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Rhinoplasty History

Dr Phil Solomon MD, FRCSC Otolaryngology Head and Neck Surgery practicing Facial Plastic Surgery in Toronto Canada.

Rhinoplasty (Greek: Rhinos, “Nose” + Plassein, “to shape”) is a surgical procedure which is usually performed by either an otolaryngologist-head and neck surgeon, plastic surgeon or maxillofacial surgeon. When performed to improve the function it’s referred to as (reconstructive surgery), when done for appearance its known as Cosmetic Rhinoplasty. Rhinoplasty is also commonly called “nose reshaping” or “nose job”. Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes to correct trauma, birth defects or breathing problems. The history of the procedure dates back over 2000 years.

Reconstructive nose surgery was first developed by Sushruta, an important Ayurvedic physician in ancient India. Sushruta first described nasal reconstruction in his text Sushruta Samhita circa 500 BC. The nose in Indian society has remained a symbol of dignity and respect throughout antiquity. In ancient times, amputation of nose was frequently done as a punishment for criminals, war prisoners or people indulged in adultery. The practice of Rhinoplasty slowly started as a result of the need to reconstruct the external nose and later developed to the full fledged science. The techniques of forehead flap rhinoplasty he developed are practiced almost unchanged to this day.

Sanskrit text of ‘Sushruta Samhita’ was later translated in Arabic by Ibn Abi Usaybia (1203-1269 AD)4.As the historical pages started opening up, the knowledge of Rhinoplasty spread from India to Arabia and Persia and from there to Egypt. However, it took centuries for the principles and the technique of Rhinoplasty to travel to Europe and other parts of the world. In the 15th century, Gaspare Tagliacozzi from Italy documented similar technique of nasal reconstruction. He successfully reconstructed the nose by using the skin of the upper arm. There is little doubt that plastic surgery in Europe which flourished in medieval Italy is a direct descendant of classical Indian surgery.

The precursors to the modern cosmetic rhinoplasty surgeons include Johann Dieffenbach (1792-1847) and Jacques Joseph (1865-1934), who used external incisions for nose reduction surgery.

Jacques Joseph (1865-1934), pioneered modern day cosmetic rhinoplasty surgery.The first real nose job by modern standards was performed in 1885, on a Jewish patient. Jakob Lewin Joseph in Königsberg, Prussia, he was the third child of Rabbi Israel Joseph and his wife Sara. He was an innovator in modern plastic surgery and reconstructive surgery who developed methods for aesthetic plastic surgery, including cosmetic rhinoplasty. He noted that cosmetic surgery, while not a physical necessity, was worth the risks to a person’s health because of its positive impact on their spirit, personality, and role in the world. He was the pioneer of rhinoplasty, which he developed and performed on many of Berlin’s Jewish community.

In 1904, Jacques Joseph published his first report on the simultaneous, intranasal correction of a hump nose with the correction of the front nasal septum. In 1916, he was appointed head of the newly founded Department of Facial Plastic Surgery at the Ear, Nose and Throat Clinic at the Charité by the Prussian Ministry of Education and Cultural Affairs. In 1928 and 1929 the first two sections of Jacques Joseph‘s book on ‘Nasal plastic surgery’ were published at Curt Kabitzsch Publishers, Würzburg and Leipzig. In 1931 the expanded final version of his book on ‘Nasal Plastic Surgery and Other Facial Reconstructive Procedures. As Jews became more and more unwelcome in Germany before WWII, Dr. Joseph late in his carrier offered to perform a free Rhinoplasty for any of his fellow Jews to help help hide their Semitic heritage.

John Orlando Roe (1848-1915) is credited with performing the first intranasal rhinoplasty in the U.S. in 1887. JOHN ORLANDO ROE (1848-1915) an otolaryngologist-Facial Plastic Surgeon who hailed from Rochester, NY, is believed by some to rightfully be credited as the father of aesthetic rhinoplasty. His contemporary, Jacques Joseph, has often been held this title. Although Joseph’s contributions to the field of facial plastic surgery should not be underestimated, Roe’s pioneering endeavors were truly innovative and possibly antedated Joseph’s. Roe devised a unique intranasal approach that corrected the tip of the nose with internal nasal incisions, his findings of were published in 1887.

In the 1920s Gillies performed nasal surgery with external incision extending along the nose. Sir Harold Delf Gillies (17 June 1882 – 10 September 1960) was a New Zealand-born, and later London based, otolaryngologist who is widely considered as the father of plastic surgery. In World War one, Harold Gillies developed many of the techniques of modern facial plastic surgery in treating soldiers suffering from disfiguring facial injuries.

Between the 1930s-1950s Drs Rethi, Zagreb, Sercer and Padovan futher refined rhinoplasty surgery.

In 1973, Dr. Wilfred S. Goodman Professor of Otolaryngology head and Neck Surgery Division Facial Plastic Surgery at the University of Toronto published an article entitled “External Approach to Rhinoplasty” which helped initiate a shift in rhinoplasty techniques to what has become known as the open rhinoplasty.

The open rhinoplasty technique was further popularized by Dr. Jack Anderson Otolaryngologist Head and neck Surgeon- Facial Plastic Surgeon in his article “Open rhinoplasty: an assessment”. Dr Anderson published over 50 research articles on including many articles on rhinoplasty techniques.

Current statistics indicate that approximately 300000 rhinoplasty procedures are done annually in North America. There are also hundreds of thousand procedures carried out in South America, Asia and the Middle East each year. The procedure has become commonplace amongst people of all different ethnic and religious background. For example Teran Iran, which has been called the “nose job capital of the world.” Rhinoplasty rates have been rising dramatically in the Islamic republic. African American, Asian, and Hispanic rhinoplasty procedures have become more popular as techniques have improved to refine noses of all different types. Rhinoplasty Surgery which dates back over two thousand years has changed over the centuries to often reflect changing times. It first began as a procedure to correct serious deformity from injury or illness. It has over the years become a common cosmetic procedure which helped certain cultural groups assimilate. Currently Rhinoplasty is a common cosmetic procedure which is sought out by people of all walks of life.