Look familiar? Surgeon cuffs originated in the military. Here, a Foot Private's tunic, 1865. Fort York, Heritage Toronto.

A sign of a good dresser is the wearer’s attention to detail. When a man cares enough to be mindful of the finer details of dressing, he will insist on  surgeon’s cuffs on his suit jackets.

On suits and jackets, there are usually two to four buttons at the lower edge of each sleeve. Off-the-rack jackets have non-functioning buttons decorating the outside of each sleeve, a practice that originated in the military when buttons, or pips, worn at the front of the uniform sleeve indicated rank.

Military pips were worn with regimental lace (braid) stitched and pressed into a faux buttonhole (this page shows how to make your own) has dubious beginnings, but we do know that the cuff decoration began as a deterrent to keeping one’s tunic clean. One source claims the sleeve buttons “began as an effort by Lord Nelson to keep young midshipmen and cabin boys from wiping their noses on their sleeves.”

Functioning buttons on the other hand, buttons used as closures with real buttonholes are known as “surgeon’s cuffs”. Nowadays, surgeon’s cuffs are worn for style, but when they were first developed, practicality was at top of mind. The Economist explains the history of the surgeon’s cuff:

Savile Row was inhabited largely by surgeons before the tailors moved in during the 19th century, and their influence can be seen in the “surgeon’s cuff”. On the most expensive suits the cuff buttons, which mirror the pips of military rank, can be undone, allowing the sleeve to be rolled back. This let surgeons attend patients spouting blood without removing their coats—an important distinction that set them apart from shirt-sleeved tradesmen of the lower orders.

In this way, surgeon’s cuffs become an indication of social rank (200 years ago, doctors were “upper class”) and to this day are typically found on higher end, tailored garments.

Holland Esquire jacket with contrast piping and covered buttons.

Philip Zappacosta at Nanni Couture in Toronto says, “surgeon’s cuffs are an indication to others of your refined taste in clothing.”

Philip says that the bottom 1-2 buttons are left unbuttoned to showcase the detail on a jacket, and other Italian clothiers I deal with also insist on having at least one button open.

For a more casual look, Philip says, “the jacket cuff can be rolled up slightly to show off more shirt cuff, cuff links, watches, or jewellery.” Revealing the lining, especially if it’s bright and interesting, will also be shown when the cuff is turned back.

Nanni carries beautiful and refined tailored goods like Corneliani, an Italian lifestyle brand, and  Holland Esquire, a smaller and unique label designed by Nick Holland, a major UK tailor, who weaves elements of old world tailoring in his modern line. Both lines feature surgeon cuffs on their jackets.

Sporting a surgeon cuff is always fantastic, but remember, once the surgeon cuffs are created on a jacket, the sleeve length should not be altered.  Unless you have the sleeve length for a perfect off-the-rack fit, beware of buying finished surgeon’s cuffs – changing the sleeve length will throw off the proportion of the buttoned cuffs and it will just look silly. Good tailors will not sew in the buttons and buttonholes until the sleeve length is properly fitted to the client – this is optimal and strongly suggested if you want to do it right.

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Comment by Leah Morrigan on May 4, 2012 at 11:12pm

There is definitely something ostentatious about the surgeon's cuff, Luke, no doubt. I wouldn't say they are anything to take lightly - surgeon's cuffs have a good deal of symbolism attached to them. I have surgeon's cuffs on my jackets because I like the style, but I also feel lucky to be able to afford them. My tailors basically say, if you've got it, flaunt it, so I keep the first button open. It's an Italian thing,

Comment by Luke on May 4, 2012 at 5:15am

Functioning cuff buttons are fine, but leaving them unbuttoned strikes me as rather vulgar, as it is showing off that the wearer can afford bespoke suits.

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