that would change Song’s life—and ultimately bring plastic surgery to China.

An elderly patient arrived at the hospital for dental surgery. The operation was complex: Song had to extract seven rotten teeth, flatten out the man’s deformed alveolar bone, and suture the whole thing up—but the procedure went smoothly, “clean and neat” as Song recalled later. 

As it turned out, the patient was no ordinary old man; as Song had guessed on sight, he was Chen Bulei, national political leader Chiang Kai-Shek’s personal assistant, speechwriter and policy-drafter, recently appointed deputy secretary general of the Supreme National Defense Council, the top organ of wartime China. A few days after the surgery, Chen’s wife came to the hospital to seek out Song. Chen, she told him, had suffered so long from his rotten teeth that he’d tried to pull a tooth himself and only succeeded in passing out. Chairman Chiang himself had finally insisted that he take time off and get surgery. But now, Chen’s wife told Song, Chen “didn’t feel any discomfort at all.”

“You are a promising young person who should be trained,” she said. “He is willing to send you to the United States for further study."

Song and Ivy

In 1943, Song arrived in New York. Traveling by air, land and sea—and avoiding the theaters of war—the journey had taken him more than a month and 7,500 miles. When he’d left China, he wrote later in his memoir, it was late summer. But here, it was already snowing.

“No one was wearing a thin shirt and shorts like me. The first thing I had to do was to buy a pair of warm clothes,” he wrote. “The first time I put on a beautiful new suit made in the United States, I felt a little inconvenient. I didn’t know where to put my hands.”

For the first year, he worked as a resident at Rochester University Hospital. But the dental and oral surgeons had been called to the front, and Song wound up as an assistant to a brain surgeon instead of training in his own specialty. So in 1944 he traveled to Philadelphia to meet with a surgeon who taught at the University of Pennsylvania: Robert Ivy, MD (1905), DDS (1902). Recognizing Song’s talent—and facing a shortage of plastic surgery trainees—Ivy invited him to stay at Penn and “make himself useful in the surgery room,” as Ivy wrote later.

The two were in some ways kindred souls. Ivy had more than a passing familiarity with Chinese culture—he had spent part of his childhood and two years of his young adulthood in Shanghai, where his father, a British dentist, practiced for many years. And, like Song, Ivy had begun as a dentist whose wartime experiences had led him toward surgery. A commissioned captain during World War I, he was posted to the office of the Surgeon General in Washington, D.C. to help plan for the care of soldiers injured in the jaw and face.

The problem before Ivy in the U.S. in 1917 was much the same one that faced Song in China in 1942: Organizing care for the incoming wounded was difficult, Ivy wrote later in his memoir, because “at that time there was no recognition of plastic surgery as a specialty and very few men were known to be proficient or specially interested in this field.” In one way, however, Ivy was more fortunate than Song would be a generation later: The armies with which Ivy served had already developed some techniques through necessity in the previous years of war. Before they were deployed in the field, Ivy and his fellow surgeons were sent to train briefly at hospitals in France and England. “Thus, the Americans had the advantage of profiting from the experience of their French and British colleagues who had had to start from scratch,” Ivy wrote.

Today, World War I is acknowledged by scholars as the origin of modern plastic surgery—as well as cosmetic surgery. It didn’t take long for the public to realize, as plastic surgeon Max Thorek put it, “If soldiers whose faces had been torn away by bursting shell on the battlefield could come back into an almost normal life with new faces created by the wizardry of the new science of plastic surgery, why couldn't women whose faces had been ravaged by nothing more explosive than the hand of the years find again the firm clear contours of youth?"

Ivy rejected cosmetic surgery as less essential than reconstructive surgery and would not practice it, but Song—eager to learn everything he could—studied the nose job and other cosmetic techniques with other surgeons while he was at Penn.

Whether or not Ivy endorsed this line of study, he was impressed by Song. “Ronald Sung,” as Ivy knew him, was “one of the most remarkable students” to attend Penn’s Graduate School of Medicine, Ivy wrote many years later in his memoirs. Just as he had as a student in Chengdu, Song kept an exacting notebook of every operation, illustrated by watercolor diagrams and cross-sections, and this notebook would eventually become a master’s thesis.

To help support Song while he studied, Ivy arranged for him to work as a teaching assistant in the department of anatomy. Between this job, his surgical residency, and his thesis, Song was extremely busy, often working late into the night.

In 1946, Song’s wife Wang—who would go on to be a dental pioneer in her own right—came to the U.S. on her own program of study. She was stationed first in Boston and then in New York, but they must have found time to visit: In 1948, Wang gave birth to their second child, a daughter.

In the same year, Song earned his Master of Medical Science degree from Penn and received a prestigious job offer from the university in Chengdu. It was not an easy decision for Song and Wang. The Sino-Japanese war that had sent Song to the U.S. was over, but the Communist revolution was fully underway. Their daughter was an American citizen by birth, and many of their friends at Penn advised them to stay in the U.S.

Nonetheless, Song decided to return. As he wrote many years later, he believed he could be useful to his country. “China needs to build,” he reasoned. “The people need plastic surgery.”

After Song left Philadelphia, Ivy thought often of his former student—one of Song’s watercolors had pride of place in Ivy’s dining room.

Decades of Turmoil

When Song returned in 1948, China was entering what would be decades of turmoil. A year later, the Communist Party took over the country, including the operations of Chengdu hospital; two years after that, the Korean War began, pitting Chinese and North Korean soldiers against South Koreans backed by the U.S. Once again, Song’s skills were needed to treat the wounded. But the weapons of war were different than those used in World War II: The U.S. forces had napalm. No known treatments for the resulting severe burns existed, so Song was forced adapt extensive skin grafting techniques to save the victims’ lives. There were so many wounded, and so few plastic surgeons available, that he rotated from surgery to surgery—finishing one operation, changing clothes, then immediately starting another—sometimes for twelve hours at a time. When he wasn’t operating, he was training military surgeons in Changchun and Beijing, and traveling across the country to lecture and to oversee particularly difficult cases. In this way, he trained many of that generation’s plastic surgeons across China.

He also found time to treat civilians—including the daughter of a high-ranking Communist leader, securing him temporary favor in the party.

Song’s professional success continued in the decade after the Korean War. He established a plastic surgery hospital in 1957, and he continued to invent new surgical innovations—such as figuring out a way to accomplish in a single surgery what had previously been a three-stage procedure for nasal reconstruction. His work as a surgeon seemed to align with the values of the new Communist regime: a discipline that could “relieve the suffering of the working people,” Song wrote later. He even developed a procedure to reconstruct the crushed and deformed bound feet of rural women, allowing them to walk without pain.

But the very meaning of plastic surgery was changing around him. Increasingly, under the influence of Communism, plastic surgery was being connected to bourgeois Western notions of vanity.

 

Song’s work reconstructing the injured faces of Korean War soldiers had been seen as legitimate—as long as he did not focus too much on aesthetic concerns. Over time, the government began to apply the concept of class struggle to plastic surgery more and more. “Emphasizing form is a capitalist style of treatment; a proletarian ought to emphasize the recovery of function,” he recalled being told.

For a time just after the Korean War’s end, Song had weathered a political campaign that had targeted him and other prominent doctors. His youth and his background of poverty had shielded him from attacks that were linked to the suicide deaths of some of his colleagues then.

But in the mid-1960s the Cultural Revolution began, and Song and his family would not be spared.

Song’s plastic surgery hospital was condemned as a “bourgeois beauty salon” and shut down. Song himself was convicted of crimes, his home was ransacked, and his wife, Wang, was imprisoned. Song would say later that she never really recovered from her time in prison, where her back was broken. For the rest of her life she walked with a stoop, and she suffered from depression until her death in 1988.

Song himself was sent to one of the notorious “May 7th” re-education schools, where he and other intellectuals were made to study Chairman Mao’s writing and do hard physical labor. Though he rarely discussed this part of his life, he later told one interviewer that he had once been forced to write his own name in the dirt, and then rub it out until all that was left was dust.

Reconnecting East and West

Song had managed to write to Robert Ivy back at Penn just once during the Communist era in China, but after the Cultural Revolution began there were no more letters. Ivy had never forgotten his friend, however. As an old man, he still talked about Song with younger colleagues, including Linton Whitaker.

When Whitaker got to know Ivy, the latter had become a “legend” at Penn. Whitaker was tasked as a young faculty member with chauffeuring the retired Ivy to medical conferences. “I was assigned to go get the old man,” he said. “And we’d talk a lot on these car trips.”

Whitaker heard the name of Song Ruyao again in the 1980s, when China began to open to the West.

Song had been reprieved from his re-education in the countryside by a moderate leader in the Communist Party. He had re-established his plastic surgery teaching hospital; the rebuilt hospital, Badachu, had 400 beds. And as China opened itself to the West, he once again began attending international conferences. On one trip to California, he visited Mann’s Chinese Theater and saw the famous sidewalk where movie stars had signed their names in cement. He remembered being forced to write his name in the dirt and erase it. But upon seeing Greta Garbo’s name, he wrote, his thought was, “Hey, the famous movie stars also wrote their names in the dirt with their fingers!”

He also began hosting plastic surgery conferences, inviting distinguished doctors from East and West to “learn from each other's strengths, and jointly improve the level of plastic surgery.”

As the Western doctors were escorted into the lecture hall at Badachu Hospital at the first conference in 1981, a band played “Jingle Bells”—the only Western song they knew. But Western surgeons who attended later noted they were impressed by what Song had accomplished there. Peter Randall, MD (1923-2014), then the chief of Plastic Surgery at Penn, was among them.

One night during that first conference there was a banquet for the visiting surgeons. Song, who usually wore a “Mao suit”—the Communist uniform of political correctness—came to the banquet in a double-breasted Western-style blue serge suit. It fit him perfectly. “You look very sartorial,” Joseph McCarthy, MD, a plastic surgeon from New York University, complimented him. Song thanked him, adding, “I bought it in Philadelphia when I was with Dr. Ivy.”

Ivy had passed away in 1974, but by inviting Randall to China, Song had made a new point of contact at the school where his mentor had worked. “The connection was re-established,” said Whitaker, who in 1987 succeeded Randall as chief and today remains a professor and chief emeritus.

Song befriended both Randall and McCarthy in the 1980s, and later, when they helped found Smile Train, a charity helping children with cleft palates, Song worked closely with the organization to establish the pilot program in China.

And then, in 1992, Whitaker received a letter from Song, asking to return to Penn. “He looked at it as his beginnings and his inspiration for being a plastic surgeon,” Whitaker said. “He contacted me wanting to come back to his origins.”

Song arrived on the Penn campus in 1993, accompanied by his second wife, Chen Nanping. Philadelphia was “a city full of memories,” Chen said. Her husband visited the Graduate Hospital and the anatomy laboratory where he had worked, and reread his thesis in the library, she said.

And every day, for two years, he wrote his life story. 

When he returned to China, at 81 years old, he continued to work, both performing surgery and innovating new techniques. He authored textbooks detailing the procedures he had invented. And he adapted to a changing China: Where before he had been persecuted for practicing cosmetic surgery, now demand for cosmetic procedures was constant. In 1998, commissioned by the China Medical Foundation, he hosted the first “beauty medicine” conference in China.

Song died in 2003, having lived the adage a colleague attributed to him: “A scientific worker must live into old age, learn into old age, work into old age, survive and survive, never stop.”