Rhinoplasty

History of  rhinoplasty dates back from the times of ancient Indian medicine when it was described by Sushruta, a genius surgeon of the time around 500 BC. He described  total reconstruction of the traumatised nose in ancient  Sanskrit language by a pedicled flap from the forehead. In addition he  described  about 29 various operations in the head and neck region and designed many surgical instruments studying the various beaks of the birds. These instruments  are still in use today with some modifications.

Later on in India a Dr. Tribhovan M. Shah, a chief medical officer in Junagadh district in Gujarat state wrote a monograph on Rhinoplasty  in 1889 based on 100 cases performed in five years.

Keegan (1900) – wrote personal experience in Rhinoplasty and quoted that in 1897 – 152 Rhinoplasties were performed in various parts of India.

Later in Europe , Tagliacoozi, a professional of anatomy in Bologna from Italy in 1597 described a technique of reconstructing a nose from an arm flap that did not become popular at large.

It was not until in the 20th century an orthopaedic  surgeon, jaqua joseph  from Berlin in Germany described removal of the hump of the nose and invented several instruments which are being named after him.

Even a small excision of the dome of the lower lateral cartilage has a significant effect in the ultimate shape of the nose due to scar tissue formation.  This would be more apparent in a thin skin individual like women and less in men with generally thick skin over the tip of the nose.  The excision has to be extremely precise with the possibility of development of the scar tissue and the ultimate result.

In assessing the surgical anatomy of the nasal skeleton, it is important to remember that there are wide variations in the number of nasal structures such as long, short, wide, narrow nasal bones and frontonasal process of maxilla especially if the surgeon in considering osteotomies in an individual patient. There are a number of variations in the size, shape, thinness, and thickness resilience  of the cartilaginous structures of the nasal skeleton.

As a result the surgeon must adapt a particular technique of correction of deformity to suit an individual patient for a successful or aesthetically pleasing outcome for the patient. Last but not the least, assess the thinness and thickness of the skin over the nasal skeleton. Any irregularities of the corrected nose will be easily seen through the thin skin than a thick skin individual.