A Brief History of Rhinoplasty

By Sam Most, MD, FACS

The idea of changing nasal shape has been around for centuries. On my visit to the Uffizi a few years ago, I was struck by my tour guide’s description of this famous pair of portraits of the Duke and Duchess of Urbino by Piero della Francesca.

Do you notice anything about the Duke’s nose?  According to my tour guide, he did not just break his nose accidentally. His radix was reduced by him, or another, specifically to allow him to see better across his high nasal bridge! Rumor or fact? We’ll never know. At least two groups have written about this in the medical literature (Arch Soc Esp Oftalmol. 2010 Jan;85(1):47-50., “Seeing further than your nose.” Perception. 2013;42(5):481-7 van Tonder G1, Zavagno D, Sakurai K, Ono H., and ”The legend and the truth about the nose of Federico, Duke of Urbino”, Santoni-Rugiu P, Massei A., Br J Plast Surg. 1982 Jul;35(3):251-7).

In the more modern parlance, one of the first papers on rhinoplasty was published by John Orlando Roe, and otolaryngologist in Michigan, in 1887. His paper, entitled ‘Correction of the pug deformity’, he is credited with documentation of the first rhinoplasty.

We are a bit more sophisticated with our before and after pictures today.  However, this was groundbreaking at the time.  

The notion that one could elect to change the appearance of the nose was taken much further by Dr. Jacques Joseph, an orthopedic surgeon by training, who came to be one of the most famous facial plastic surgeons of all time.  He founded and headed the first hospital for Facial Plastic and Reconstructive Surgery, much of the work of which was a result of World War I injuries.  His interests broaded from reconstructive to aesthetic surgery of the face (and body).  Many of his concepts of nasal septal surgery and rhinoplasty are still used today.

For example, Dr. Joseph's concepts of reducing the bony and cartilaginous skeleton of the nose using precise cuts are still used today, albeit in modified form.

Throughout the 20th century, many surgeons (too many to name here) were important contributors to the development and refinement of rhinoplasty techniques. To name but a few, Dr. Maurice Cottle developed important concepts of nasal physiology as it relates to form. Dr. Irving Goldman popularized several techniques for endonasal rhinoplasty (so-called ‘closed rhinoplasty’--a term that is incorrect). Dr. Jack Anderson started as an endonasal rhinoplasty surgeon, became famous for it, then adopted external rhinoplasty (‘open rhinoplasty’, also an incorrect term). He became a major proponent of this technique, and spoke often of its advantages.