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The Facial Plastic Surgery Center
Dr William Portuese - Board Certified Facial Plastic Surgeon

Rhinoplasty: The Long and Short Story

The Fascinating Journey of Rhinoplasty: A Look into Its History

Rhinoplasty, a surgical treatment aimed at restructuring the human nose, has captivated the interest of individuals and cultures since antiquity. Rooted in societal, aesthetic, and medical necessities, rhinoplasty’s evolution showcases the remarkable journey of surgical innovation and cultural norms across centuries. This comprehensive exploration of the history of rhinoplasty helps put the evolution and advancements of the procedure into sharper focus.

The Genesis: Ancient Egypt and India

The earliest documented reference to rhinoplasty dates back to ancient Egypt. A part of the Edwin Smith Papyrus, an Egyptian medical text from around 3000-2500 BC, describes a surgical procedure to repair a broken nose.

However, it was in ancient India, around 600 BC, that rhinoplasty started to gain prominence. The renowned ancient Indian surgeon Susruta authored the ‘Susruta Samhita,’ a fundamental text of Ayurvedic medicine, where he describes a flap rhinoplasty procedure. He used a pedicled flap technique, where skin from the forehead was used to recreate the nose – a method not far removed from present-day practices.

The Middle Ages: Rhinoplasty in Europe

It wasn’t until the Middle Ages that rhinoplasty saw resurgence in western medicine. Amidst frequent wars, duels, and public brutality, facial injuries were rampant, often leading to nasal deformities. A critical event marking this period’s beginning was the ‘Branka’ procedure of the Sicilian family during the fifteenth century. They developed their approach to repairing noses, ears, and lips, which were commonly sliced off as punishments for various offences.

Renaissance Era: European Contributions

The Renaissance period signaled a time of significant advancement in literature, arts, and sciences. European surgeons started to rethink surgical procedures, including rhinoplasty, and devised methods to improve results while reducing distress.

The most crucial development towards modern rhinoplasty during this era was pioneered by Gaspare Tagliacozzi, an Italian surgeon. Tagliacozzi perfected the ‘Italian Method’ of using an arm flap to reconstruct the nose, a technique that remained popular until the 20th century.

The Birth of Modern Rhinoplasty

The modern principle of rhinoplasty emerged in the late 19th and early 20th centuries. In 1887, American doctor John Orlando Roe pioneered the ‘Intranasal’ approach, highlighting cosmetic appeal and hiding scars for the first time.

In the late 1920s, Jacques Joseph, a German surgeon, made several advancements in both reconstructive and aesthetic rhinoplasty and became universally recognized as the ‘Father of Modern Aesthetic Surgery.’ He embraced the philosophy of preserving the patient’s unique features rather than creating an ‘ideal’ nose, a concept still relevant in contemporary practices.

Post-War Era: The Age of Innovation

The aftermath of World Wars led to a surge in reconstructive surgeries. Advancements were made not only in surgical techniques but also in anesthesia and operative conditions. The necessity of repairing disfigurements caused by the war gave birth to the subspecialty of plastic surgery, including rhinoplasty.

In 1981, a pioneering effort by American surgeon Dean Toriumi, introduced the ‘open’ or ‘external’ rhinoplasty technique. This approach made complex nose surgeries safer and more predictable as it allowed full visibility of the nasal structures.

Rhinoplasty Today: A Blend of Tradition and Innovation

Rhinoplasty today is a blend of tradition and innovation, elevated by technology. Laser and ultrasonic devices now assist in precise bone cutting. Imaging technology allows surgeons and patients to envision potential results before surgery. Non-surgical nose jobs using fillers and botox offer temporary adjustment options. The quest for personal confidence and identity continues to drive the demand for improved techniques.

Yet, as our understanding of beauty diversifies, there is an increasing emphasis on maintaining individuality and cultural features, harking back to Jacques Joseph’s earlier philosophy. Despite the advances in technology and surgical techniques, the heart of rhinoplasty remains an art form centered around personalized care and aesthetics.

FUTURE: Rhinoplasty Tomorrow?

As history has demonstrated, rhinoplasty is an evolving field, and advancements in technology and medicine continue to shape its future. Bioengineering of tissues and organs may soon revolutionize the post-surgical healing process. Three-dimensional printing and increasing precision robotics could give surgeons even more control over outcomes.

Throughout its fascinating history, rhinoplasty has woven itself into the intricate tapestry of societal norms, personal aspirations, and medical achievements. From Susruta’s pedicled flap technique to Toriumi’s open rhinoplasty and beyond, the surgical procedure constantly evolves, emboldened by necessity and human persistence, flagship towards a future as distinct as the noses it molds.

The nasal bones and septum are typically to blame for the crooked nose. This frequently results in breathing issues as well as cosmetic deformities, which can have an impact on exercise, sleep, and sinus issues. In this area, The Seattle Facial Plastic Surgery Center has conducted a lot of research.

When we say that cartilage has “memory,” we mean that it prefers to return to its previous state. To guarantee that the cartilage stays in its new, straight position, our surgeons employs every technique at his disposal. However, over time, cartilage can warp (bend) on its own. Spreader grafts, strut grafts, PDS foil, and even extracorporeal Septoplasty—which entails removing the crooked piece of the septum and repairing it entirely—are methods used by our surgeons to reduce the degree of change following surgery. Few surgeons in the world are able to perform this sophisticated operation.

Before After Rhinoplasty

Treatment of the Crooked Nose

A crooked nose can take a lot of different forms. The nose is divided into thirds on the outside and on the inside. middle third, bottom third, and top third.
This “Principle of Thirds” helps our surgeons decide how to treat a crooked nose. One of the trickiest procedures in rhinoplasty surgery is correcting a crooked nose.
There are numerous methods currently available to address the malformation of the crooked nose. Surgery patients have a variety of surgical objectives, and it is crucial for the surgeon to comprehend these objectives. While some patients are more interested with the aesthetic result, others are more concerned with the improvement in practical quality. Patients more frequently have both cosmetic and functional issues.

Causes of a Crooked Nose

Congenital (present at birth), traumatic (resulting from an accident), or iatrogenic (caused by prior surgery) factors can all contribute to a crooked nose.
There is frequently a connection between an inherently crooked nose and overall facial asymmetry. Most patients exhibit minor asymmetry in their faces. Prior to surgery, the patient should be made aware of these facial asymmetries and how they might or might not effect their outcome. Congenitally crooked noses can be difficult to treat since it is difficult to locate a common midline because of the surrounding deviation of the internal and external facial framework. Traumatic crooked noses can be caused by a high velocity force or a low velocity force that causes the septum to deviate and produces irregularities in both the nasal bridge and the nasal tip.

Our facial surgeons will conduct a complete physical examination and history during your consultation.
In order to come up with the ideal strategy for achieving the most straight a nose can be, it is crucial to ascertain the cause of the deviation.

Washington Ambulatory Surgery Center Association Washington State Medical Association American Academy of Facial Plastic and Reconstructive Surgery Real Self