Nasal Reconstruction
The reconstruction of the nose dates back thousands of years, and the ancient Hindus are credited with the first nasal reconstruction attempts. In ancient India, punishment involved having one’s nose cut off, and such a defect was reportedly first repaired by transposing a cheek flap. The Italians also executed reconstructive techniques for the nose during the Renaissance, when the Branca family and Tagliacozzi experimented with arm flaps and rhinoplasty techniques. Additionally, the British documented the Indian techniques of reconstruction they saw during their time in the subcontinent. Gillies, of England, formulated rules and techniques for nasal reconstruction as he helped those injured during wartime. These efforts were passed on, expanded, and refined to form the multitude of reconstructive options available today which not only include the aesthetic reconstruction of the nose, but the functioning of the nose as well. With the advent of cosmetic surgery at the turn of the 20th century, rhinoplasty techniques branched out to cosmetic rhinoplasties as the demand for a more beautiful nose rose.
“[Indian Rhinoplasty].”
B.L. Gentleman’s Magazine 64, pt.2, no. 4 (1794).
In this issue of Gentleman’s Magazine, a reader identified as “B.L.” reported on a nasal reconstruction performed in the then-British colony of India. This report revolutionized the practice of rhinoplasty, which had not been written about in nearly 200 years. This case study, written by a non-medical practitioner in a non-medical journal, describes a bullock driver named Cowassjee in the English army during the war of 1792, when he had his nose and arm chopped off while held as a prisoner at war. The reconstructed nose was made from a forehead flap as described by Tagliacozzi centuries prior. Although published for a popular readership, the report does show the stages of the reconstruction. This article helped to spark a revival of plastic surgical operations in the 19th century.
An Account of Two Successful Operations for Restoring a Lost Nose. . . .
Joseph Carpue. London: Longman, Hurst, Rees, Orme and Brown, 1816.
Joseph Carpue was an English surgeon in the early 19th century. He is credited with the first nasal reconstruction in England, performing the surgery on the nose of an army officer whose nose collapsed from chronic mercury treatments for a disease of the liver. It was performed under no anesthetic, reportedly in less than thirty minutes, from forehead skin as described previously as the Italian method. Although he became famous for this rhinoplastic procedure, Carpue has also been credited for his experiments with electricity in medicine and their therapeutic benefits.
Sulla restituzione del naso: rapporto [A report on the return of the nose].
Albert Schonberg. Naples: Reale tipografia della Guerra, 1819.
In this early Italian book, just three years after Carpue, Schonberg recreates his early nasal reconstruction. He builds upon the work of his predecessors, Tagliacozzi, Carpue, and von Gräfe. The beautiful illustrations that accompany the book are derived from the surgery von Gräfe was performing earlier in Germany.
Di autoplastica [Autoplasty].
Augusto Ferro. Rome: Tipografia Contedini, 1846.
Augusto Ferro was a prominent 19th-century Italian surgeon. In this rare book, Ferro describes his techniques in facial plastic surgery. He describes his technique for nasal reconstruction and mandible (jaw) reduction. His operations on men and women are beautifully illustrated with detailed drawings.
“Über eine neue Methode der totalen Rhinoplastik” [On a new Method of Total Rhinoplasty].
Bernhard von Langenbeck. Berliner klinische Wochenschrift 1, no. 2 (January 1864).
Bernhard von Langenbeck was a 19th-century German surgeon. He specialized in ophthalmology and was also a skilled military surgeon. He succeeded Johann Dieffenbach as the director of the Clinical Institute for Surgery and Ophthalmology at Charité in Berlin. It was at Charité that he devised and implemented a system where recent medical graduates would reside at the hospital as they assumed increasing responsibility in the care and supervision of surgical patients. This system led to the terms “house staff” and “residency” and earned von Langenbeck the title “father of the surgical residency.” His most famous residents were Theodor Billroth and Emil Kocher. This house staff and residency model was adopted by William Osler and William Halstead in the Medicine and Surgery departments at the Johns Hopkins University Hospital later in the 19th century. In this publication, Langenbeck discusses total rhinoplasty reconstruction addressing both the hard tissue (bony framework) and soft tissue (skin). Previous publications addressed mostly only soft tissue reconstructions.
“Partielle Resection der Nasenscheidewand by hochgradiger Verkrűmmung derselben” [Nasal septoplasty].
Arthur Hartmann. Deutsche medizinische Wochenschrift 8 (1882).
Arthur Hartmann was a German surgeon in the 19th century. As rhinoplasty was becoming more of a commonly performed surgical procedure, surgeons started to operate on all the other parts of the nose, including the septum, turbinates, and sinuses. Surgeons such as Gustav Killian and Otto Freer promoted this work, but it is Hartmann who is credited with first practicing the septoplasty to correct a deviated nasal septum. Prior to this surgery there were very few and ineffective means available to address this medical condition. Hartmann was also the first to perform turbinate reduction on the 1890s.
“Zwei neue Methoden der Rhinoplastik” [Two new methods of rhinoplasty].
James Israel. Langenbecks Archiv für klinische Chirurgie 53 (1896).
James Israel was a German surgeon during the latter half of the 19th and early 20th centuries. As was true of most other surgeons during this period, Israel was a military surgeon. Although a pioneer in urologic surgery, he did make significant advances in plastic surgery. In this work, Israel discusses the first free bone graft to the nose, where bone was harvested at a site away from the nose and replanted to the nose to give support for a nasal reconstruction. Without this support, a nasal reconstruction would fail because of collapse. He was also known in the field of microbiology when in 1878 he was the first to describe the disease known as actinomycosis in humans caused by a pathogen later named Actinomyces israelii.
“Zur Deckung von defecten der Nasenflügel” [To cover a defect on the nose].
Franz König. Berliner klinische Wochenschrift 39, no. 7 (February 1902).
Franz König was a German surgeon in the 19th century. Although mostly known for his orthopedic surgical work involving bone and joint surgery, he did make contributions to plastic surgery. In this work, König describes the use of a composite graft, which involves the transfer of all tissue layers from one part of the body to another. Unlike a flap, where the blood supply is still attached, a graft brings no blood supply. In the nasal reconstruction performed here, a defect of the alar rim of the nose was reconstructed with a composite graft from the ear.
Plastická chirurgie [Plastic surgery].
František Burian. Prague: Joint Stock Printers, 1924.
František Burian was a Czech plastic surgeon in the early 20th century. In the Czech Republic, he is also known as the father of plastic surgery. Although not nearly as well known as his contemporaries, he contributed greatly to plastic surgery and ranks with Gillies, Esser, and McIndoe as one of the masters and founders of modern plastic surgery. He acquired his military surgery background during the Balkan wars of 1912–1913 and performed extensive amounts of facial reconstruction. In this work, Burian describes treatments and surgery for soldiers with extensive skull and facial injuries. His wife, Anna Lakasora-Burianova, who was among the earliest women to graduate as a doctor under the Austrian monarchy, assisted him during this period.
Quelques considerations sur la chirurgie plastique et esthetique du nez et de la face [Some considerations on plastic and aesthetic surgery of the nose and face].
Prevot. Marseille: Ed. Sergent, 1929.
Dr. Prevot was an early 20th-century French plastic surgeon who practiced at Lyon Hospital. In this small and heavily complete pamphlet, Prevot reviews the history and anatomy of facial reconstruction. He details reconstructions of the nose, lips, and ears. Facelifts are also detailed, as is the treatment of vascular lesions of the nose. The work is complete with pre-operative and post-operative photographs, which were rarely published in France at that time.
Nasenplastik und sonsitige Gesichitsplastik: nebst einem Anhang über Mammaplastik [Rhinoplasty and facial plastic surgery: with an appendix on mammoplasty].
Jakob L. Joseph. Leipzig: Curt Kabitzsch, 1931.
Jakob (or Jacques) Joseph was a German plastic surgeon in the latter part of the 19th and early 20th centuries. He was an innovator not only in plastic surgery—particularly rhinoplasty and breast surgery—but in aesthetic surgery as well. He developed the basis of cosmetic rhinoplasty as we know it today. He knew that while cosmetic surgery was not a medical necessity, it would be worth the risk to perform it if that led to a positive impact on the personality and spirit of the patient. In this extremely comprehensive work, Joseph discusses many operative techniques of both rhinoplasty and mammoplasty. The text is accompanied by numerous photographs and illustrations.
Korrektive-kosmetische Chirurgie der Nase, Ohren und des Gesichtes [Corrective cosmetic surgery of the nose, ears and face].
Victor Frühwald. Wien: Wilhelm Maudrich, 1932.
Victor Frühwald was an Austrian plastic surgeon of the early 20th century. In this book written for surgeons wanting to learn more about facial plastic surgery, Frühwald details step-by-step instructions, with scores of illustrations, for plastic surgeons to correct deformities of the nose, ears, and face. Many different methods are discussed that had been recently discovered and improved upon. There is also a section on cosmetic surgery with descriptions on removing facial wrinkles and eyelid creases.