Dr. Abdelhalim MahmoudDr. Abdelhalim MahmoudENT Specialist ENT Specialist

Magrabi Hospital-Jeddah Magrabi Hospital-Jeddah

Rhinoplasty is plastic surgery that can be used

to improve the look of the nose or improve its

function.

Plastic surgery is defined as any procedure used

to correct or restore either form or function of a

body part.

Cosmetic rhinoplasty makes

the nose more beautiful.

Functional rhinoplasty

improves the function and the

look of the nose and usually

associated with other procedure

like Septoplasty referred to as

Septo-rhinoplasty.

The ancient origins of the

plastic surgery and

rhinoplasty go back to the

date 1213 B.C. in Egypt where

ancient Egyptian started to

do plastic surgery for there

mummies .

It was believed that one's face

was the only physical

attribute that carried over

into the after life .

Ramses II, an ancient Egyptian king , was noted for having a

very large , elongated nose .

To ensure he was recognized and received as a king in the

after life , his mourners surgically inserted bone and seeds

into his nose creating the 1st known record of Rhinoplasty.

Rhinoplasty is believed to have been first developed by

an ancient Indian physician Sushruta (600 BC) who

described reconstruction of the nose in the Sushruta

Samhita ( 600 BC)

The physician Sushruta and his medical students

developed and applied plastic surgical techniques for

reconstructing noses, genitalia, earlobes, etc, that were

amputated as religious, criminal, or military punishment.

The portion of the nose to be covered should be first

measured with a leaf. Then, a piece of skin of the required

size should be dissected from the living skin of the forehead

and turned back to cover the nose, keeping a small pedicle

attached to the forehead.

The physician then should

place the skin on the nose

and stitch the two parts ,

keeping the skin properly

elevated, by inserting two

tubes of eranda (the castor-

oil plant) in the position of

the nostrils, so that the new

nose has proper shape

Figure for old Indian instruments

Aesthetic Surgery

• Romans were the 1st to use plastic

surgery to improve self-image.

• Procedures for wealthy women

whose ears had become stretched by

the weight of their earrings .

• Freed slaves underwent procedures

to remove or cover the brands used

to mark them

• The most famous roman

plastic surgeon Aulus

Cornelius Celsus wrote

“De Medicina” how to

guide various plastic

surgery procedures in the

face and nose.

• Celsus book was the

plastic surgeon’s reference

guide for more than 1,700

year

Roman doctors used opium capsules ,

alcohol and pain relief for anesthesia ,

but the patients were always awake

during procedures .

Anesthesia and Tools in Roman Surgery

The Romans used primitive

versions of the same tools

plastic surgeons use today

including forceps , scalpels and

bone drills.

Method Of Anesthesia In Old Surgery

Rhinoplasty plays a Role in Roman Politics

• After being overthrown , a Roman

Emperor named Justinian II’s nose

was amputated in an effort to

prevent him from regaining the

thrown, his nickname “Rhinotmetus”

“one whose nose has been cut off.

• The outside emperor got nose job ,

after returning to Rome with his new

nose , Justinian II regained the

thrown and he ruled for several years

before his execution .

In the 11th century, at Damascus, the

Arab physician Ibn Abi Usaibia (1203–

1270) translated the Sushruta Samhita

from Sanskrit to Arabic . Sushruta’s

medical experience travelled from

Arabia to Persia to Egypt

The Islamic Conquest of India

and parts of Europe, brought

with it plastic surgery

techniques, including Sushruta’s

procedures for Rhinoplasty.

Ibn Abi Usaibia (1203–1270)

Spread of Plastic Surgery Techniques 9th-12th Century

AD

In the late sixteenth century,

an Italian surgeon named

GasparoTagliacozzi

described a procedure for

nose reconstruction in which

he attached part of the bicep

muscle to the patient’s face,

left his arm attached to his

nose for 5 weeks, and then

staged a second surgery to

separate the two.

By this technique Gasparo

tried to minimize scarring in

the face by taking the skin

from the arm, but the

problem was this method

required the arm remain

attached to the nose for 5

weeks.

In 1887, an American

Otolaryngologist, John

Orlando Roe, performed the

first Aesthetic Rhinoplasty

in modern history. He wasn’t

merely reconstructing a

missing nose, he was

correcting a deformity e.g.

saddle nose deformity

He wrote about nasal

Deformity Termed “Pug

Nose” ,,A short nose that is

somewhat flattened and

turned up at the end,, and its

Correction, by a Simple

Operation” in 1887. He also

discussed the correction of

the condition of saddle nose.

Two years later, Jacques

Joseph,(1865-1934) considered

by many the father of modern

Rhinoplasty and facial plastic

surgery,performed rhinoplasty

surgery on a 28 year-old man

whose extremely large nose

caused him such

embarrassment that he

couldn’t bear to appear in

public.

In 1931 he wrote his book,

“Milestone In Plastic Surgery”

in which he explained the

Nasal Plastic Surgery and

Other Facial Reconstructive

Procedures, with an Appendix

on Reconstructive Breast

Surgery and some other

Procedures in the area of

External Plastic Surgery, an

Atlas and Text Book.

• Rhinoplasty, became more sophisticated

and wide-ranging in the 20th century.

• In 1902 through 1904, Freer and Killian

developed sub mucous resection

Septoplasty, a surgery for the correction

of a deviated septum.

• In 1921, Rethi introduced the Open

Rhinoplasty approach featuring an

incision to the columella to gain access to

the nasal cartilage and facilitate

modifying the tip of the nose.

In 1947, Cottle performed a closed, or endonasal surgery for

rhinoplasty in which he gained access to the nasal bone and

cartilage through intra-nasal incisions .

One of the most confusing dilemmas in rhinoplasty is the choice between

open and closed techniques.

Each technique has its advantages and disadvantages

Table 1: Advantages & Disadvantages of Closed Rhinoplasty

Advantagesof Closed Rhinoplasty

Disadvantage of Closed Rhinoplasty

Shorter Surgery Time Requires more skill to refine nasal tip

Better Circulation to the nasal tip skin

Requires more skill to perform Revision Rhinoplasty

Less nose swelling

Faster Recovery

Table 2: Advantages & Disadvantages of Open Rhinoplasty

Advantagesof Open Rhinoplasty

Disadvantage of Open Rhinoplasty

Allows refinement of nasal tip in most difficult cases

Prolonged surgical time

Allows easy placement of cartilage graft

Prolonged swelling of the nose

Enables execution of complex maneuvers necessary for Revision Rhinoplasty

Poor circulation to the nasal tip skin

Easier approach for plastic surgeonsNasal skin incision scar over the columella

Prolonged recovery time

• Today the newer advanced

rhinoplasty techniques try to

maximize the chance of

successful outcome and

minimize the recovery time .

The surgeons uses the latest

advances to achieve a better

visualization techniques such

as the high definition 3D

Rhinoplasty to achieve a

precise and natural outcome.

High definition 3D Rhinoplasty

It is a type of endonasal rhinoplasty where the use of

the telescope (high definition) is used to better

visualize the bridge of the nose to get a better view

during the surgery on a high definition 3d screen,

allowing for a more natural result with a minimal

recovery.

Patients are paying more attention to the techniques

surgeons are using and learning more about what

they want before surgery.

Patients are seeking out surgeons for natural look.

They do not want to look done or a operated on

anymore.

• Rhinoplasty is one of the top 5 cosmetic procedures performed

in the United States every year

• 253,000 Rhinoplasty procedures were performed in 2010

according to the American Society of Plastic Surgeons (ASPS) .

74% of them are women.

The average total cost of

rhinoplasty ranges from $3,000

to $8,000. What the patient pay

will vary based on the surgeon’s

fee, the extent of structural and

cosmetic changes made to the

nose, and the geographic

location.