International Journal of Advanced and Integrated Medical Sciences

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History of Rhinoplasty
History of Rhinoplasty
1Danish Arora, 2Chander Mohan, 3Prashant Bhardwaj, 4Sadhna, 5Abhinav Srivastava
1Junior Resident, 2Professor and Head, 3,4Senior Resident5Assistant Professor
1-5Department of ENT, Rohilkhand Medical College and HospitalBareilly, Uttar Pradesh, India
Corresponding Author:
Abhinav Srivastava, Assistant ProfessorDepartment of ENT, Rohilkhand Medical College and HospitalBareilly, Uttar Pradesh, India,
Rhinoplasty, is derived from the Greek word rhinos (nose) andplassein (to shape), and is a surgery performed to achieve tworesults: To improve breathing function of nose and to improvecosmetic look of the nose. Rhinoplasty is a plastic surgery forcorrecting and reconstructing the form, restoring the functions,and esthetically enhancing the nose, by resolving nasal trauma(blunt, penetrating, blast), congenital defect, respiratory impediment,and a failed primary rhinoplasty. An otolaryngologistor a plastic and reconstructive surgeon creates a functional,esthetic, and facially proportionate nose by separating the nasalskin and the soft tissues from the osseocartilaginous nasalframework, correcting them as required for form and function,suturing the incisions, and applying either a pack or a stent,or both, to immobilize the corrected nose to ensure the properhealing of the surgical incision. The nonsurgical rhinoplastyprocedure corrects and modifies slight defects of the nose bymeans of subcutaneous injections of biologically inert fillers;the results tend to be relatively transitory, in comparison withthe results of nose surgery. The forehead rhinoplastic reconstructionof nose practiced by Indians centuries ago is knownuniversally as Indian forehead flap for nasal reconstruction.
Keywords: Flap, Hump nose, Reconstruction, Saddle nose.
How to cite this article: Arora D, Mohan C, Bhardwaj P,Sadhna, Srivastava A. History of Rhinoplasty. Int J Adv IntegMed Sci 2017;2(1):40-43.
Source of Support: Nil
Conflicts of Interest: None


According to the Code of Manu, amputation of nosewas punishment laid down for adultery. The deliberateamputation of the nose of Supanakha by Lakshmana, theyounger brother of Lord Rama, in 1500 bc is perhaps theearliest example of nasal amputation known to mankind.1

The presence of paranasal sinuses is documented inancient Egypt where instruments were used to removebrain through the ethmoid sinuses in the process of mummification.In prehistoric times, babies born with nosedefects were considered as evil omen and were killed atbirth. Loss of nose reduced acceptability in the society.Social crimes, such as adultery and sex offenders werepunished by amputation of the nose.2


Edwin Smith Papyrus (3000-2500 bc)3: An ancient Egyptianmedical text4 describes rhinoplasty as the plastic surgicaloperation for reconstructing a nose destroyed by rhinectomy;such a mutilation was inflicted as a criminal, religious,political, and military punishment in that time and culture.It was first to mention treatments for plastic repair of brokennose. Thus, rhinoplasty has its roots in ancient Egypt.3,5 Itwas transcribed as Ebers papyrus in 1550 bc.6

History of Rhinoplasty

Sushruta (600 bc, India): Ayurvedic physician whowrote Sushruta Samhita (his medicosurgical compendium)in Sanskrit. He described technique of totalreconstruction (referred to as Indian rhinoplasty). Hedesigned tubular nasal speculum (Netiyantra), usedleaf patterns of nose to measure various dimensionsprior to nasal reconstruction, developed forehead flaprhinoplasty procedure that remains contemporary plasticsurgical practice, and described the modern free graftIndian rhinoplasty as Nasikasandhanai. The original textis lost but revision of Sushruta's text by Buddhist monkVasubandhu is believed to be the only authentic record.

Aulus Cornelius Celsus (27 bc to 476 ad, RomanEmpire): Published 8-tome medical notes De Medicina(On Medicine, c. ad 14), which described his plasticsurgery techniques and procedures for the correctionand the reconstruction of lips, ears, nose, and so on, andfor the amputation of diseased and damaged parts ofthe human body.7


History of Rhinoplasty

History of Rhinoplasty

Oribasius (300 ad): Royal Physician of ByzantineRoman court of Emperor Julian the Apostaste. Published70-volume Synagogue Medicae (Medical Compilations,ad fourth century), which described congenital facialdefect reconstructions that featured loose sutures thatpermitted a surgical wound to heal without distortingthe facial flesh and how to use autologous skin flaps torepair damaged cheeks, eyebrows, lips, and nose.

History of Rhinoplasty

Celsus and Galen (first and second century): Practicedtissue transplantation. Celsus in De re Medica gave anaccount of repairing of lips and noses with skin flapsfrom adjacent area.

Anglo Saxon physician (920 ad): Published Bald'sLeechbook manual (in old English), describing plasticrepair of cleft lip.

Ibn Abi Usaiba (eleventh century): Arab physician atDamascus translated Sushruta Samhita from Sanskrit toArabic at Damacus leading to its spread from Arabia toPersia to Egypt.

Branka (1442, wound doctor): From Catania in Sicily,Branka reintroduced the ancient method of Sushrutausing flaps from cheek and forehead for repair of nasaldefects. His son Antonio developed the arm pedicle flapfor mutilated nose. During this time various wars werefought in Europe and syphilis was rampant, leading tosaddle nose deformity.

Gasparo Tagliacozzi (1597, Italy): Professor ofanatomy and surgery at the University of Bologna,Gasparo Tagliacozzi published Curtorum Chirurgia PerInsitionem (The Surgery of Defects by Implantations), atechnicoprocedural manual for the surgical repair andreconstruction of facial wounds in soldiers. It is a series of40 patients of rhinoplasty and is the first to record usinga pedicle flap in reconstruction. This guide was the firstof its kind and included groundbreaking diagrams andillustrations of postoperative patients.8

History of Rhinoplasty

Mannucci Niccalao (1652-1708): Viennese physicianwho lived in India and gave an account of reconstructionof nose by Indian physicians in his work Storia de Mogor.Thomas Cruso and James Findlay (1794, East IndiaCompany surgeons): Observed forehead flap reconstructionof nose on a prisoner of war named Cowesjee capturedin the Third Anglo-Mysore War of colonial annexation,by British against Tipu Sultan. They witnessed Indianrhinoplasty procedures at the British Residency in Poona.They described the operation in detail and reported asa curious operation of a new nose in London. It markedthe beginning of interest in rhinoplasty in Europe. Inthe English language Madras Gazette, the surgeons publishedphotographs of the rhinoplasty procedure and itsnasal reconstruction outcomes.9

History of Rhinoplasty

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Joseph Constantine Carpue (1815): First surgeon toperform Indian rhinoplasty in London. Published theaccount of two successful operations for restoring a lostnose in Great Britain (battle-wounded nose and arsenicdamagednose) outlining medical techniques for restoringnoses (Carpue's operation).10

Karl Ferdinand Von Graefe (1816, Germany): Founderof German rhinoplasty (introduced Indian rhinoplasty).Published Rhinoplastik (Rebuilding the Nose) wherein hedescribed 55 historical plastic surgery procedures (Indianrhinoplasty, Italian rhinoplasty, etc.), and his technicallyinnovative free graft nasal reconstruction (with a tissueflap harvested from the patient's arm).6

Lisfranc (1827, France) and Warren (1837, NorthAmerica): Made Indian rhinoplasty popular.

Johann Friedrich Dieffenbachia (1829, Germany):Was among the first surgeons to anaesthetize the patientbefore performing nose surgery. Published Die OperativeChirurgie (Operative Surgery, 1845), which became afoundational medical and plastic surgical text.

GT Vigne (1833-1839): French traveler visited Kangradistrict in Himachal Pradesh, India, and had describedKangra nasal plastic surgery in his travelogue.

History of Rhinoplasty

John Orlando Roe (1887, USA): Performed the firstmodern endonasal rhinoplasty (closed rhinoplasty). Firstsurgeon to perform cosmetic rhinoplasty. Reported in hisarticle the deformity termed pug nose and its correctionby a simple operation and management of saddle nosedeformity. Popularized intracartilaginous approach tothe bulbous tip.9,11

Robert Weir (1892): Corrected nasal deformities byendonasal approach and described a series of operations.He excised a wedge from alae to reduce nasal base.

Jacque Joseph (1898, father of corrective rhinoplasty):Orthopedic surgeon from Berlin described in detail reductionrhinoplasty for hump and other specific deformities.He founded and headed the first hospital for facial plasticand reconstructive surgery and was the first to draw attentionto the social and psychological factors to be taken intoconsideration prior to rhinoplasty. He established intranasalrhinoplasty in Europe on a scientific basis at the turnof the twentieth century. He also published Nasenplastikund sonstige Gesichtsplastik (1928; Rhinoplasty and otherFacial Plastic Surgeries), which described refined surgicaltechniques for performing nose reduction rhinoplasty viainternal incisions,6 and designed many instruments.

History of Rhinoplasty

Keegan (1900): Written a monograph on his experienceof rhinoplastic operations during his posting in aCharitable Hospital at Indore and he quoted that duringa single year there were 152 reconstructive rhinoplastiesperformed in various parts of India.

Aufricht and Safian (1920): Worked with Joseph andintroduced his techniques in the USA.

Jack Anderson (1982): Reported his refinements ofnose surgery technique in the article "Open Rhinoplasty:An Assessment."

Freer and Killian (1902-1904): Pioneered submucousresection and septoplasty procedure for correcting adeviated septum, which is the standard we follow today.

Miller (1907): Experimented with paraffin and vaselineinjections in cases of saddle nose deformity. He alsotreated hump noses.

A Rethi (1921): Introduced the open rhinoplastyapproach featuring an incision to the columella to facilitatemodifying the tip of the nose.12

Peer and Metzenbaum (1929): Performed the firstmanipulation of the caudal septum, where it originatesand projects from the forehead.

Maurice H Cottle (1947): Endonasally resolved a septaldeviation with a minimalist hemitransfixion incision,which conserved the septum; thus, he advocated for thepractical primacy of the closed rhinoplasty approach.


History of Rhinoplasty

History of Rhinoplasty

A Sercer (1957): Advocated the "Decortication ofthe Nose" (Dekortication des Nase) technique, whichfeatured a columellar incision open rhinoplasty thatallowed greater access to the nasal cavity and to thenasal septum.

Padovan (1970): Presented his technical refinements,advocating open rhinoplasty approach.

Wilfred S. Goodman (1970): Reported his technicalrefinements in the article "External Approach toRhinoplasty" (1973) and popularized the open rhinoplastyapproach.13

Jack P Gunter (1987): Reported technical effectivenessof the open rhinoplasty approach for performing asecondary rhinoplasty in the article "External Approachfor Secondary Rhinoplasty."14 His improved techniquesadvanced the management of a failed nose surgery.15,16

  1. Sood VP. History of rhinology in India. Indian J OtolaryngolHead Neck Surg 1996 Jan;48(1):4-5.

  1. Kaluskar SK. Evolution of rhinoplasty. Indian J OtolaryngolHead Neck Surg 2008 Apr-Jun;69:101-105.
  2. Shiffman, MA.; Giuseppe, DA. Cosmetic surgery: art andtechniques. In: Shiffman MA, Giuseppe DA, editors. Historyof cosmetic surgery. New York: Springer Heidelberg; 2013.p. 20-21.
  3. Mazzola, RF.; Mazzola, IC. History of reconstructive andaesthetic surgery. In: Gurtner GC, Neligan PC, editors. Plasticsurgery: principles. Elsevier Health Sciences; p. 11-12.
  4. Rinzler, CA.; Grant, RT.; Darrow, S. In the encyclopedia ofcosmetic and plastic surgery. New York: Facts on File, Inc.An imprint of Infobase Publishing; 2009. p. 151.
  5. Goldwyn RM. Johann Friedrich Dieffenbach (1794-1847).Plast Reconstr Surg 1968 Jul;42(1):19-28.
  6. Chernow, BA.; Vallasi, GA.; editors. The Columbia encyclopedia.5th ed. New York: Columbia University Press; 1993.p. 488-489.
  7. Daily Mail. Ye olde nose job: the 16th century diagrams thatdetail the world's earliest plastic surgery. Daily Mail, London,Dec 2010.
  8. Saraf S. Parihar RS. Rhinoplasty in 600 B.C. Internet J PlastSurg 2007;3(2):1-4.
  9. Rinzler, CA. The encyclopedia of cosmetic and plasticsurgery. In: Rinzler CA, Grant RT, Darrow S, editors. Factson File library of health and living. New York (NY): Facts onFile; 2009. p. 151-152.
  10. Roe JO. The deformity termed 'pug nose' and its correctionby a simple operation. Arch Otolaryngol Head Neck Surg1989 Feb;115(2):156-157.
  11. Rethi A. Operation to shorten an excessively long nose. RevChir Plastic 1934;2:85.
  12. Goodman WS, Charles DA. Technique of external rhinoplasty.J Otolaryngol 1978 Feb;7(1):13-17.
  13. Anderson JR, Johnson CM, Adamson P. Open rhinoplasty:an assessment. Otolaryngol Head Neck Surg 1982Mar;90(2):272-274.
  14. Gunter JP, Rohrich RJ. External approach for secondary rhinoplasty.Plast Reconstr Surg 1987 Aug;80(2):161-174.
  15. Goodman WS. External approach to rhinoplasty. Can JOtolaryngol 1973;2(3):207-210.

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