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.

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.

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.

[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.

The ear and the nose in literary parodies. the "hymn of deafness" by Du Bellay and "the nose" by Gogol.

Literary parody is a mode of expression characterized by irony. Every people, every language showcases its own genius in it. Du Bellay practices self-mockery. Gogol opts for a comic marked by the fantastic. Nevertheless, in both cases, parody is but a means to hide misery: behind its mask, human suffering is hinted at (Figures 1,2).

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.

The primacy of the Vianeo family in the invention of nasal reconstruction technique.

The birth of plastic surgery is identified with the history of rhinoplasty, which was practiced in ancient India when nose amputations were a common practice. Nose reconstruction was the most frequent surgical operation required in India at that time, and it was based on the use of a forehead flap and called an Indian method. The revolution of this technique took place in the south of Italy in the 15th century with the introduction of "the Italian method" invented by 2 families: the Brancas from Sicily and the Vianeos from Calabria. In our opinion, many questions remain as to why the Branca and Vianeo families began nose reconstruction; how and from whom they learned this technique; and which of the 2 families was first to practice it. Gustavo Branca has been always considered as the inventor of the Italian method. Historical references date Brancas in the first half of 15th century and Vianeos in the second half of the same century, but the dates can be inverted. Vianeos are no more the successor, but they are contemporary or immediately predecessors because by our documentation Vincenzo Vianeo, first surgeon of his family, performed rhinoplasty operation in the early years of the 15th century.

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.

[Pioneers and martyrs: Delpech, Guinard, Pozzi]. / Pionniers et martyrs : Delpech, Guinard, Pozzi.

Jacques Mathieu Delpech, Aimé Guinard Samuel Pozzi, three famous surgeons of the 19th and early 20th century were murdered by patients. All three contributed to the history of plastic surgery. Delpech (1777-1832) carried out the first plastic surgery in France using a forehead flap to replace a loss of substance on the face, Guinard (1856-1911) did the first reduction mammaplasty. Pozzi (1846-1918) was probably the first to perform an operation of face lift on one of his patients but did not publish it. These three surgeons were killed by unbalanced patients they had operated of benign lesions.

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.

The nose between ethics and aesthetics: Sushruta's legacy.

OBJECTIVES: The aim of this article is to determine the origin of interest in rhinoplasty in ancient India, as well as to discuss the ethical and aesthetic implications of the nose in human history. STUDY DESIGN: Literature review. MATERIALS AND METHODS: Articles on history of medical ethics and rhinoplastic surgery were reviewed. RESULTS: Sushruta is considered "the father of plastic surgery," and ancient India a cradle of rhinoplastic method called "the Indian method." Origin of interest in and need for rhinoplasty is deeply rooted in ancient Indian society due to the practice of nose mutilations as a form of public punishment for immoral conduct. CONCLUSION: The nose, once symbol of morality expressed through physical integrity, today becomes an important factor of human beauty. Rhinoplastic surgery is, both then and now, deeply pervaded with both ethics and aesthetics.

Reconstruction of the nose--a historical review.

As the central and most prominent part of the human face, the nose contributes to determine the beauty of a person significantly. Certain ancient populations, particularly in India, had the common tradition to cut off a person's nose as an act of humiliation to thieves and prisoners of war or vengeance for some real or fancied wrong. To erase the signs of this cruel disfigurement, the ingenuity of surgeons conceived different solutions over the centuries, therefore the birth and evolution of plastic surgery strictly parallel the art of replacing missing noses. Nasal restoration by means of a skin flap taken from the arm is an operation of Italian origin, whereas by a skin flap taken from the forehead is an operation of Indian origin. This review highlights the development of this interesting and at the same time challenging surgical technique. Currently, the forehead flap is considered the solution of choice due to the excellent colour match. However, for the success of the repair it is essential to have the forehead flap of a correct size and shape depending on the defect. Nowadays, the operation has achieved excellent results due to the accuracy of technical details. Defects of the nasal tip require replacement of the different layers, mucosa, framework and cover. Donor areas must be carefully selected to leave minimal local morbidity, whereas recipient sites are treated aesthetically so as to obtain the most successful type of repair. In conclusion, the lesson from our forefathers has positively influenced the evolution of nasal reconstruction techniques.

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.