Rhinoplasty: New York... History

The history of rhinoplasty and that of plastic surgery are inextricably intertwined. In fact, it is fair to say that plastic surgery came into existence in order to treat defects of the nose.

Treatment of nasal injuries was recorded in the "Edmund Smith Papyrus," an ancient Egyptian document dating from about 3000 B.C.

The famous forefather of modern medicine, Hippocrates (fifth century BC), outlined measures to treat and restore injured noses in his book, "Mochlicon." He recorded case descriptions, classified nasal injuries and discussed treatments ranging from poultice application to reshaping of the nasal bones in the case of fractures or deviation.

Rhinoplasty and Plastic Surgery

The Indian art of total nasal reconstruction constitutes what many people consider the first chapter in the history of plastic surgery. Surgery for nasal reconstruction was in great demand, as acts of nasal mutilation were commonly used in India and surrounding regions as methods of lasting humiliation. The method of stigmatization was practiced on adulterers, thieves, and other criminals.

In northern India, during the sixth century BC, a priestly class called the Koomas (potters), developed techniques for replacing skin of the nose. Sushruta, a member of this group, described a method of transferring skin from the forehead and skin from the cheek using his own surgical instruments. These were the first operative procedures for reconstructing noses. (Whereas early research dated Sushruta's work at 600 BC, modern historians dispute this, placing its writing anywhere from 400 BC to the first century AD).

Communication of medical knowledge between the west and east was limited in ancient times. However, the great Roman physician and writer Aulus Cornelius Celsus, included similar techniques to repair mutilated lips, ears, and noses in his classic medical text of the first century, "De Medicina." It is thought that Byzantine Emperor Justinian II of the second century benefited from such surgery after suffering nasal mutilation at the hands of political enemies.

Rhinoplasty in Europe

It may be that Muslim invaders of Sicily brought knowledge of Indian flap methods with them, (acquired from having earlier invaded India). With the Renaissance came a re-flourishing of surgical pursuits, and the Indian technique came to be known and practiced by Heinrich von Pfalzpaint in Germany and Branca in Sicily. Branca's son inherited the technique, (which was a carefully guarded family secret), and modified it to use skin flaps from the arm, (the so-called, "Italian" method). This was accomplished fully 100 years before the description of this method by Gaspare Tagliacozzi in his, the earliest compendiums in plastic surgery, "De Curtorum Chirurgia per Insitionem."

Rhinoplasty Progresses

The most often-cited impetus to the new age of reconstructive surgery was a letter published in the Gentleman's Magazine of London in October of 1794, (Fig. 1). In this account, a British surgeon named Lucas described an operative procedure for reconstructing the amputated nose. The surgery was performed in India by a man of the brickmaker caste and involved the forehead flap. The article was read by British surgeon, Joseph Carpue, who practiced on corpses before performing two total nasal reconstructions, (reported in "An Account of Two Successful Operations for Restoring a Lost Nose from the Integuments of the Forehead").
Fig. 2

Modern Rhinoplasty

The era of modern rhinoplasty began in the mid to late nineteenth century, when the basic tenets of successful nose reconstruction were established: (1) establishing the nasal framework, (2) fashioning a proper lining, and (3) applying a viable skin covering. It had become apparent that the results of unlined forehead flaps were poor.

John Roe, an American otorhinolaryngologist, is credited with developing the first aesthetic approach to rhinoplasty, and in 1891, Roe introduced the endonasal approach to rhinoplasty. However, it was German counterpart Jacques Joseph who truly championed the importance of cosmetic rhinoplasty and is considered by most the father of modern rhinoplasty. His analysis, classification, and repair techniques for the various types of nasal deformities make this difficult to refute. Joseph's seminal work, "Nasenplastik und Sonstige Gesichtplastik," published in 1928, was one of the most comprehensive and innovative texts ever written concerning rhinoplasty.

While nasal reconstruction following traumatic injury was carried on by British surgeon Sir Harold Gillies, American students of Joseph brought his cosmetic perspective and techniques to this country. Gustave Aufricht and Joseph Safian brought Joseph's teachings to New York in the 1930's where the next generations of American surgeons enthusiastically endorsed the European methods. Prominent New York surgeons of the 1970s and 1980s who continued to refine European cosmetic rhinoplasty included John Conway, Dicran Goulian and Thomas Rees. In the 1990s and today the tradition is carried forward by the likes of Norman Godfrey and Nicholas Tabbal.