History of Rhinoplasty

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Rhinoplasty is one of the oldest surgical procedures in existence, having been developed originally in India. It was first practised in India by Sushruta samhita in around 800BC who described the procedure in his book which survives down to us. He started out working on criminals, reconstructing various body parts such as earlobes, genitalia and noses. To rebuild the criminals' noses, he used a technique that is still used today called forehead flap rhinoplasty. This was where he took skin from the forehead of the criminal and used it to rebuilt amputated noses. The reason skin from the forehead is used it because it is of such close proximity to the nose as to be almost identical and so therefore is less likely to get rejected by the body. He described the procedure thus; he took the skin from the forehead and pivoted it so that he could place it over the place where the missing nose should have been. Then, keeping the skin elevated, he stitched the two parts down. To get the shape of the nostrils the surgeon was to place two tubes of the caster oil plant into the skin in the correct position (Sushruta samhita 1.16). Predating this medical book is the Egyptian Ebers Papyrus which was written around 1550BC which also describes Rhinoplasty performed on criminals who had had their noses cut off. The practise of plastic surgery was continued by the Romans and is described by Aulus Cornelius Celsus who lived from 27BC until 50AD in his book De Medicina, in which he described the various operations that were performed on patients to correct birth defects accidental mutilation etc.

After the fall of the Roman Empire the technique of Rhinoplasty was lost to Europe. Though in the eleventh century Sushruta samhitas' writings were rediscovered by the Arab physician Ibn Abi Usaibia who translated them from the original Sanskrit into Arabic, they did not come over to Europe. From there they began their slow transference to Europe where by the fifteenth century they were known. The practise of Rhinoplasty in Europe was begun by the Italians in the sixteenth century; most specifically in the work of Gasparo Tagliacozzi who lived from 1456 until 1499. Tagliacozzi worked on the facial disfigurements of soldiers, using the bicep muscle to reattach the nose and then a graft which was put on three weeks after the procedure. Two weeks after the graft, the skin that had been reattached was shaped back into a nose. During the eighteenth century, when Britain began to conquer India, Sushruta Samhitas' writings were rediscovered. Thomas Cruso and James Findley were among the first to bring the technique back having witnessed Indian Rhinoplasty while abroad in India. In the closing decade of the eighteenth century Rhinoplasty began to be practised in England and other English speaking countries with details of the procedures being published in the medical journals of the period.

Rhinoplasty began to develop quickly during the nineteenth century with the publication of Carpues' Account of Two successful Operations at Restoring a Lost Nose in 1815. In Germany the procedure was furthered by Berlin Professor Karl Ferdinand Von Grafe. In his book Rhinoplastik, published in 1818, he describes the history of the Rhinoplasty and goes on to talk about his own technique known as the free-graft Rhinoplasty where he used skin taken from the patients arm. From there, Rhinoplasty continued to develop until the first closed Rhinoplasty was performed in America in 1887 by John Orlando Roe, the description of which he published later that year in a medical journal. In 1921 Rethi brought forward a new innovation in Rhinoplasty which featured the modern procedure of cutting an incision into the tip of the nose. However, despite this and other refinements to the procedure the endonasal form of Rhinoplasty continued to be the norm, until the 1970s when open Rhinoplasty began to gain popularity, something is had held until the modern day. It is clear, therefore, to see that Rhinoplasty has had the benefit of stemming from one of the earliest recorded medical procedures in recorded history, with over three thousand years of practise behind it.

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