“Rhinoplasty,” derived from the Greek words rhinos (“nose”) and plassein (“to shape”) is a surgery performed to achieve two results: (1) to improve the breathing function of the nose and/or (2) to improve the cosmetic look of the nose.
Rhinoplasties have been around for thousands of years. Nasal surgery techniques appear early on in recorded medical history, and many different countries and cultures have put their imprint on the procedure. The rhinoplasty continues to evolve today at an even more rapid pace and has become safer and as well as less invasive.
Rhinoplasty in BCE
Rhinoplasty has its roots in ancient Egypt, beginning in 3,000 B.C. During this time, a common punishment for criminals committing theft and acts of a religious or political nature was a rhinectomy. A rhinectomy, as the name suggests, is the removal of the nose, and a procedure that left countless offenders mutilated and unsightly. Ancient Egyptian doctors developed techniques for reconstructing noses and detailed their procedures in hieroglyphics. Information about the procedure was contained in the Ebers Papyrus, the oldest and most authoritative Egyptian papyrus on medical procedures. Although this antediluvian document was simplistic in nature, it laid the groundwork for future developments centuries later.
Similarly, in India, beginning in 500 B.C., the amputation of a thief or criminal’s nose was also commonplace. A prolific doctor named Sushruta began the reconstruction of these men’s noses, using a more evolved technique than used by the Egyptians. Sushruta is credited as inventing the forehead flap rhinoplasty, the bases of which are still seen in modern plastic surgery. Sushara changed the lives of his patients, removing the stigma once attached to ostracized convicts, allowing them to re-enter society and function as normal, every-day citizens.
During the Roman Empire (27 BC – AD 476), plastic surgery was introduced via early medical texts. The first, De Medicina (“On Medicine”) authored by Aulus Cornelius Celsus, describes detailed surgical procedures for reconstructing the nose and other body parts. The Synagogue Medicae (“Medical Compilations”), written by the royal physician Oribasius, focused on techniques to reconstruct noses stricken by birth defects.
Evolution of Rhinoplasty
Medical Compilations made great strides in the advancement of rhinoplasty techniques. It includes details on the prevention of post-op facial distortion via loose sutures, cleaning exposed bones, elimination of damaged tissue, and preventing infection. The “skin flap” technique is also extensively covered, instructing surgeons on the use of the patient’s own skin flaps in nasal reconstruction.
Translations of these texts were integral for the practice of rhinoplasty in other parts of the world. Arab physician Ibn Abi Usaibia deciphered many of the Indian medical texts, including then-plastic surgery bible, Sushruta samhita. After translating it from Sanskrit to Arabic, the text made its way to different corners of the world, arriving in the western world in the 15th century.
The Italian surgeon, Dr. Gasparo Tagliacozzi is the first Western innovator of facial plastic surgery. His text, The Surgery of Defects by Implantations, written in 1597, described rhinoplasty procedures performed on soldiers who had suffered various battle wounds and deformities.
This guide was the first of its kind. It included groundbreaking diagrams and illustrations of post-op patients. One case study describes a patient whose nose was connected to a small flap of skin taken from the bicep. To ensure proper healing, the patient maintained a position for three weeks, wherein his forearm was attached to his head, so that the flap of skin would grow and attach itself to the nose. After this step, it took an additional two weeks for the skin to shape itself around the nose, completing the procedure.
Fast forward to the 1800’s where rhinoplasty entered another surge of development in the western world. This new era of medicine focused on a new type of patient. Instead of criminals afflicted by rhinectomies, surgeons worked to reconstruct noses that had been destroyed in war and by arsenic. During this time, there were numerous studies and medical reports written by visionary physicians of the era.
English surgeon Joseph Constantine Carpue authored Account of Two Successful Operations for Restoring a Lost Nose in 1815, outlining medical techniques for restoring noses in the above situations. That same year, in Germany, Dr. Karl Ferdinand von Gräfe, the founder of German rhinoplasty released a book about nasal reconstruction techniques.
Dr. von Gräfe is considered a plastic surgery innovator. He used the groundwork laid by other western European plastic surgeons like Gasparo Tagliacozzi, to create a more advanced, specialized techniques. His text describes more than fifty ancient plastic surgery methods from around the globe, also including his own method, called a free-graft nasal reconstruction.
An American ENT surgeon named Dr. John Orlando Roe performed the first closed rhinoplasty in 1887. Dr. Roe was also the first surgeon to perform cosmetic rhinoplasty. His patient was a man in his 20’s who suffered from extreme embarrassment and agoraphobia because of his large nose. The patient reported an increase in his quality of life following the surgery, marking a giant milestone in plastic surgery history.
As the 19th century came to a close, cosmetic plastic surgery advanced more and more each day. American and European surgeons saw rhinoplasty as an opportunity to provide both a nose that was both aesthetically pleasing and boasted improved respiratory abilities.
After World Wars I and II, there were rapid advancements in science and medicine and surgeons further honed the cosmetic rhinoplasty method. Rhinoplasty had once been seen as a dire necessity, due to the high risk of anesthesia complications; however safer anesthesia methods were soon introduced, and elective rhinoplasty became a tangible option for those seeking to change the outward appearance of their nose.
Although previous rhinoplasty methods were not nearly as refined as they are today, the 1950’s brought rhinoplasty to the forefront of trends. Rhinoplasty had been considered fashionable, reserved for the wealthy and famous. Movie stars of the era, including Marilyn Monroe, Rita Hayworth and John Wayne all went under the knife to improve their appearance.
The next sixty years saw further technological advancements in the medical field, evolving the procedure into the procedure we commonly associate rhinoplasty with today. It is no longer an option solely for the upper echelons, but a common procedure often covered by insurance, improving the health and self-esteem of millions around the world.
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