16th century
Surgery Prof. Gasparo Tagliacozzi devised a new eponymous rhinoplasty technique.(Bologna, Italia)
In Italy, Gasparo Tagliacozzi (1546-1599), professor of surgery and physiology at the University of Bologna, released Curtorum Chirurgia Per Insitionem (The Operation of Flaws by Implantations, 1597), a technico-procedural guide for the surgical repair and reconstruction of facial wounds of soldiers who were wounded in battle. The illustrations featured a reattachment of the graft -weeks post-process; which, at 2-weeks post-attachment, the surgeon then shaped into a nose.
18th century
Entire metal nose with nostrils
Manufactured nose -18th century Europe. This was to be worn as a substitute to rhinoplasty.
In time, the 5th century BC Indian rhinoplasty technique — featuring a free-flap graft — was rediscovered by Western medicine in the 18th century, during the Third Anglo-Mysore War (1789-1792) of colonial annexation, by the British against Tipu Sultan, when the East India Company surgeons Thomas Cruso and James Findlay had seen Indian rhinoplasty processes at the British Residency in Poona. In the English language Madras Gazette, the surgeons released photographs which were taken of the rhinoplasty process and its nasal reconstruction results; after, in the October 1794 issue of the Gentleman’s Magazine of London, the physicians Cruso and Findlay released an illustrated report describing a brow pedicle-flap rhinoplasty that was a technical version of the free-flap graft technique that Sushruta had described some twenty three centuries before:
A thin plate of wax is fitted to the stump of the nose, so as to make a nose of great look; it’s then flattened and placed on the brow. A line is drawn around the wax, which is then of no further use, and the operator then dissects away as much skin [the flap] as [the wax plate] had covered, leaving undivided a little slide [the flap-pedicle] between the eyes. Till an union has taken place between the new and the old components this slide maintains the blood circulation. The cicatrix of the stump of the nose is pared off, and, instantly behind the component that was new, an incision is made through the skin, which goes along the top lip, and passes around both alae. The skin brought down from the brow, and being twisted half-about, is added into this incision, so that a nose is formed with a double hold with septum and its alae, and above under, fixed in the incision. A little Terra Japonica (light-catechu) is dampened with water, and after being spread on cases of material, five or six of these are set over each other to ensure the joining. No other dressing, but this cement, is used for four days. It’s subsequently removed, and materials dipped in ghee are used. The linking slickness of skin is broken up at about the twentieth day, when a more dissection is required to enhance the look of the nose that was new. For six or five days after the surgery, the patient is made to lie on his back, and on the tenth day, touches of material that was soft are set into the nostrils to keep them adequately open. This procedure is consistently successful. The man-made nose is fixed and seems almost together with the nose that was natural, nor is the scar on the forehead quite observable after a period of time. (Gentleman’s Magazine of London, October 1794)
19th century
In 1815, Dr Karl Ferdinand von Grafe composed the novel about rebuilding the human nose.
Predating the Indian Sushruta samhita medical compendium is the Ebers Papyrus (c. 1550 BC), an Ancient Egyptian medical papyrus that describes rhinoplasty as the plastic surgical operation for re-building a nose ruined by rhinectomy, such a mutilation was inflicted as a criminal, spiritual, political, and military punishment in that time and culture. In the occasion, the Indian rhinoplasty technique continued in 19th century Western European medicine; in Great Britain, Joseph Constantine Carpue (1764-1846) released the Report of Two Successful Procedures for Restoring a Lost Nose (1815), which described two rhinoplasties: the reconstruction of a conflict-injured nose, and the repair of an arsenic-damaged nose. (cf. Carpue’s procedure)
The polymath Johann Friedrich Dieffenbach given one of the foundation texts of the plastic surgery speciality. (1840)
In Germany, rhinoplastic technique was refined by surgeons including the Berlin University professor of operation Karl Ferdinand von Grafe (1787-1840), who printed Rhinoplastik (Reconstructing the Nose, 1818) wherein he described fifty five (55) historic plastic surgery procedures (Indian rhinoplasty, Italian rhinoplasty, etc.), and his technically advanced free-graft nasal reconstruction (with a tissue-flap harvested from the patient’s arm), and surgical strategies to eyelid, cleft lip, and cleft palate corrections. Dr von Grafe’s protege, the medical and surgical polymath Johann Friedrich Dieffenbach (1794-1847), who was among the first surgeons to anaesthetize the patient before performing the nose operation, released Die Operative Chirurgie (Operative Surgery, 1845), which became a foundational medical and plastic surgical text. (see strabismus, torticollis) Also, the Prussian Jacques Joseph (1865-1934) released Nasenplastik und sonstige Gesichtsplastik (Rhinoplasty and other Facial Plastic Surgeries, 1928), which described refined surgical techniques for performing nose-decrease rhinoplasty via internal incisions.
In America, in 1887, the otolaryngologist John Orlando Roe (1848-1915) performed the first, modern endonasal rhinoplasty (shut rhinoplasty), about which he reported in the post The Deformity Termed “Pug Nose” and its Correction, by An Easy Procedure (1887), and about his direction of saddle nose deformities.
20th century
In the early 20th century, Freer, in 1902, and Killian, in 1904, respectively initiated the submucous resection septoplasty (SMR) process for correcting a deviated septum; they lifted mucoperichondrial tissue flaps, and resected the cartilaginous and bony septum (including the vomer bone and the perpendicular plate of the ethmoid bone), keeping septal support with a 1.0-cm border at the dorsum and a 1.0-cm border at the caudad, for which initiations the technique became the foundational, regular septoplastic process. In 1921, A. Rethi introduced the open rhinoplasty approach featuring an incision to the columella to ease changing the point of the nose. In 1929, Metzenbaum and Peer performed the first manipulation of the caudal septum, where it projects and originates from the brow. In 1947, Maurice H. Cottle (1898-1981) endonasally worked out a septal deviation with a minimalist hemitransfixion incision, which preserved the septum; so, he recommended for the practical primacy of the shut rhinoplasty strategy. In 1957, A. Sercer recommended the “decortication of the nose” (Dekortication des Nase) technique which featured a columellar-incision open rhinoplasty that permitted greater access to the nasal cavity and to the nasal septum.
However, at mid-20th century, despite such refinement of the open rhinoplasty approach, the endonasal rhinoplasty was the common way of nose operation — until the 1970s, when Padovan presented his technical refinements, urging the open rhinoplasty strategy; he was seconded by Wilfred S. Goodman in the later 1970s, and by Jack P. Gunter in the 1990s. Goodman impelled practical and procedural improvement with the post Outside Method Of Rhinoplasty (1973), which reported his technical refinements and popularized the open rhinoplasty approach. In 1982, Jack Anderson reported his refinements of nose operation technique in the post Open Rhinoplasty: An Evaluation (1982). During the 1970s, the main use of open rhinoplasty was to the first-time rhinoplasty patient (i.e. a main rhinoplasty), not as a revision operation (i.e. a secondary rhinoplasty) to correct an unsuccessful nose operation. In 1987, in the post Outside Strategy for Secondary Rhinoplasty (1987), Jack P. Gunter reported the technical effectiveness of the open rhinoplasty approach for performing a secondary rhinoplasty; his improved techniques enhanced the direction of an unsuccessful nose operation.
Thus does modern rhinoplastic praxis derive from the primeval (c. 600 BC) Indian rhinoplasty (nasal reconstruction via an autologous brow-skin flap) and its practical forms: Carpue’s procedure, the Italian rhinoplasty (pedicle-flap reconstruction, aka the Tagliocotian rhinoplasty); and the shut-strategy endonasal rhinoplasty, featuring only internal incisions that allow the plastic surgeon to palpate (feel) the corrections being effected to the nose.
Because of the work done by our ancestors today we are fortunate enough to have very reliable Rhinoplasty surgery techniques.
