ABSTRACT
The first known description of nasal surgery is found in a 3000-year-old Egyptian papyrus containing a detailed account of the diagnosis and treatment of a nasal fracture. Until the mid-19th century, nasal surgery was reserved for the correction of severe acquired and congenital malformations. Modern rhinoplasty began with the advent of cocaine and the pioneering efforts of Dieffenbach, Roe, and Joseph. Dieffenbach and others during the late 19th century corrected nasal deformities through external incisions along the side or dorsum of the nose. John Orlando Roe, an otolaryngologist from Rochester, New York, performed the first aesthetic intranasal rhinoplasty in 1887. Jacques Joseph, an orthopedic surgeon from Berlin, Germany, subsequently did seminal work on aesthetic rhinoplasty and is considered by most to be the father of modern rhinoplasty and facial plastic surgery. The technique that Dr. Joseph used for intranasal rhinoplasty was the standard for the majority of rhinoplasty procedures performed through the 1960s. His technique included intercartilaginous and full transfixion incisions, hump removal with an osteotome, medial osteotomy with a chisel, lateral osteotomy with a saw, and tip cartilage reduction. His technique came to be known as reduction rhinoplasty in contrast to the more modern technique of augmentation rhinoplasty. Grafts (e.g., autografts, allografts, and synthetics) were not commonly used in routine rhinoplasty, although they were often used for the correction of nasal deformities such as a saddle nose. As the aesthetic norms shifted away from the operated look of a patient who had undergone a typical reduction rhinoplasty, the techniques of augmentation rhinoplasty took hold. Aside from the cosmetic concerns over reduction rhinoplasty, several functional problems emerged as these patients were followed over the long term. Cartilage excision produced noses that lacked support in the lower and middle thirds resulting in collapse of the nasal valve and nasal obstruction. As cosmetic and functional concerns mounted in the late 1960s, surgeons and patients began to embrace a different philosophy. Techniques were adapted that would result in a natural-appearing and wellsupported functional nose. Cartilage reshaping and augmentation, often through
open techniques (i.e., external rhinoplasty), enhanced the short-and long-term results of aesthetic rhinoplasty. Subsequent developments up to the present have continued to improve on this modern philosophical and technological paradigm.
