Spotlight on Rhinoplasty: A history of the nose job

Derived from the Greek words ‘rhinos’, for nose, and ‘plastos’ which means ‘shaped’ or ‘molded’, Rhinoplasty is thought to be the world’s oldest cosmetic surgery procedure.

Nowadays, a Rhinoplasty procedure encompasses many techniques to alter all aspects of the nose, both for aesthetic and functional purposes. A bump or hook on the bridge of the nose can be removed, the tip or nostrils made smaller, cartilage straightened, the overall nose made smaller or the angle of the nose to the lip improved. Poor breathing can also be addressed. Nose reshaping surgery has constantly evolved from its earliest origins and today approximately 4,000 Rhinoplasty procedures are performed per year in the UK by BAAPS surgeons.

Rhinoplasty in Ancient Egypt

A common punishment in Ancient Egypt was to have the nose removed, which gave rise to the development of techniques to rebuild the nose that was recorded on papyrus dating from 3,000 BC. The Rhinoplasty procedure was detailed in the Ebers Papyrus, Egypt’s oldest-known guide to medicine.

Rhinoplasty in India

Crime and punishment was also the driving force behind the development of Rhinoplasty in India. Living some time between 1200 and 600 BC, Sushruta carried out reconstruction of noses of criminals, as well as men and women whose noses had been disfigured through trauma (dacoits – armed robbers – would often cut off the noses of their victims) or illness, with the use of skin grafts.

Most importantly, he is credited as inventing the Forehead Flap Rhinoplasty and modifications of his techniques are still very much part of the modern plastic surgical repertoire.

The Spread of Rhinoplasty

Many Indian medical texts, including the ‘Sushruta Samhita’, were translated by Arabian physicians and from there information on a wide range of surgical procedures, including Rhinoplasty, spread, arriving in Southern Europe in the 1400s, the earliest European Rhinoplasty being performed by the Sicilian based surgeon, Branca, in 1442.

Modern-day Rhinoplasty

The famous Italian surgeon, Gaspare Tagliacozzi, was an innovator in facial plastic surgery including Rhinoplasty. He performed many operations on soldiers disfigured in battle and detailed his discoveries and techniques in his guide, ‘The Surgery of Defects by Implantations’. His definitive biography, ‘The Life and Times of Gaspare Tagliacozzi, surgeon of Bologna, 1545 – 1599’ by Martha Gnudi and Jerome Webster (a distinguished American Plastic Surgeon), published in New York by Herbert Reichner in 1950 (limited edition) is highly recommended.

For the next couple of centuries, Rhinoplasty was mainly performed to rebuild noses, destroyed through battle injuries or other trauma, Forehead Rhinoplasty being popularised in Europe (where it became known as ‘Carpue’s operation’) by Joseph Carpue, a surgeon at St George’s Hospital in London through his publication ‘An Account of Two Successful Operations for Restoring a Lost Nose from the Integument of the Forehead’.

In 1887, an American ENT surgeon, John Orlando Roe, performed the first Cosmetic Rhinoplasty. He operated on a man in his 20s who suffered great embarrassment and distress due to his large nose. The success of the nose reshaping procedure greatly increased his quality of life, the hallmark of all successful cosmetic surgery .

War played a major role in the development of Rhinoplasty techniques and the World Wars of the twentieth century greatly advanced what surgeons were able to achieve, both to improve form and function of the nose. Anaesthetic became much more safer, allowing more patients to undergo an elective procedure. The German surgeon, Jacques Joseph, (1865-1943), is widely acknowledged as the Father of modern Aesthetic Rhinoplasty and the Joseph Elevator remains an instrument commonly used in its execution

After World War II, many Hollywood stars went under the knife to improve their appearance. Since then, Cosmetic Rhinoplasty or nasal reshaping surgery has become a common procedure for both men and women. For more information on Rhinoplasty or any Cosmetic Surgery procedure, book a consultation at my Leamington Plastic Surgery Clinic by calling 01926 436341.

Who should be performing your cosmetic surgery procedure?

A recent article in the International Business Times shone a spotlight on the ongoing ‘turf war’ in America about which medical practitioner is adequately qualified to perform particular cosmetic surgery procedures, an issue we are very familiar with here in the UK.

Plastic surgeons in America are understandably worried that other medical specialties are offering cosmetic procedures, from liposuction to breast augmentations, without the necessary training. They claim that this trend is driven wholly by greed, with medical practitioners keen to benefit from this growing and lucrative sector of medicine. And the person who’s often left counting the cost is the patient.

Since the PIP crisis, the aesthetics sector in the UK has come under a great deal of scrutiny, especially on the question of who should be performing which procedure and what training, qualifications and experience they should have.

Part of the problem in the UK is that there are no clear regulations in place and this was one of the key areas investigated by the Review of the Regulation of Cosmetic Interventions carried out by Professor Sir Bruce Keogh and published in April 2013.

Cosmetic, aesthetic or plastic

In the UK, Plastic Surgery is one of the nine surgical specialties recognised by the Royal College of Surgeons. The road to becoming a Plastic Surgeon is necessarily long and challenging; after medical school, trainees spend two years in a Foundation programme to gain varied experience and full registration with the General Medical Council. From there it is possible to apply for Core Surgical Training, which takes two years, and involves placements in several surgical specialties. Only then can trainees apply to their chosen sub-specialty and, following a rigorous selection process amidst stiff competition, will then undergo six years of Plastic Surgery training.

However, Cosmetic Surgery or Aesthetic Surgery is not a defined surgical specialty, allowing for surgeons and even doctors from other fields to use the title. My best advice for anyone considering having a Cosmetic Surgical procedure is to check out credentials on the GMC’s list of Medical Practitioners, which will confirm a surgeon’s specialist field, in particular whether he or she is a Plastic Surgeon or not. Worryingly, a recent study by the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS), of which I am a member, found that a quarter of all people having Cosmetic Surgery in the UK do not check their surgeon’s qualifications.

The non-surgical sector

A further problem has been the explosion in the non-surgical sector with the growing popularity of injectables, such as Botox and dermal fillers, and lasers or light-based treatments. Though they are termed non-surgical, these procedures can cause a degree of damage if misused, with far-reaching consequences.

Botox is termed a prescription medicine, so should only be performed by a properly qualified medical practitioner such as a Surgeon, doctor, dentist or nurse prescriber. However, most other injectables or laser treatments do not fall into this category so can be performed by anyone who is able to access the device or product. However, they too should have received adequate training and, as a basic safeguard, it is always possible to demand to see evidence of that.

Hopefully, clear guidelines and regulation will emerge soon to make the aesthetics sector safer, but in the meantime it is essential that patients protect themselves as much as possible by researching their practitioner fully. There are also key questions you should be asking your surgeon; I fully support BAPRAS’s Think Over Before You Make Over campaign which includes invaluable advice on the consultation.