History of Dorsal Preservation Surgery: Seeking Our Historical Godfather(s) for the "Push Down" and "Let Down" Operations.

There are 2 approaches for lowering the osseocartilaginous nasal dorsum. The most frequently used method includes resection of the osseocartilaginous nasal dorsum. The second method is based on preservation of the osseocartilaginous nasal dorsum. The concept of dorsal preservation surgery is to preserve, not resect, the nasal bones and upper lateral cartilage. Reduction rhinoplasty with preservation of the nasal dorsum is not only possible, but results in a natural appearing postoperative dorsal esthetic line. Thus, the rhetorical question: Why reconstruct the nasal dorsum when you can simply preserve it?

The First Descriptions of Dorsal Preservation Rhinoplasty in the 19th and Early- to Mid-20th Centuries and Relevance Today.

INTRODUCTION: The basis of dorsal preservation rhinoplasty goes back to the late 19th and the early 20th centuries. In that era, pioneers such as Drs. Goodale, Lothrop, and Cottle were prominent surgeons who reported on this technique. Currently, there has been a renewed interest of this technique that stems from the nasal anatomy and an interest in less destructive techniques. In this review, we discuss examples of the contributions of those surgeons, which represent some of the earliest experiences in this field. METHODS: We reviewed several journals from the late 19th and early 20th centuries as detailed in the references section. We collected the related publications on closed reduction techniques performed by Drs. Goodale, Lothrop, and Cottle. RESULTS: The publications on closed reduction techniques by Drs. Goodale, Lothrop, and Cottle described similar thought processes and techniques comparable to current dorsal preservation rhinoplasty techniques. The thought processes of these 3 renowned rhinoplasty surgeons appear to be very much relevant today. CONCLUSIONS: Although there has been recent resurgence in dorsal preservation rhinoplasty techniques due to anatomical and functional aspects of the nose, the basis of dorsal preservation rhinoplasty goes far back to more than 100 years ago.

40 Years of Total Extracorporeal Septal Reconstruction: The Past, Present, and Future.

BACKGROUND: Even today, severe septal deformities are a challenging problem for any rhinoplasty surgeon. Standard techniques are often not able to achieve satisfactory long-term results regarding function or aesthetic form. In such severe cases, a partial or total extracorporeal septal reconstruction may be used, as these techniques provide reliable and lasting results. METHODS: The aim of this work is to present the authors' experience with the technique of total extracorporeal septal reconstruction and its development to today's standard and to prove its effectiveness in the long-term follow-up. RESULTS: This article presents 40 years of clinical experience in this field and describes the technical changes that have evolved. Low complication rates, safe techniques, and favorable long-term outcomes of the total extracorporeal septal reconstruction show the benefits of this technique. CONCLUSION: The indication for a total extracorporeal septal reconstruction has been limited by the development of less complex surgical procedures, but it still represents the best technique to achieve long-term functional and aesthetic results in patients with very complex septal deformities. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Trascendencia de la cirugía plástica y la rinoplastia en la historia y la filosofía de la medicina / Transcendence of plastic surgery and rhinoplasty in the history and philosophy of medicine

Se explica el origen de los términos cirugía plástica y rinoplastia, así como los inicios de la especialidad y de esta cirugía nasal. Se exponen cuáles fueron las necesidades que atendieron y qué lugar ocuparon la reparación y la reconstrucción en la historia y la filosofía de la medicina. La cirugía plástica se instaló como la disciplina quirúrgica encargada de buscar la recuperación de la identidad perdida. (AU)

The origin of the terms of "plastic surgery" and "Rhinoplasty" is explained, as well as the beginning of the specialty and this nasal surgery. It explains what his need was and how he filled that gap, the repair and reconstruction in the history and philosophy of medicine. It was installed as the surgical discipline in charge of seeking the recovery of the lost identity. (AU)

The Paramedian Forehead Flap for Nasal Reconstruction: From Antiquity to Present.

Nasal reconstruction is considered the historic foundation of facial plastic surgery, and the forehead flap remains the workhorse of repair. To recreate both the aesthetic contour and function of the nose, all anatomic layers must be addressed-covering, lining, and structural support. This article reviews the noteworthy history underlying the development of the paramedian forehead flap as the primary tool in reconstruction of large nasal defects while highlighting its implications on modern nasal repair. Current developments in the use of 2-staged paramedian forehead flap reconstruction are examined and a modern technique is presented.

Nasal Tip Grafts.

OBJECTIVES: The nasal tip is the most prominent part of the nose. The aim of this paper is to review nasal tip grafts with detailed explanation and figures. METHODS: The authors searched PubMed, Google, Google Scholar, and Proquest Central database of the Kirikkale University. Search was performed with the key words of "nasal," "tip," "graft." The indications and grafting techniques were presented. RESULTS: The external shape of the nasal tip is determined by the curves and contours of the lower lateral cartilages and their interactions with the surrounding tissues. Normative data exist regarding the ideal shape and shadowing of the nasal tip. The mainly used tip grafts in rhinoplasty are "Floating graft (Goldman) ," "Tip Onlay Graft," "Columellar Strut Graft," "Caudal Septal Extension Graft," "Shield Graft," "Alar batten onlay graft," "Lateral Crural Strut Grafts," "Alar rim grafts." CONCLUSION: When tip sutures are not enough, cartilage tip grafts offer a versitile and effective way to change the nasal tip. While there has been a vast array of grafting techniques described, this paper reviewed many of the most popular and useful grafts in modern use.

History of plastic surgery: Art, philosophy, and rhinoplasty.

The 200th anniversary of K. F. Graefe's "Rhinoplasty," E. Zeis' naming of the specialty of plastic surgery in 1838, and the continuing discussion on what is plastic surgery have prompted this historical-conceptual review with a semantic insight into the meaning of the word "plastic." A literature search has revealed that this term contains dual aspects: artistic and philosophical. The progressive development of these two connotations can be traced from their origin in the ceramics and the myths of ancient Greeks to their metamorphoses in fine arts, science, and philosophy of plasticity of the modern day. Although the names of plastic procedures and the title of the specialty carry both the artistic and philosophical features, the philosophical notion is less evident. This article underlines the importance of etymology in the interpretation of the concept of plastic surgery.

On the Function, Utility, and Fragility of the Nose: Early Modern Patients and Their Surgeons.

This paper presents how rhinoplasty as a surgical technique with a particular social impact developed, and how motivated patients and courageous surgeons contributed to the process before Gaspare Tagliacozzi published his seminal work De curtorum chirurgia in 1597. The few sources that provide evidence of people having their noses reconstructed enable us to understand how this technique gradually spread across Europe from the south of Italy northwards. They also give information about the fate of some individual patients and their surgeons. While patients considered rhinoplasty a painful but worthwhile procedure, liberating them from having to wear a prosthesis, scholars' and physicians' opinions on the subject were polarized.

Facial Transplants: What are Authentic Faces?

Do our faces reflect who we are? Or do they display the person we would like to be? Or even the person our society would like us to be? What is the difference between "enhancement" and "reconstruction", between "improving" facial features and restoring them? To what extent is the definition of these terms determined by cultural assumptions, particularly when it comes to what makes our appearance "authentic"? This article critically investigates the frequently circulating opinion that face transplants serve to reconstruct, while cosmetic surgery "improves" our appearance according to our wishes. The historical case study presented here begins with the history of nose operations in Berlin in the 19" century and ends with the practice of face transplants in the 21st century.

Heinrich von Pfalzpaint, Pioneer of Arm Flap Nasal Reconstruction in 1460, More Than a Century Before Tagliacozzi.

Heinrich von Pfalzpaint (circa 1415-1465) was a Bavarian military surgeon of the Teutonic Order who treated more than 4000 casualties during the siege of Marienberg Fortress (1454-1457). In 1460, he reported "How to create a new nose if it has been chopped off and the dogs have eaten it" in his treatise on wound care Bündt-Ertznei. He used opium-soaked sponges for anesthesia, described the surgical extraction of bullets and cleft lip repair. Pfalzpaint would have been the first author to describe nasal reconstruction in Europe if his treatise had not been lost. Only 5 copies of his manuscript existed. One was rediscovered and printed in 1868. Pfalzpaint's technique for nasal reconstruction was performed in 2 stages using an undelayed skin flap from the upper arm, which was sutured to the nasal defect and the arm was bandaged to the head. After 8 to 10 days, he divided the pedicle; inset the flap; and fashioned the nasal dorsum, alae, and columella. Tagliacozzi described arm flap nasal reconstruction more than a century later in 1597. He used delayed skin flaps, with at least 6 operative stages over 4 months. Pfalzpaint was ahead of his time regarding his knowledge of wounds, insistence on surgical cleanliness, and his technically easier arm flap rhinoplasty, compared with Tagliacozzi. Pfalzpaint, who is rarely referenced in the literature, should be remembered as a great pioneer of reconstructive surgery in Europe.

Sir Harold Delf Gillies, the otolaryngologist and father of modern facial plastic surgery: review of his rhinoplasty case notes.

BACKGROUND: Sir Harold Gillies, born in New Zealand, is widely considered a British icon and the father of modern plastic surgery. OBJECTIVE: This article provides an overview of his life and the circumstances which led to him laying the foundations of plastic surgery in Britain in the early twentieth century. METHODS: A hand search and review of case notes from the Gillies Archives at Queen Mary's Hospital in Sidcup, UK, where he made history, was conducted. RESULTS AND CONCLUSION: Gillies' ongoing legacy was found to also include his influence on the development of his cousin Sir Archibald McIndoe's work. Gillies was a talented sportsman who engaged in charitable activities. Additionally, he was a gifted teacher, with his hospital attracting many young surgeons from around the world. He was found to have expressed genius in both the design and execution of the art and science of surgery. He incepted reconstructive techniques ranging from the world's first gender reassignment operation to facial reanimation procedures for the treatment of facial paralysis. His operative work on ex-servicemen in need of complex rhinoplasty and in particular the inception of the tubed pedicle flap are depicted.

[Sir Harold D. Gillies, pioneer of plastic surgery]. / Sir Harold Gillies, pionier van plastische chirurgie.

In the First World War, large numbers of soldiers perished because machine guns and artillery bombardments had rendered the old techniques of combat and weapons hopelessly outdated. In addition to the many deaths, many soldiers were also seriously injured. At the outbreak of the First World War, ENT surgeon Harold D. Gillies signed up with the Royal Army Medical Corps. He used his knowledge of reconstructive surgery in a creative and innovative manner to treat the severely mutilating facial injuries. He thus improved the established techniques of nose reconstruction, skin grafts and facial reconstruction. At the end of the First World War, he had operated on about 11,000 casualties. Surgeons from every part of the world adopted his new principles and Gillies thus created the specialism of plastic and reconstructive surgery. Some of the techniques developed by Gillies are even still in use today.

Instruments in rhinoplasty: who is behind the name?

Rhinoplasty is considered one of the most commonly performed and most challenging operations in facial plastic surgery. The modern facial plastic surgeon utilizes many instruments in performing this procedure. Many of these instruments take their names from the pioneers who invented or designed them. Although meritorious, the recent trend in medicine to move away from eponyms in lieu of descriptive names should not come at the price of forgetting history. Although this communication does not seek to provide a comprehensive history of rhinoplasty or of its pioneers, our aim is to mention several of the salient contributing figures upon whose shoulders we stand and whose eponymous instruments we use commonly in rhinoplasty.

Correction of the deviated septum: from ancient Egypt to the endoscopic era.

BACKGROUND: Obstructed nasal breathing can occur due to deviation of the nasal septum. When the external nose appears grossly normal and cosmesis is not the focus, septoplasty has been the procedure used to straighten the septum with the goal of improving nasal airflow. Septoplasty has evolved over time. METHODS: A historical literature review was conducted to look for primary source journal articles and medical conferences proccedings addressing the evolution of the septoplasty procedure. RESULTS: Early techniques involved forcible fractures and splinting. Submucous resection was the first major advancement in surgical technique. Once the complications resulting from this technique were observed, it was subsequently revised with attempts to better address the caudal septal deviation. Attention was then turned to better incorporating the role surrounding support structures, such as the upper lateral cartilages. The premaxilla-maxilla approach attempted to address the overall nasal structure to best improve nasal breathing. The advent of endoscopic technique has been the most recent shift in surgical technique with improved visualization allowing for targeted septoplasty and reoperation on complicated cases including pituitary and skull base surgery. CONCLUSION: This paper discusses the evolution of septoplasty techniques over time from the initial undertakings of the ancient Egyptians to the modern-day septoplasty. While the principles behind septoplasty have remained much the same, experience has allowed for refinement of surgical technique. No doubt new instrumentations and innovations will further help to tailor the practice of septoplasty to the anatomy and functional needs of each individual patient.

[History of aesthetic rhinoplasty]. / Histoire de la rhinoplastie esthétique.

One of the first surgical procedures described in the history of medicine is reconstructive surgery of the nose. Over the centuries, surgeons have developed techniques aimed at reconstructing noses amputated or traumatized by disease. The concept of aesthetic rhinoplasty was only introduced at the end of the 19th century. Since then, techniques have evolved toward constant ameliorations. Nowadays, this surgery is one of the most performed aesthetic procedures. Current technical sophistication is the result of over a century of history marked by many surgeons. All of these techniques derive from a detailed understanding of the anatomical nose from the surgical and artistic point of view.

Sushruta: father of plastic surgery.

Sushruta is considered the "Father of Plastic Surgery." He lived in India sometime between 1000 and 800 BC, and is responsible for the advancement of medicine in ancient India. His teaching of anatomy, pathophysiology, and therapeutic strategies were of unparalleled luminosity, especially considering his time in the historical record. He is notably famous for nasal reconstruction, which can be traced throughout the literature from his depiction within the Vedic period of Hindu medicine to the era of Tagliacozzi during Renaissance Italy to modern-day surgical practices. The primary focus of this historical review is centered on Sushruta's anatomical and surgical knowledge and his creation of the cheek flap for nasal reconstruction and its transition to the "Indian method." The influential nature of the Sushruta Samhita, the compendium documenting Sushruta's theories about medicine, is supported not only by anatomical knowledge and surgical procedural descriptions contained within its pages, but by the creative approaches that still hold true today.

Plastic surgery in 17th century Europe. case study: Nicolae Milescu, the snub-nosed.

The rising and the existence of plastic and aesthetic surgery in early modern Europe did not have a specific pattern, but was completely different from one nation to another. Colleges of Physicians could only be found in some places in Europe; different Parliaments of Europe's nations did not always elevate being a surgeon to the dignity of a profession, and being a surgeon did not always come with corporate and municipal privileges, or with attractive stipends. Conversely, corporal punishments for treacherous surgeons were ubiquitous. Rhinoplasty falls into the category of what Ambroise Paré named "facial plastic surgery". The technique is a medical source from which many histories derive, one more fascinating than the other: the history of those whose nose was cut off (because of state betrayal, adultery, abjuration, or duelling with swords), the history of those who invented the surgery of nose reconstruction (e.g. SuSruta-samhita or Tagliacozzi?), the history of surgeries kept secret in early modern Europe (e.g. Tropea, Calabria, Leiden, Padua, Paris, Berlin), and so on. Where does the history of Nicolae Milescu the Snub-nosed fall in all of this? How much of this history do the Moldavian Chronicles record? Is there any "scholarly gossip" in the aristocratic and diplomatic environments at Constantinople? What exactly do the British ambassadors learn concerning Rhinoplasty when they meet Milescu? How do we "walk" within these histories, and why should we be interested at all? What is their stike for modernity? Such are the interrogations that this article seeks to provoke; its purpose is to question (and eventually, synchronise) histories, and not exclusively history, both in academic terms but also by reassessing the practical knowledge of the 17th century.