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Ancient nose jobs not so pretty

Medicine | ESOTERICA MEDICA

June 12, 2006|Elena Conis

Cosmetic surgery dates back to the 1890s, when anesthesia and sanitation were finally advanced enough to warrant smoothing out or resizing a nose for purely aesthetic reasons. Surgeons had been reconstructing noses -- and other body parts -- for medical reasons for more than 2,000 years at that point.

Elena Conis

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Around 600 BC, an Indian surgeon, Sushruta, jotted down tips for restoring damaged noses and ears. He instructed surgeons -- often members of the tile and brick makers' castes -- to cut skin from the cheek or forehead, press it to the severed part, and sew the ensemble back in place.

It was handy advice: In India at that time, adultery and other crimes were grounds for having one's nose cut off.

In ancient Rome, surgeons reconstructed lost ears and noses of gladiators, and medical tomes of the day included instructions on avoiding unsightly scars and collapse of the new appendages.

That knowledge may have been of particular help to Emperor Justinian II, who was deposed in 695 AD. Believing a disfigured man could never reign, his foes cut off his nose. But Justinian returned to power in 704, and scholars point to signs of a forehead scar on old imperial statues as evidence he'd had a nose job.

In subsequent centuries, surgery fell out of favor. When it came back into fashion in 15th century Europe, it was mainly the domain of barbers. A pair of Sicilian barbers, for example, reconstructed noses using upper arm flesh (the result was a nose that was whiter than the rest of the face). In another case from that era, Leonardo Fioravanti, an Italian military surgeon, reattached a soldier's nose while posted in North Africa. He picked the nose out of the sand, washed it with his urine and sewed it back on.

Surgeons and barbers sometimes took tissue for re-crafting noses and ears from "donors" -- a sister or neighbor, or even a duck. They were puzzled by the astounding rate at which those new noses and ears shriveled up and fell off. They concluded that the flesh was "sympathetic" -- that it died when its donor did.

European interest was rekindled in the 1700s, when tales of Indian rhinoplasty traveled west. The tales inspired one British surgeon, Joseph Carpue, to test the technique on cadavers. By his own account, he could restore a missing nose in just over 15 minutes.

European surgeons further honed such techniques. Armed with anesthesia, surgeons no longer had to rush to spare their patients pain. The advent of germ theory led to fewer infections. By the 1890s, a few doctors argued that rhinoplasty could be performed for aesthetic reasons alone.

World War I drove more advances in plastic surgery than any other period. Trench warfare resulted in so many head and neck injuries that the U.S. military appointed 30 doctors to reconstruct shattered jaws, missing ears and lips and unrecognizable noses. WWII ushered in techniques to rebuild entire limbs, graft skin to extensive burns and advance the field of hand surgery.

Today, plastic surgery is more cosmetically oriented than ever: Of the 15.6 million procedures performed by U.S. plastic surgeons last year, more than 10 million were purely cosmetic. Liposuction topped the list -- but, in a nod to the practice's start, rhinoplasty came in a close second.

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