The History of Rhinoplasty ② — India, 2,600 years ago: the original nasal reconstruction

Nose surgery began with the restoring of function, and the place where it grew into reconstruction — the making of a lost nose — was ancient India.

Sushruta, thought to have been active around 600 BC, left behind a medical text called the Sushruta Samhita, and of everything in it, the nasal reconstruction is the best known.

The background to that surgery is heavy. In the India of the time the nose was a symbol of honour and dignity, and cutting it off was a common punishment for crimes such as adultery.

Someone who lost a nose suffered not only the damage to their face but exclusion from society along with it.

Sushruta’s method went like this. Skin was raised, but one end was left attached and the flap moved across.

That was to keep the blood supply. This idea — the pedicle flap — is still used in reconstructive surgery today.

There is a point worth noting here.

The operation is often introduced as the forehead flap, but what is described in Sushruta’s own text is skin taken from the cheek, and there is a view that the forehead method is a later variation.

This is a place where the sources diverge, so rather than settling it, it is probably more accurate to say that what was established then was the principle itself — that you move a person’s own tissue to make a nose.

Two thousand six hundred years later, the autologous-tissue rhinoplasty we perform rests on the same principle after all.

Not someone else’s material, but tissue moved from your own body to build a shape.

The technique has become incomparably more refined, but I try not to forget what this surgery was for.

What Sushruta gave back was not a nose. It was a person’s standing to appear in front of other people.