Rhinoplasty, today supposed to make “gracious” those important noses out there, is a relatively modern branch of surgery. However not many people know that the very first operations of nose reconstruction took place in India and Egypt in 2000 BC. Back to those years the condemnation to nose amputation was common for those who had committed adultery as well as other crimes.
The technique was described in details in a Hindu surgical essay dating 800 BC where it is mentioned the use of skin flap coming from forehead and cheeks for the reconstruction of the nasal pyramid.
Even the Roman Aulus Cornelius Celsus (25 BC– 50 AD) in his essay “De Medicina” treated such a topic; however to get to talk about rhinoplasty as an independent branch of surgery it was necessary to wait until the 16th century with Gustavo and Antonio Branca from Catania, who used skin flaps coming from cheeks and the inner side of the mouth for that type of operation.
Antonio Branca invented a technique which entailed the usage of skin taken from the arm. The peculiarity of such a method was that the shred of flesh was supposed to stay attached to both the nose and the arm in order to allow the vascularity of the tissue, hence their long-lasting reconstitution.
Paolo and Pietro Vianeo of Tropea utilised this technique as well between the 1540 and the 1565. Who was indicated as the founder to the rhinoplasty though was Gaspare Tagliacozzi (1545-1599), writer of the essay “De Curtorum Chirurgia per insitione”; there, inspired by the technique of Antonio Branca, he described the reconstruction of the nose by using skin taken from the pedunculated flap of the upper limb.
why during the Renaissance, where the practice of nose amputation was not common any longer, the rhinoplasty has such a high demand?
The cause was to be linked to the high transmission of the sexual disease of syphilis; it remained incurable until the discovery of penicillin in 1928. The victims were subject to skin ulcers, blindness, progressive paralysis, dementia and eventually dead.
People with syphilis usually used to develop a condition called “saddle nose” which would make the bone of the nose drop, with the nostrils moving forward and a gradual rotting of the flesh around it.
Below: picture showing an example of a light form of saddle nose
In the Renaissance society the saddle nose was sign of infamy, of moral lacking and corruption of the ill man. Due to all these prejudices linked to it, those who suffered from it were turning to expert surgeons such as Gaspare Tagliacozzi to help them hide their deformity.
Tagliacozzi became popular for having codified the surgical method of the pedunculated flap. Instead of removing a portion of skin from the forehead to recreate the nose, as it was popular in those times, he used to cut a nose-shaped flap of tissue from the arm; later on he would stuck the new nose onto the face of the patient, that for 2 weeks had to keep nose and arm joined together, waiting for the nose to be grafted. By that time the flap was then cut off and shaped with new skin. The entire process could take up to 5 months.
There were people who believed that such a method was inferior in terms of quality to the popular one of the time known as the “Indian Method” an in fact some of the noses recreated through the Tagliacozzi technique eventually rejected the tissue. Despite that, the surgeon kept on using this method until his death, affirming that the noses made by him were the very best ones. Even when the method fell into disuse after his death, it was still occasionally employed up until the WW2.
Above: the face of the soldier was heavily damaged in 1944 and the Tagliacozzi method was used for the reconstruction of his nose.