A popular podcast called Stuff You Should Know recently released an episode called Rhinoplasty, aka Nose Jobs. This podcast is hosted by Chuck Bryant and Josh Clark, forever-curious people who first met as writers for HowStuffWorks.com. Together, Chuck and Josh educate the public about a myriad of things, showing how they work by simplifying them and unveiling surprising facts about them. This particular episode was done because host Josh was researching reconstructive rhinoplasty for a deviated septum from a childhood injury at the time of recording. While researching the procedure, Josh realized that rhinoplasty would be an excellent topic for the podcast, and we couldn’t agree more! In this episode, Josh and Chuck break down rhinoplasty by telling us about the history and evolution of the procedure and making it much more approachable by putting rhinoplasty into perspective for today’s patients!
Josh and Chuck begin by talking about rhinoplasty from what they know before researching. Both hosts agree that while it is possible to completely change a nose during rhinoplasty, “nose sculpting” or “reshaping” seem to be better terms since the modern take on rhinoplasty, or “the nose job,” where the surgeon doesn’t do anything “too ridiculously radical.” While rhinoplasty is still the term used by many medical professionals, Josh and Chuck are not too far off the mark. The word rhinoplasty itself is derived from 2 Greek words: rhino, meaning nose, and plasikos, meaning to shape and to mold. Plastikos is also where “plastic” in plastic surgery is derived! Especially in recent years, desired results tend to look more like nose reshaping rather than replacing. Many plastic and cosmetic surgeons today perform rhinoplasties that offer natural results.
To truly appreciate how far rhinoplasties have come, Josh and Chuck take us through the history of the procedure. We were inspired by their synopsis and created a timeline below adding in a few more landmarks to highlight the evolution of rhinoplasty throughout its long history!
3000 BCE: The Edwin Smith Papyrus
Rhinoplasty dates back to as early as 3000 BCE in Ancient Egypt, where procedures for facial reconstruction were documented in what is now referred to as the Edwin Smith Papyrus.
Crude methods used to repair and reshape the nose are also recorded in the Ebers Papyrus, dating back to 1550 BCE.
7th Century: Sushruta, the Father of Plastic Surgery
In 7th century India, thieves and adulterers were punished by cutting off or mutilating the nose, as mentioned by Josh and Chuck at the beginning of the podcast. A physician during this time known as Sushruta, a given title meaning “renowned,” developed methods of repairing and replacing noses. Using his techniques, he published a detailed manual where he describes many different procedures, including one using a skin flap, cut from the cheek, to lay over the nose and repair it for aesthetic purposes. This technique, named The Indian Flap, was incredibly advanced, especially for the time, and remained in use into the 20th century. Elements of the procedure are still reflected in rhinoplasties today. His development and documentation of such techniques led to his moniker of “Father of Cosmetic Surgery.”
Syphilis and the use of Flaps
The syphilis outbreak in the late 15th and early 16th centuries led Western nations to adopt Sushruta’s methods. In 1597, Gaspare Tagliacozzi utilized skin from the upper arm, rather than the cheek, to perform the Indian Flap procedure on those whose soft facial tissue had been ravaged by the necrotic effects of the disease.
In the 18th century, East India Company surgeons James Findlay and Thomas Crusoe watched a rhinoplasty surgery in India that implemented a modified version of Sushruta’s methods where a flap from the forehead was utilized. They published what they witnessed, which led to a resurgence of reconstructive surgery in the West.
1887: First Intranasal Rhinoplasty
In the late 19th century, Dr. John Orlando Roe is the first modern surgeon to perform saddle nose deformity rhinoplasty and record it in medical journals.
Jacques Joseph, aka “Nose Joseph,” did rhinoplasties during World War 1 to assist soldiers returning from World War 1 with deformities from bombs, bullets, and burgeoning chemical warfare. He then proceeded to perform rhinoplasties on Jewish Europeans to assist them in assimilating into increasingly hostile European societies. While Jacques Joseph was a medical professional, his successful foray into aesthetic procedures led to an increase of unlicensed practitioners performing questionable rhinoplasties and other cosmetic augmentations.
Today: Advancing Plastic Surgery and Rhinoplasty
Stringent regulations and licensing were introduced, and the cosmetic and reconstructive surgery community has improved immensely. It is constantly being improved through careful research and study by surgeons worldwide.
After delving into the history of rhinoplasty, Josh and Chuck give a great anatomy lesson on the nose before defining a few different types of rhinoplasties. If you're seeking rhinoplasty, it can be very helpful to familiarize yourself with nasal anatomy. But, if you don't grasp it, don't worry. A great surgeon is happy to explain everything in common terms to patients.
Once their crash course on nasal anatomy is complete (great job to them!), Chuck and Josh delve into a few different types of rhinoplasty procedures available today by most rhinoplasty surgeons.
They first mention projection rhinoplasty, where the nose is elongated and projected to make it look more narrow and distinct using cartilaginous tissue from other areas of the body. Next, they define open and closed rhinoplasties. Open rhinoplasty is where a single incision is made at the columella (the “column” between nostrils). This procedure is preferred when extensive cartilaginous extraction is necessary. A small scar can be left after the healing process, and it has a longer recovery time, but the procedure also allows more access to the cartilaginous tissues and bone in the nose. Closed rhinoplasty is where an incision is made in each nostril, allowing access to the cartilaginous tissue and bone in the nose. This procedure does not leave a visible incision during the healing process and may have a faster recovery time than open rhinoplasty, depending on the patient.
The hosts of Stuff You Should Know then mentioned some of the less pleasant sides of aesthetic procedures. They noted an interview where an Iranian woman said, “Women do nose jobs… because it’s the only part of their body they can show in society. We have to wear a scarf over our hair, so we get a nose job to make ourselves beautiful, and it starts in high school.” Iranian women have some of the highest rates of rhinoplasty of all demographic groups at 180 cases per 100k people. They also touched on the prevalence, both in the past and today, of ethnic rhinoplasties. An ethnic rhinoplasty typically augments the nose to make it appear more “European” and is usually done to better “pass,” or blend, in a society with a eurocentric beauty standard. While the advent of self-acceptance and body positivity has led to a decrease in such procedures, it is still sought out by some patients. On this note, they also discussed how the recent surge in body-positive media led many people to seek a procedure to undo either a botched or ethnic rhinoplasty called a reverse rhinoplasty to find a nose shape that suits the patient and better reflects their personality and heritage.
During their conversation, Josh and Chuck spoke about why someone might want to have the procedure done and the costs associated with a rhinoplasty in the United States. As they mentioned, there are many reasons someone might seek out a rhinoplasty: wanting purely aesthetic changes or something more functional such as fixing a hole in the septal wall, changing the shape of the nose to solve difficult breathing, and correcting a departure of the septum from the centerline are just a few.
The average cost of rhinoplasty across the United States is between $5,000-$10,000 though that will vary based on location and practitioner and can cost up to $25,000 in certain areas of the country. Ultimately, your choice of the place and surgeons comes down to personal preference.
Finding a doctor that you feel comfortable with is very important. Be sure to ask questions and talk through possible outcomes so you know what to expect. Many insurances will cover the procedure if you go in for a deviated septum or other related health concern so be sure to ask your surgeon if your procedure is covered.
Josh was sure to mention the importance and difficulty of post-operative recovery. After a rhinoplasty, the nose will be extremely sensitive. This means you will want to avoid sneezing or blowing your nose, breathing should be done through the mouth, and take precautions to ensure optimal results with the best recovery time. You will want to set aside around 2 weeks to take care of yourself at home before resuming daily activities at a pace recommended by your surgeon. Communication with your doctor about what your recovery process will look like is critical for setting your expectations for recovery time and precautions appropriately. Many surgeons will place a postoperative splint for the first week and then utilize taping or custom postoperative splints to continue to manage swelling and protect the nose during healing.
If you are looking to get a rhinoplasty, do your research! Start with taking a 3D scan of yourself from home to give you a better foundation for understanding how you look today. Photos can be misleading and oftentimes don’t accurately reflect our faces. From there, make a list of questions and start looking for a surgeon near you or in a city you can travel to and from safely.
Many patients may elect to do surgery with a surgeon that requires significant travel. While this can give you even more options for surgeons to choose from, you’ll want to be sure you can maintain postoperative contact while you recover. You may need to stay in a hotel for at least a week to initially recover safely.
As you evaluate surgeons online, we recommend looking at their results. Do they show before and after photos from many angles? Are the photos current or outdated? Do you see a variety of results or mainly one type? If one type, is that what you want or envision for yourself?
Seeking out surgery, even for something as common as rhinoplasty, is a big decision. Take your time. Find a surgeon you trust. And be sure to communicate openly with your surgeon and be willing to listen to what is surgical feasible and safe.
Have more questions? You can reach out anytime and we’ll try to answer any questions you have.