history of rhinoplasty
TRANSCRIPT
Dr. Abdelhalim MahmoudDr. Abdelhalim MahmoudENT Specialist ENT Specialist
Magrabi Hospital-Jeddah Magrabi Hospital-Jeddah
Rhinoplasty is plastic surgery that can be used
to improve the look of the nose or improve its
function.
Plastic surgery is defined as any procedure used
to correct or restore either form or function of a
body part.
Cosmetic rhinoplasty makes
the nose more beautiful.
Functional rhinoplasty
improves the function and the
look of the nose and usually
associated with other procedure
like Septoplasty referred to as
Septo-rhinoplasty.
The ancient origins of the
plastic surgery and
rhinoplasty go back to the
date 1213 B.C. in Egypt where
ancient Egyptian started to
do plastic surgery for there
mummies .
It was believed that one's face
was the only physical
attribute that carried over
into the after life .
Ramses II, an ancient Egyptian king , was noted for having a
very large , elongated nose .
To ensure he was recognized and received as a king in the
after life , his mourners surgically inserted bone and seeds
into his nose creating the 1st known record of Rhinoplasty.
Rhinoplasty is believed to have been first developed by
an ancient Indian physician Sushruta (600 BC) who
described reconstruction of the nose in the Sushruta
Samhita ( 600 BC)
The physician Sushruta and his medical students
developed and applied plastic surgical techniques for
reconstructing noses, genitalia, earlobes, etc, that were
amputated as religious, criminal, or military punishment.
The portion of the nose to be covered should be first
measured with a leaf. Then, a piece of skin of the required
size should be dissected from the living skin of the forehead
and turned back to cover the nose, keeping a small pedicle
attached to the forehead.
The physician then should
place the skin on the nose
and stitch the two parts ,
keeping the skin properly
elevated, by inserting two
tubes of eranda (the castor-
oil plant) in the position of
the nostrils, so that the new
nose has proper shape
Figure for old Indian instruments
Aesthetic Surgery
• Romans were the 1st to use plastic
surgery to improve self-image.
• Procedures for wealthy women
whose ears had become stretched by
the weight of their earrings .
• Freed slaves underwent procedures
to remove or cover the brands used
to mark them
• The most famous roman
plastic surgeon Aulus
Cornelius Celsus wrote
“De Medicina” how to
guide various plastic
surgery procedures in the
face and nose.
• Celsus book was the
plastic surgeon’s reference
guide for more than 1,700
year
Roman doctors used opium capsules ,
alcohol and pain relief for anesthesia ,
but the patients were always awake
during procedures .
Anesthesia and Tools in Roman Surgery
The Romans used primitive
versions of the same tools
plastic surgeons use today
including forceps , scalpels and
bone drills.
Method Of Anesthesia In Old Surgery
Rhinoplasty plays a Role in Roman Politics
• After being overthrown , a Roman
Emperor named Justinian II’s nose
was amputated in an effort to
prevent him from regaining the
thrown, his nickname “Rhinotmetus”
“one whose nose has been cut off.
• The outside emperor got nose job ,
after returning to Rome with his new
nose , Justinian II regained the
thrown and he ruled for several years
before his execution .
In the 11th century, at Damascus, the
Arab physician Ibn Abi Usaibia (1203–
1270) translated the Sushruta Samhita
from Sanskrit to Arabic . Sushruta’s
medical experience travelled from
Arabia to Persia to Egypt
The Islamic Conquest of India
and parts of Europe, brought
with it plastic surgery
techniques, including Sushruta’s
procedures for Rhinoplasty.
Ibn Abi Usaibia (1203–1270)
Spread of Plastic Surgery Techniques 9th-12th Century
AD
In the late sixteenth century,
an Italian surgeon named
GasparoTagliacozzi
described a procedure for
nose reconstruction in which
he attached part of the bicep
muscle to the patient’s face,
left his arm attached to his
nose for 5 weeks, and then
staged a second surgery to
separate the two.
By this technique Gasparo
tried to minimize scarring in
the face by taking the skin
from the arm, but the
problem was this method
required the arm remain
attached to the nose for 5
weeks.
In 1887, an American
Otolaryngologist, John
Orlando Roe, performed the
first Aesthetic Rhinoplasty
in modern history. He wasn’t
merely reconstructing a
missing nose, he was
correcting a deformity e.g.
saddle nose deformity
He wrote about nasal
Deformity Termed “Pug
Nose” ,,A short nose that is
somewhat flattened and
turned up at the end,, and its
Correction, by a Simple
Operation” in 1887. He also
discussed the correction of
the condition of saddle nose.
Two years later, Jacques
Joseph,(1865-1934) considered
by many the father of modern
Rhinoplasty and facial plastic
surgery,performed rhinoplasty
surgery on a 28 year-old man
whose extremely large nose
caused him such
embarrassment that he
couldn’t bear to appear in
public.
In 1931 he wrote his book,
“Milestone In Plastic Surgery”
in which he explained the
Nasal Plastic Surgery and
Other Facial Reconstructive
Procedures, with an Appendix
on Reconstructive Breast
Surgery and some other
Procedures in the area of
External Plastic Surgery, an
Atlas and Text Book.
• Rhinoplasty, became more sophisticated
and wide-ranging in the 20th century.
• In 1902 through 1904, Freer and Killian
developed sub mucous resection
Septoplasty, a surgery for the correction
of a deviated septum.
• In 1921, Rethi introduced the Open
Rhinoplasty approach featuring an
incision to the columella to gain access to
the nasal cartilage and facilitate
modifying the tip of the nose.
In 1947, Cottle performed a closed, or endonasal surgery for
rhinoplasty in which he gained access to the nasal bone and
cartilage through intra-nasal incisions .
One of the most confusing dilemmas in rhinoplasty is the choice between
open and closed techniques.
Each technique has its advantages and disadvantages
Table 1: Advantages & Disadvantages of Closed Rhinoplasty
Advantagesof Closed Rhinoplasty
Disadvantage of Closed Rhinoplasty
Shorter Surgery Time Requires more skill to refine nasal tip
Better Circulation to the nasal tip skin
Requires more skill to perform Revision Rhinoplasty
Less nose swelling
Faster Recovery
Table 2: Advantages & Disadvantages of Open Rhinoplasty
Advantagesof Open Rhinoplasty
Disadvantage of Open Rhinoplasty
Allows refinement of nasal tip in most difficult cases
Prolonged surgical time
Allows easy placement of cartilage graft
Prolonged swelling of the nose
Enables execution of complex maneuvers necessary for Revision Rhinoplasty
Poor circulation to the nasal tip skin
Easier approach for plastic surgeonsNasal skin incision scar over the columella
Prolonged recovery time
• Today the newer advanced
rhinoplasty techniques try to
maximize the chance of
successful outcome and
minimize the recovery time .
The surgeons uses the latest
advances to achieve a better
visualization techniques such
as the high definition 3D
Rhinoplasty to achieve a
precise and natural outcome.
High definition 3D Rhinoplasty
It is a type of endonasal rhinoplasty where the use of
the telescope (high definition) is used to better
visualize the bridge of the nose to get a better view
during the surgery on a high definition 3d screen,
allowing for a more natural result with a minimal
recovery.
Patients are paying more attention to the techniques
surgeons are using and learning more about what
they want before surgery.
Patients are seeking out surgeons for natural look.
They do not want to look done or a operated on
anymore.
• Rhinoplasty is one of the top 5 cosmetic procedures performed
in the United States every year
• 253,000 Rhinoplasty procedures were performed in 2010
according to the American Society of Plastic Surgeons (ASPS) .
74% of them are women.
The average total cost of
rhinoplasty ranges from $3,000
to $8,000. What the patient pay
will vary based on the surgeon’s
fee, the extent of structural and
cosmetic changes made to the
nose, and the geographic
location.