On an Ancient Egyptian papyrus scroll, a scroll measuring 15.4 feet long, is the oldest recorded rhinoplasty method in history. It is dated to circa 2,500 B.C. Even then, folks understood that small noses often correlated to big egos. Not until approximately 3,200 years later, however, would someone become the official godfather of modern rhinoplasty.

He was an Indian physician named Sushruta. His method was simple and effective, more often than not. He sliced off skin from the patient’s cheek and, after filleting the nasal stump, attached that flap of cheek skin to the nose-to-be. The patient would stick two castor oil stalks up his nose until it had finished forming some months later. Some noses, unfortunately, were known to turn purple and fall off.

1280px-Shushrut_statue

“Shushrut statue” by Alokprasad at en.wikipedia. Licensed under CC BY-SA 3.0 via Wikimedia Commons

Thankfully, procedures had evolved by the 20th century. In 1902, a time when cars lacked both windshields and roofs, physicians Freer and Killian developed the submucous resection septoplasty to correct a deviated septum. After slicing through the cartilage and bone of the nasal septum, they easily relocated it. Two one-centimeter supports at the dorsum and caudad, located at the middle and top of the nose bridge, respectively, kept the nose from collapsing upon itself. Patients benefited from improved respiratory health.

Rethi pioneered a new surgery in 1921, one that adjusted the tip of the nose by cutting into the columella. That same decade, physicians Metzenbaum and Peer were the first to brave the caudal septum, located behind the forehead. Metzenbaum preferred to remove almost the entire nose, a vivisectionist procedure he callously named “the swinging door technique,” but Peer wanted to just remove the septum, straighten it out, and then reinsert it.

Medical advances during the World Wars, including the perfection of anesthesia, transformed rhinoplasty from a mere reconstructive surgery into a national hobby. Physicians had figured out how to safely adjust the tip, bridge, orientation and size of the nose. Even John Wayne, that Old Duke, went under the knife.

During the 1960s, surgeons began using silicone gel to plump up the soft tissues of the nose. Unfortunately, direct insertion caused ulcers and granulomas, so one surgeon named Orentreich devised a new method, one in which tiny droplets of silicone were inserted over multiple visits.

One last debate remained: endonasal (closed) rhinoplasty versus external (open) rhinoplasty. During closed surgeries, surgeons labored inside the nostrils. Unfortunately, nostrils being as small as soda straws, this limited visibility and finger access. Sometimes, the nose was stretched so vigorously that, like an old Slinky, it refused to return to its original shape.

Endonasal rhinoplasty remained the go-to procedure until the 1970s. Surgeons Goodman and Padovan publicly advocated their technical refinements of the open rhinoplasty, a procedure in which a trans-columellar incision allowed the façade of the nose to be lifted back like a car hood. In 1987, surgeon Gunter proved that open rhinoplasty worked well for revisions as well as primary surgeries.

By the time 2000 arrived, both methods had their staunch supporters. Neither one, thankfully, caused someone’s nose to turn purple and fall of.