The History of Rhinoplasty ⑥ — 1887: the first nose surgery done for appearance

Every nose operation up to this point had been an operation to get something back.

A nose cut off as a punishment, a nose lost in battle, a nose brought down by disease. The work was returning what had been there.

Surgery to change something into a better version of what had never been missing began in 1887.

That year John Orlando Roe (1848–1915), an ear, nose and throat physician in Rochester, New York, published a paper.

Its title, put into our language, comes out roughly as “The deformity termed ‘pug nose’ and its correction, by a simple operation.” It was a case of correcting an upturned nose.

Two things about it were radical for the time.

First, it was surgery on a person who was neither ill nor injured. Not curing a disease but changing an impression — aesthetic surgery, in other words. The very idea of aesthetic surgery was unfamiliar then.

Second, he placed the incision inside the nose only.

Until then nose surgery had been cut from the outside in several places, and so the fact of having had surgery stayed on the face as a scar.

Roe set out to leave no scar.

There is a striking passage in his paper: a warning to take particular care not to remove too much tissue, and that going all the way through the skin will leave a scar or a depression on the surface of the nose afterwards.

It is a sentence from 139 years ago, and it is not far from what I say in the consulting room today.

Is shaving away a great deal, or removing a lot of tissue, ever really the better choice? Tissue you cannot get back is not to be touched lightly.

In a second paper in 1891 Roe published an operation that took in the bridge and treated the nose as a whole, and he printed before-and-after photographs with it. It is one of the early instances of recording a result photographically.

This is how aesthetic rhinoplasty began. That its goals from the very start were to touch as little as possible and to leave no scar is, I think, worth something.