Cosmetic Surgery had its beginnings at the end of the nineteenth century. At first, the morality of people willing to undergo such surgery was questioned, but with time, the procedure gradually became more acceptable.
There were many factors affecting the growth of cosmetic surgery. The development of general anaesthesia was a key issue since, until the 1920’s, dripping Ether onto a rag covering the patients face was the most one could expect. The discovery of the first antibiotic and Sulfanamide, in the 1930’s was also a major factor, as the risk of infection in such operations was high. Antibiotics became more widely used after World War II. Most importantly perhaps, surgeons merely lacked knowledge or the appropriate techniques needed to perform effective cosmetic surgery. With the development of general anaesthesia, antibiotics and new techniques, reliable operations and instruments could then be designed to accomplish cosmetic changes and reduce the risks involved.
Throughout its history, cosmetic surgery has always attracted opportunists; surgeons seeking a quick and easy profit. At first, people were keen to believe in the promise of youthful looks and were prepared to pay handsomely for it. In the early days, patients seeking cosmetic surgery had merely wanted scars concealing, but by the 1950’s women were demanding their noses to be reshaped, purely to be in keeping with fashion and the popular image of beauty.
Reputable cosmetic surgeons are firstly general surgeons, plastic surgeons or otolaryngologists familiar with the body in general. They are therefore able to manage any surgical complaints which might arise. Traditionally, the best surgeons have actually been trained as reconstructive surgeons, helping patients to look normal.
One’s nose draws the observer’s eye because of its prominent position in the middle of the face. Surgeons have realized the anguish an obtrusive nose can cause to its owner and have developed ways to solve it.
Surgeons at first had to experiment in altering the shape of the nose. They trimmed nostrils that were too wide, elevated drooping tips and flattened humps of bone and cartilage to smooth humped noses. The real challenge was not the operation itself but leaving no obvious scars afterwards.
Johann Friedrich Dieffenbach (1794-1847), a Prussian surgeon,made the first recorded attempt to reshape a nose. He removed a wedge of flesh in order to raise a drooping tip and generally reduce the size of the nose. To slim the thick skin of a man’s nostrils, Dieffenbach removed wads of skin using a punch, an instrument similar to the tool used by a leather or metal worker.
John Orlando Roe (1848-1915), an ear, nose and throat surgeon from Rochester, New York, first addressed the problem of the elimination of all visible scarring. He recognized the importance of making the nose blend with the rest of the face and he proposedoperating on the nose through incisions hidden within the nostrils. Using this approach, he showed how he could reshape a pug nose, a deformity of the nasal tip resembling a dog’s stubby snout. Roe reduced an entire nose by removing excess bone and cartilage through an unobtrusive internal incision. The anaesthetic Roe used was cocaine. He applied it to the interior of the nose and injected it under the skin. Roe was unaware of the dangers of cocaine and was using it for his patient’s comfort. He appreciated the psychological benefits of cosmetic surgery. A well performed operation could relieve a patient’s embarrassment by eliminating a disfiguring feature.
Karl Koller (1857-1944), had introduced the use of cocaine in eye surgery while an intern at Vienna’s General Hospital. The world famous ENT Clinic in Vienna, Allgemeines Krankenhaus, was founded in 1884 by a surgeon unable to gain entry into general hospital. Robert Barany who received a Nobel Prize and George Von Bekesy practised at this clinic.
Robert Fulton Weir (1838-1927) of New York, introduced the subtle technique of reducing and refining a large, distorted nose. Weir operated through incisions hidden within the nostrils. To reduce the width, Weir chiselled the bones loose, moved them inward, and secured them by piercing them with a needle that was prevented from slipping by a metal shot
placed at either end. He also reported on how he narrowed the flaring nostrils of the wide, flat nose of an adult patient whose deformity typically accompanies a cleft lip. It is now routine to use Weir’s procedure of removing a wedge from the base of each nostril, then rolling the nostril inwards.
In Weir’s paper `On Restoring Sunken Noses` he identified the patient who is never satisfied with results and demands operation after operation, searching for perfection.
Jacques Joseph (1865-1934) Berlin, performed his first nose operation in 1896. Joseph tackled the problems of reducing a large nose while leaving as few offending scars as possible. He could shorten the nose, reduce its hump, straighten it and make the nostrils smaller by using incisions in the skin. Joseph performed the surgery through the inside of the nostrils. He had great success and, like his techniques, the saws, chisels and clamps that he devised for surgery are still in use today. Joseph was originally trained in Orthopedics. At that time cosmetic surgery was considered unimportant and unethical at Joseph’s University. He was temporarily suspended from his academic post for his unorthodox activities. He was not discouraged by this and continued to develop operations to correct abnormal features. In the year 1898, Joseph presented his procedures to the Medical Society of Berlin, where many local and American doctors were attending. He used intranasal incisions, removed nasal humps, performed lateral osteotomies and employed ivory for augmentation. (Joseph used to obtain ivory from a nearby piano factory). Joseph’s outstanding work enabled him to develop a worldwide reputation and people came from far and wide to have their rhinoplasty performed by him. Even more importantly, surgeons travelled great distances too in order to learn from him. Joseph, who was referred to as `Joseph Noseph`, specialized in rhinoplasty but also performed facelifts, otoplasty and general plastic surgery. In January 1934, Joseph performed his last rhinoplasty on the 16-year-old daughter of a Munich restaurateur. When Hitler rose to power, Joseph fled from Berlin to Prague. After his death, Joseph’s students brought his work to the attention of English-speaking surgeons. Among Joseph’s students were Gustave Aufricht, a Hungarian surgeon and Joseph Safian, both of whom became reputable as facial plastic surgeons in the United States. Safian was a careful and conservative surgeon who concentrated on how to avoid mistakes and how, if they were made, to correct them. Aufricht modified the Weir’s incision, and devised the Aufricht retractor which is still used in every rhinoplasty today.
The master rhinoplasty surgeons of the last twenty years (1980-2000) such as Robert Simons, Gaylon McCollough, M.E. Tardy, R.W.H. Kridel, Rollin Daniel, Webster, Dean Toriumi of the United States, and Tony Bull from the United Kingdom and others, have greatly contributed to the advances in our techniques today. The Tony Bull Course, London, has been operating for the last twenty years. The participants are surgeons from all over the world who are wishing to consider a career in rhinoplasty.
Edward Talbot Ely (1850-1885), Otolaryngologist at the Manhattan Eye and Ear Hospital pioneered the method for reshaping ears. However, this was not a problem free method since cutting out a strip of cartilage to flatten the ears left them with too sharp a crease. William Henry Luckett (1872-1929), New York, was the first to decide exactly what twist of anatomy made the ear protrude. A normal, visually pleasing ear gently folds back on itself and Luckett speculated that the protruding ear lacked such a fold. He set out to create a fold in the ear and after doing so he secured it with a line of stitches so that the ear was permanently rolled back toward the skull. Luckett took on the problem of setting back protruding ears as just one more in a long series of challenges. He also devised new methods of tying sutures, diagnosing skull fractures and removing diseased gallbladders.
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