Rhinoplasty Boston

Boston Plastic Surgery

Rhinoplasty History

Rhinoplasty means surgery to alter the appearance and structure of the nose. Although this change may also be desirable for functional reasons, in today’s understanding rhinoplasty describes nasal surgery for cosmetic enhancement.
In 1845 removed the German surgeon Dieffenbach a nasal hump followed by American surgeons Roe (1887) and Weir (1892). Smith and Monks removed humps more elegantly by leaving the overlying nasal skin intact. It was then in 1898 when the young German surgeon Jacques Joseph performed the first successful modern rhinoplasty in Berlin. Both Joseph and the Parisian surgeon Bourget performed and expanded aesthetic rhinoplasty over the following years. As a pioneer in facial plastic surgery, Jacques Joseph made a rich contribution to rhinoplasty. Aside from surgical technique, many of the instruments used today for nasal procedures were developed by Joseph. After performing some nasal surgeries through external incisions, Joseph introduced what today is known as the endonasal rhinoplasty. With this techniques only internal incisions are necessary, visible cuts are avoided.

Most noses that are improved with rhinoplasty today are not the kind that Dr. Joseph encountered at the turn of the century. We rarely come across truly ugly noses that give origin for ridicule or even represent monstrosities. Most cosmetic nasal operations attempt to transform an average looking nose into an attractive one. This quest for beauty in conjunction with the complexity of the nasal anatomy and nasal dynamic make rhinoplasty one of the most challenging procedures. Joseph’s endonasal rhinoplasty techniques require that the surgeon “can see through the skin” in order to achieve the wanted results. Although possible, this certainly required thorough understanding of the nasal anatomy (without actually seeing it) and experience in rhinoplasty.

In the quest to make surgery of the nasal tip easier for the rhinoplasty surgeon, in the 1920s Rethi introduced a procedure where the nasal tip cartilages are exposed through external incisions. The skin is flipped up revealing the structural cartilages. After completing the operation, the skin is repositioned and sutured. Independent of Rethi’s technique, Padget described a similar technique called “external exposure” of the nose in 1938. Sercer, an ENT surgeon from Zagreb (Yugoslavia) expanded on Rethi’s idea and performed thousands of nasal operations using an open technique in the 1950s and 60s. He termed this approach “Decortikation der Nase”, which means in free translation peeling of the nasal envelope. Although the technique of the “open” rhinoplasty was popular in Europe, it took until the late 1970s and 80s to be explored in the US. Two facial plastic surgeons, Drs. Johnson and Toriumi, published in 1990 a book called “Open Structure Rhinoplasty” which introduced open rhinoplasty techniques to American nasal surgeons.

Today, both open and closed rhinoplasty techniques are used. The end-results are independent of surgical approach but more dependent on the surgeon mastering the details of rhinoplasty. One will find rhinoplasty surgeons favoring one over the other technique – usually recommending the technique this particular surgeon prefers.

In addition to expertise in rhinoplasty and the particular technique, the modern look of the nose prefers a natural and well-supported nose that will be stable for decades to come. The operated-on appearance of a small and pinched nose with a scooped bridge is not favored any longer.

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Written by cosmetic surgery specialist and boston rhinoplasty surgeon Dr. Fechner.
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