The Thousand Year History of the Nose Job
The celebration of the New Year is a traditional time for taking stock, reappraising, and redirecting one’s life. Many resolutions focus on professional and interpersonal goals and dreams, but others are about transforming one’s own appearance. Diets and exercise plans form part of the countless internal revolutions that take place this time of year. New Year, New You, as the saying goes. But for some people sneakers and a chia bowl don’t quite cut it: they turn to the medical profession to bring the new them into 2017.
Plastic surgeons report that post-holiday winter is the most popular time of year for cosmetic surgery. This is in part a practical affair: the party season is on pause and the heaver clothes of winter conceal the scars and swelling of operations. The would-be patient can hibernate in the aftermath of their nips and tucks only to emerge, butterfly-like, in time for swimsuit season.
Given the dangers and discomfort associated with surgery in the time before effective antiseptics, anesthetics, and antibiotics, we might expect that cosmetic surgery was a relatively recent innovation. And, for many procedures, that is certainly the case. But not so for rhinoplasty, which was invented in the center of the Ganges valley thousands of years ago.
Before Jacques Joseph of Berlin because the father of modern cosmetic rhinopolasty, followers of Sushruta were refining the noses of 6th-century inhabitants of Northern India. The medical treatise Susruta’s Compendium describes the reconstruction of noses. His method involved removing flaps of skin from the forehead or cheek of the patient and using it to reconstruct a new nose. The Roman medic Celsus seems familiar with his techniques when he describes the reconstruction of lips, ears, and nose. For almost two millennia, however, much of the Susruta’s learning went unnoted by European doctors. It survived only in Sanskrit before being translated into Arabic, spreading to medieval Egypt, and passing over to the Western world via the fifteenth-century medical encyclopedia the Cerrahiyet-ul Haniye, a text that, coincidentally enough, includes the earliest protocols for breast reduction surgery.
Reconstructed noses of one kind or another were popular precisely because the removal of noses (and ears) was a common punishment in wartime or for those who committed adultery or treason. Sushruta and his followers developed their practice to replace those noses, genitalia, and ears that had been amputated for religious, military, or criminal punishment. The brutality of this kind of punishment in the modern world was publicized by the case of Aesha Mohammadzai, whose face adorned a 2010 issue of Time magazine. Sold to a Taliban fighter at the age of 12, her new “family” cut off her nose and ears and left her for dead when she attempted to escape.
But the reconstruction of the nose was not solely about treating the victims of harsh criminal systems; it was about beauty and even character. For many groups the shape of noses – like the shape of heads, bodily proportions, and hair color – signified something substantial about a person’s character. In her The Nose: A Profile of Sex, Beauty, and Survival, Gabrielle Galzer’s traces the legacy of ancient physiognomy in the nineteenth century. Straight noses were seen as a sign of refinement while, under the influence of anti-Semitism, “hawk” noses were interpreted as indicative of cunning and moral deception. Changing the shape of one’s nose, therefore, was not just about repair or beautification; it was about improving social status.
Nose jobs began to catch on in Europe in the late 16th century as a result of the syphilis epidemic. One of the lesser-known symptoms of syphilis is the manner in which it (somewhat like cocaine) can destroy the soft tissue in the nose and lead to a gaping hole in the middle of the patient’s face. The result wasn’t just discomfort, it was also social stigmatization. As Elizabeth Harken has written in her book Venus Envy: A History of Plastic Surgery, this social stigmatization also affected those who had lost their noses through injury, war, accident, or frostbite.
In the United States, cosmetic procedures have always been popular, but they were wildly unregulated. In the nineteenth century medical journals and newspapers were filled with advertisements for appearance-improving contraptions like “facial prostheses,” “bust developers,” and “abdominal perfectors.” There were even advertisements for an ineffective procedure called a “mini-lift,” a name unnerving precisely because it is still used by surgeons today.
In the late 1890s and the early twentieth century, Chicago doctor Charles Conrad Miller, the man often credited as the first cosmetic surgeon, began more serious and earnest medical work on beautification. In 1906 he published his first article, on “The Excision of Bag-like Folds of Skin From the Region about the Eyes” (blepharoplasty, to modern surgeons), and published a follow up, with pictures, a year later. He found himself on a roll, producing other articles on the correction of a hump nose and on the efficacy of paraffin injections as “fillers” for the skin. By the time he published Cosmetic Surgery in 1925 he had devised surgical methods for creating dimples, lip plumping, crows feet removal, and pinning back protruding ears.
Miller was a colorful character, whose career was blighted by his careless administration of pharmacological drugs and the untimely death of his wife, but he and others like Frederick Kolle, Eugen Hollander, Erich Lexer, and Raymond Passot laid the groundwork for surgeons today. In the case of Hollander and Lexer, the fathers of the facelift, the inspiration for their procedures came from their patients themselves. In developing a groundbreaking facial surgery, Lexer recalled that he was approached by an actress who, having habitually taped her face, now needed certain flaps of skin removed. A Polish aristocrat approached Hollander and similarly identified for him the folds of skin that she wished to have pinned back by her ears. In the case of both surgeons the ingenuity of their female patients was part of their success.
Religious attitudes to cosmetic surgery have always been mixed. Jews and Christians maintain that God created people to be a certain way – “God made nothing ugly,” says Ecclesiastes – and that altering oneself unnecessarily is tampering with God’s creation. Repairing the scars of warfare, accident, or diseases was permissible, but amplifying beauty was viewed as subtly dishonest. As late as the 1960s, Protestant minister Rev Reeves could air the concern that cosmetic surgery intended to make a person into something other than what they are. Interestingly, and in anticipation of religious objections to the trans-rights movement, much of the conversation speaks approvingly about correcting aberration and restoring normality, but opposes making fundamental changes to the God-given body. Plastic surgeon Albert Seltzer could argue in the JMA, “when we, as plastic surgeons, correct or relieve any detriment to human health or appearance, God endorses our skills.”
Many of the narratives told by doctors working on plastic surgery involve liminal characters: Polish aristocrats and aging actresses make for sensational stories, and they serve to project the desire for these kinds of procedures onto social outsiders. But with the advent of World War I, much of this would change. In trench warfare the noses, lips, and jaws of soldiers were vulnerable. A medical cottage industry sprung up around these brave injured men who were offered prostheses (such as the facial mask featured in HBO’s Boardwalk Empire) and surgery to replace their destroyed facial features.
Those among us who are looking to take the ‘New Year, New You’ axiom painfully literally might take comfort in knowing that there are lots of more traumatic reasons to be getting plastic surgery. Even if deeply prejudicial cultural norms about beauty are influencing our aesthetic choices, at least social assumptions about criminality are not.