Rhinoplasty: An Expert Manual Swapan Kumar Ghosh
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History of RhinoplastyCHAPTER 1

The word rhinoplasty originates from two Greek words: rhinos and plastikos. Rhinos means “nose” in Greek and plastikos means ‘to shape’. Plastic surgery for a broken nose is first mentioned in the Edwin Smith Papyrus,1 a transcription of an ancient Egyptian medical text, the oldest known surgical treatise, dated to the Old Kingdom from 3000 bc to 2500 bc.2 The first known cases of successful rhinoplasty were carried out in India in 600 bc by the Ayurvedic physician Sushruta, who described reconstruction of the nose in the Sushruta Samhita, his medicosurgical compendium. Sushruta and his students performed plastic surgeries for reconstructing noses, earlobes, etc. that were amputated as punishment at that time. Sushruta also developed the forehead flap rhinoplasty procedure.3 Cutting of the nose or nose tip was a common way of punishing thieves in India during that period of time.4
The Arab physician Ibn Abi Usaibia (1203–1270) translated the Sushruta Samhita from Sanskrit to Arabic. Then Sushruta's medical compendium traveled from Arabia to Persia to Egypt.
In 1794, British physicians traveled to India to see rhinoplasty being performed by native methods. In the Gentleman's Magazine (1794), Thomas Cruso and James Findlay published an article describing a forehead pedicle-flap rhinoplasty that was a variant of the free-flap graft technique that Sushruta had described long before.
In Great Britain, Joseph Constantine Carpue (1815) described two successful operations for restoring a lost nose, which mentioned two rhinoplasties: the reconstruction of two damaged noses.5 He spent 20 years in India studying local plastic surgery methods. In the mid to late 1800s doctors in Europe and America began experimenting with surgical procedures designed to enhance the shape, appearance, and functionality of the nose.
In Germany, Karl Ferdinand von Grafe (1818) published an article wherein he described fifty-five rhinoplasty procedures. During World War I, thousands of troops suffered extensive facial injuries including severe 2deformities caused by bullet and shrapnel wounds. So surgeons were obliged to make major technological advances in reconstructive faciomaxillary procedures in a short and intense period of time. With these advances came related improvements in anesthesia and antiseptic techniques. A team of surgeons from all over the western world collaborated in advancing the technologies of plastic surgery and began to form societies which later turned into organizations, such as the American Society of Plastic Surgeons. Rhinoplasty enjoyed dramatic technological advancements through the dark times of the First and Second World War. Regarding modernizing techniques for aesthetic applications, in 1845 Joseph Dieffenbach introduced external incisions to the rhinoplasty surgeon community.
In the United States, the otolaryngologist John Orlando Roe performed the first, modern endonasal rhinoplasty and he entered history as the Father of Aesthetic Rhinoplasty after having reported a “simple operation” in 1887 describing the correction of a “pug nose” through an endonasal approach.6
In 1892, Robert F Weir, another American surgeon, also published his techniques for correcting the saddled nose.7
In 1898, Jacques Joseph, an orthopedic surgeon published his paper on reduction rhinoplasty, by external approach. Many aspiring rhinoplasty surgeons traveled to Germany to watch Joseph perform his rhinoplasties. Many of the basic rhinoplasty techniques remain essentially the same today as when Joseph first described them. He is considered the father of modern rhinoplasty.8 He classified various types of nasal deformities and described different procedures for the correction of the deformities. He also invented some operative instruments. Joseph's concepts were further disseminated by surgeons, such as Gustav Aufricht, Joseph Safian, and Samuel Fomon.9
In the early 20th century, Freer, in 1902, and Killian, in 1904, respectively pioneered the submucous resection (SMR) procedure for correcting a deviated septum. They performed SMR by raising mucoperichondrial flaps and excising parts of cartilaginous and bony septum, maintaining septal support by preserving 1 cm dorsal septal margin and 1 cm caudal septal margin.
A Rethi (1921) introduced the open rhinoplasty approach with an incision to the columella to modify the tip of the nose.10 In 1929, Peer and Metzenbaum performed the procedure to correct deviation of the caudal septum.
Maurice H Cottle (1947) endonasally performed septoplasty with a hemitransfixion incision.11 A Sercer (1957) described the “decortication of the nose” technique (open rhinoplasty) allowing greater exposure. Later external rhinoplasty approach was advocated by Padovan (1970), Wilfred S Goodman (1970) and Jack P Gunter (1990).12,13 Goodman (1973) reported his technical refinements in an article and popularized the open rhinoplasty approach.14 Jack Anderson (1982) described open approach in his article ‘Open Rhinoplasty: An Assessment’.15
In 1984, Sheen first described the use of spreader grafts in cases of primary and secondary rhinoplasty. In 1987, Jack P Guntur reported the technical 3effectiveness of the open rhinoplasty approach for performing a secondary rhinoplasty.16
From the 1950s to today, rhinoplasty history has witnessed technological and cultural advancements. Though once viewed as a luxury enjoyed only by the rich and famous, plastic surgery has come to be regarded as an acceptable way for all types of people to enhance their physical form. Rhinoplasty surgery has been among the most popular techniques sought by men and women in the last decade.
  1. Shiffman, Melvin. Cosmetic surgery: Art and Techniques. Springer. P.20.
  1. Mazzola R, Mazzola I, Gurtner GC, Neligan PC, eds. Plastic Surgery: Principles. Elsevier Health Sciences. Pp. 11-12.
  1. Sushruta. Sushruta Samhita. Calcutta, India: Kaviraj Kunjalal Publishing;  1998. pp. 1907–17.
  1. Berg W. History of rhinoplasty. http:// EzineArticles.com/?expert=William Berg.
  1. Rinzler CA. The encyclopedia of cosmetic and plastic surgery. Facts on File; 2009. p.151.
  1. Roe JO. The deformity termed “Pug Nose” and its correction with a simple operation (Reprinted from the Medical Record. June 4, 1887). Plast Reconstr Surg. 1970;45(1):78–83.
  1. Weir RF. On restoring sunken noses without scarring the face. New York; The Medical Record.  1892.
  1. McDowell F, Valone JA, Brown JB. Bibliography and historical note on plastic surgery of the nose. Plast Reconstr Surg. 1952;10:149–85.
  1. Vartanian AJ. Rhinoplasty, Basic closed technique. eMedicine Plastic Surgery. 2010.
  1. Rethi A. Operation to shorten an excessively long nose. Revue de Chirurgie Plastique. 1934;2:85.
  1. Arneja JS. Basic Open Rhinoplasty. emedicine.medscape.com. 2009.
  1. Goodman WS, Charles DA. Technique of external rhinoplasty. J Otolaryngol. 1978;7(1):13–7.
  1. Gunter JP. The merits of the open approach in rhinoplasty. Plast Reconstr Surg. 1997;99(3):863–7.
  1. Goodman WS. External approach to rhinoplasty. Canadian Journal of Otolaryngology. 1973;2(3):207–10.
  1. Anderson JR, Johnson CM, Adamson P. Open Rhinoplasty: an assessment. Otolaryngology Head and Neck Surgery. 1982;90(2):272–4.
  1. Guntur JP, Rohrich RJ. External approach for secondary rhinoplasty. Plastic and Reconstructive Surgery.1987;80(2):161–74.