The History and Evolution of Rhinoplasty

Perhaps we can think that Rhinoplasty, like many other techniques within plastic, aesthetic and reconstructive surgery, is something recent, modern, of our current time. However, the history of this specialty, certainly one of the most complex, dates back many centuries.

Around 2500 years BC in places like India and Egypt began to perform important repairing (reconstructive) nose operations.

In this period one of the figures of reference is the Hindu doctor Sushruta, author of the book SushrutaSamhita, a text where around 300 surgical procedures are mentioned.

The best known contribution of Sushruta to Plastic Surgery has to do with the reconstruction of the nose, this procedure was applied in people who had lost the nasal appendix because of participating in battles or receiving sentences (by thieves or criminals) that included as punishment the amputation of the nose.

One of the techniques Sushruta documented was to take a piece of tissue from the forehead to perform nasal reconstructions. This technique, saving the distances, is still used in Reconstructive Rhinoplasty operations.

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We must take a leap of many centuries and advance until the end of the 19th century when the great challenge of the artistic modification of the nose at an aesthetic level begins to be faced and, therefore, the foundations of Rhinoplasty as it is known today are laid. in day. In this sense, the first to perform nasal reduction surgeries through external incisions was: Johann Dieffenbach.

The first data on operations carried out under Dieffenbach’s scientific rigor date from 1845, in fact his book was one of the first publications that defined the treatment of the nasal tip and hump through external incisions.

The American plastic surgeon John Orlando Roe, advanced a step further in the intervention by making incisions inside the nose, in 1887 . In addition, preoperative and postoperative photographs were also introduced for the first time.

Later, Jacques Joseph, in 1904, was the one who systematized the steps of the Roe technique, laying down the roots of modern aesthetic rhinoplasty. In fact, most of the surgical equipment used today for the procedure was developed by himself.

The challenge of improving rhinoplasty passed to Dr. Emile Rethi , in 1934, whose open rhinoplasty technique places the incision in the middle of the columella, to improve the visibility of the cartilages of the nasal tip.

Along the s. XX the surgical techniques were evolving, progressing more and more in the improvement of more and more specific aesthetic aspects. In this sense, Rhinoplasty ceases to be a mere aesthetic improvement to also seek a functional respiratory result (Killian 1905). It was precisely the concepts of Anderson’s tripod , about the support of the tip (1982), which laid the foundations for the modifications in the nasal tip, always preserving its firmness and structure.

And a long list of illustrious plastic surgeons appeared who, with their contributions, notably increased the arsenal of techniques and technical resources in favor of a more complex but also more precise rhinoplasty with better results. Cartilage grafts appeared among other resources.

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However, the most significant advances can be seen in the last 30 years, where the search for a natural result has been the main line of work. Among these new advances and techniques is that of Doctor Rodríguez-Camps. His outstanding doctoral thesis Cum Laude ‘A New Technique for Remodeling the Nasal Tip in Rhinoplasty, for Extremely Difficult Cases, Through Total Resection of the Alar Cartilages and Temporal Fascia’ has been the subject of dissemination in magazines and books of international circulation, as well as in National and International Congresses. And it is that to date there were no similar procedures in the history of Plastic Surgery.
According to the Doctor: ‘The treatment of the nasal tip is surely the most complex of Rhinoplasty. And if the tip is especially difficult, the rhinoplasty is more complicated. ‘ His technique, which is carried out at the Rodríguez-Camps Clinic, is totally innovative worldwide, and is based on the refinement and beauty of the nasal tip in highly complex cases such as broken, asymmetrical, distorted, wide, globular tips. or flattened.

Revolutionary in her field, leaving aside prejudices and taboos, both anatomical and functional, historically inherited ; This procedure removes all the cartilaginous structure of the malformed or destroyed vertex to replace it with soft tissue (temporal fascia). So you get a smooth nasal vertex, to the eye and to the touch.

Rhinoplasty Today

By the 20th century, an article by Dr. Wilfred S. Goodman was published that gave a twist to the rhinoplasty technique, called external approach rhinoplasty, which eventually ended up being called open rhinoplasty.

The open rhinoplasty comes to making cuts in the nasal pavilion and also made a small one at the bottom of the nose, so the surgeon has better access to the cartilage and bone of the nose.

Thanks to Dr. Jack Anderson this technique was perfected and popularized, but it was not until the end of the 80s when it began to be used in a secondary way.

As we have seen, rhinoplasty has had important and constant changes over time. Although it has kept the same purpose since its invention, for the benefit of thousands of people who see in it an alternative to look and feel better. Either to correct genetic malformations, accidents, corrective problems of a respiratory nature or simply aesthetic, in this way a regeneration of self-esteem is achieved.

A beautiful and well contoured nose produces an important psychological well-being. It is worth remembering that the nose is one of the attributes that stands out first of our face and the first that people see.

If you are thinking of having a rhinoplasty, to look better or if you do it for health purposes (whatever the case may be), you should look for qualified and experienced doctors, who will explain the techniques that best suit your needs, to achieve a harmonious result.…

Brief History of Rhinoplasty

If we ignore nasal reconstruction, which has been recorded for approximately 600 years BC , the modern age of rhinoplasty begins at the end of the 19th century. The North American otorhinolaryngologist John Orlando Roe published in 1887 what is supposed to be the first publication on Rhinoplasty and in 1891 his technique of reduction of the nasal dorsum through intranasal incisions. He was also the first to use preoperative and postoperative photographs and to emphasize work on the tip of the nose. Until then (according to the techniques of Dr.Dieffenbach and Dr. von Graeffe) the approach to the nose had always been performed through external incisions in the nasal skin that left the corresponding scars.

However, it is the German doctor Jaques Joseph who popularizes, refines and publishes numerous studies on Rhinoplasty by external route and also by endonasal route and intercartilaginous approach. The vast majority of instruments currently used in rhinoplasty were developed by him, his first major treatise on rhinoplastydates from 1907 and his most important work, in two volumes, from 1928-29. He is considered by all of us as the father of modern rhinoplasty.

The dissemination in North America of Joseph’s work was made by dres. Safian and Aufrich through their publications and books.

Around 1934, the Hungarian physician Emil Rethi published his experience in nasal tip reduction using traditional endonasal incisions joined through the columella by a skin incision. These are the beginnings of open or external rhinoplasty. In 1957, A. Sercer promoted what he called “decortication of the nose” ( Dekortication des Nase ), a technique that was based on the use of a columellar incision to expose the entire nose and that allowed access to all nasal structures and to the nasal septum (septum).

Regarding functional corrections, Dr. Killian (a student of Dr. Joseph) must be named for his description around 1904 of submucosalseptoplasty and Dr.Cottle for being one of the first to establish the principles of rhinoseptoplasty in 1958.