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History, and how rhinoplasty is taught

Rhinoplasty is the oldest operation in plastic surgery and one of the hardest to teach: the technique reaches a trainee through a fellowship year, a meeting, a video and, increasingly, a printed model, because the traditional apprenticeship gives most residents almost no hands-on time. The historical papers in this archive exist for the same reason as the training ones: a field that argues about who did what first is trying to work out what it knows.

35papers on file 49this page is written from 8journals, 2014–2026 5open access, full text 20with a plain-language summary

Where these 35 papers were published

  • 9Facial Plastic SurgeryFacial Plast Surg
  • 9Facial Plastic Surgery and Aesthetic MedicineFacial Plast Surg Aesthet Med
  • 5Aesthetic Surgery JournalAesthet Surg J
  • 5Plastic and Reconstructive SurgeryPlast Reconstr Surg
  • 4Aesthetic Plastic SurgeryAesthetic Plast Surg
  • 1Facial Plastic Surgery Clinics of North AmericaFacial Plast Surg Clin North Am
  • 1Plastic and Reconstructive Surgery Global OpenPlast Reconstr Surg Glob Open
  • 1JAMA Facial Plastic SurgeryJAMA Facial Plast Surg
120142201632017220183201942020320215202222023120244202552026

28 further papers on this topic came in through the history rather than the archive query: Safian J 1970, Aufricht G 1971, Freshwater MF 1972, Rogers BO 1976 and 24 more. They are counted on the landmark papers, not here.

What repeats

Six findings reported by independent groups. Each card carries the papers it rests on.

The history is contested in print, not settled

Who founded aesthetic rhinoplasty is an open argument in the journals: a 1986 paper argues for John Orlando Roe over Jacques Joseph, republished translations of Roe's 1887 "pug nose" paper keep the case alive, and a two-part 2026 study reopens Joseph's turning point from rhinopoiesis to rhinoplasty. The reconstructive lineage is contested too: the primacy of the Vianeo family against Tagliacozzi for the Italian arm flap. The site's own account of who did what, and where the sources disagree, is on the history of rhinoplasty.

Rests on: Rogers, Roe not Joseph · Jallut, Joseph part II · Greco et al., the Vianeo primacy · Marinozzi, the Vianeo and Tagliacozzi.

The operation has been recovered from its own past twice

Dorsal preservation is the clearest case: the push-down was described in the nineteenth and early twentieth centuries, disappeared, and returned as a movement after 2018. Three separate papers published between 2021 and 2025 go looking for its "historical godfathers" and trace the conservative dorsum techniques back through the literature. The same pattern runs through the reconstructive story: the Indian forehead flap reached Europe through a letter in 1794, and the operation had to be reinvented in Britain and Germany before it stayed.

Rests on: Lee et al., the first descriptions of dorsal preservation · Arancibia-Tagle et al., history of dorsum conservative techniques · Kern, seeking the historical godfathers · Whitaker et al., from the Edwin Smith Papyrus onward.

War, not vanity, built the modern specialty

The reconstructive surgeons of the two world wars are the direct ancestors of this operation: 19 named surgeons across both wars in one review, with Gillies the pivot, an otolaryngologist who became the father of modern facial plastic surgery. The cosmetic era developed alongside it and earlier than the standard account allows: a 2026 study of the 1850–1890 period documents cosmetic surgery being practised and advertised decades before it was respectable.

Rests on: Treger et al., plastic surgery in the world wars · Spencer, Sir Harold Delf Gillies · Zhang et al., 1850–1890.

Residents finish training without having done the operation

Surveying 138 plastic surgery residents in Canada and the United States alongside a systematic review: only 72% of senior residents, and 95% of final-year residents, reported adequate rhinoplasty exposure, and the model remains apprenticeship-based and largely observational. A scoping review of thirteen studies on rhinoplasty education during residency reaches the same conclusion: exposure is highly variable between programmes in both plastic surgery and otolaryngology, and the supplements used outside the operating room are what fills the gap.

Rests on: Zammit et al., reevaluating the training model · Kazei and Lin, discussion · Khetpal et al., barriers in residency education.

The answer being built is simulation, and it works on the measures used so far

Seventeen simulator studies published between 1984 and 2021, most with fewer than 25 participants. Since then the models have got better and cheaper: a validated 3D-printed model rated realistic by 91% of 53 surgeons on a course and improving measured technical skill in 20 residents; a low-cost open-rhinoplasty simulator developed and validated across disciplines; lamb heads measured against human cadaver dimensions and used to practise preservation techniques; and chicken breast, of all things, as a substrate for graft carving and suturing.

Rests on: Gill et al., systematic review of simulators · Rehman et al., 3D-printed models validated · Rosenbaum et al., a low-cost open rhinoplasty model · Apaydin et al., the lamb head · Freire and Dolci, chicken breast · Kreicher et al., a printed simulation model.

Teaching now happens on video, and the video needs standards

Intraoperative video is how technique travels between practices, so somebody had to study the camera: 114 rhinoplasty videos analysed for which angle actually shows the critical step, with recommended guidelines. A high-definition exoscope has been evaluated for teaching and workflow. The pandemic pushed the whole circuit online and surgeons were surveyed on what was lost. And what patients watch is a separate problem: across 75 articles and 75 videos, the average reading level was grade 10.3, and physician-authored videos were significantly more reliable and more educational than patient-experience videos.

Rests on: Hakimi et al., video standards · Hakimi et al., the intraoperative exoscope · Martin et al., online education after COVID-19 · Patel et al., online patient education materials.

By era

The history in the order it happened, with the papers in this archive that carry each part. The dated timeline is on the history page.

Antiquity to the Renaissance

Sushruta's cheek flap, the Edwin Smith Papyrus, the Italian arm flap and its disputed authorship. The scholarship here is about attribution and about what the sources actually say: Sushruta as father of plastic surgery, Benedetti's fifteenth-century role, Tagliacozzi's teachers, and a Renaissance portrait identified in 2019.

Key papers: Champaneria et al., Sushruta as father of plastic surgery · Sorta-Bilajac and Muzur, Sushruta's legacy · Furlan and Mazzola, Benedetti · Gurunluoglu et al., great teachers of Tagliacozzi · Ménard, an unknown Renaissance portrait.

Structure, and then preservation, 1966–2026

Skoog's 1966 resection and replacement of the nasal roof is the ancestor of both movements. Sheen's grafts, Tebbetts' sutures, Toriumi's structure approach and Rohrich's component reduction built the structural era; the preservation era recovered Skoog's instinct and its own nineteenth-century ancestry. Two 2026 reflections (thirty years of one journal, and the evolution of preservation) read as the field taking stock.

Key papers: Skoog, hump reduction preserving the nasal roof · Sheen, the spreader graft · Tebbetts · Toriumi · Rohrich et al., component reduction · Kosins et al., thirty years of the journal · Most and Patel, the evolution of preservation.

How it is taught now

Fellowship, meeting, video, simulator. A national survey asks how much preservation rhinoplasty facial plastic surgery fellowships actually teach; an interview series records how one master's technique evolved; the training-model literature keeps arriving because the problem is not solved. Who teaches, where, and on what terms is on the training page.

Key papers: Vargas et al., preservation in fellowships · an interview with Dean Toriumi · Park, teaching rhinoplasty. Are we making a difference? · Constantian, Ehrenpreis and Sheen, the expert teaching system, 1987.

The terms, defined

Every term the papers above use to mean something specific, in plain language.

  • Rhinopoiesis: making a nose: the reconstructive tradition, from the Indian forehead flap to the Italian arm flap, as distinct from reshaping one. [41038749]
  • The Indian method and the Italian method: reconstruction with a forehead flap, and with a flap raised from the inner arm and kept attached for weeks. The two competing solutions to an amputated nose. [17572582, 11624564]
  • Submucous resection (SMR): Killian's operation removing septal cartilage from between its mucosal linings; the ancestor of septoplasty and, in its excesses, of the saddle nose. [6381428, 6755110]
  • Push-down and let-down: lowering the bony pyramid intact rather than cutting the hump off. Described in the nineteenth century, lost, and recovered after 2018. [32397810, 33220834]
  • Structure rhinoplasty: building a framework with grafts and sutures instead of reducing one; the dominant American school from the 1990s. [19331957, 8016254]
  • Apprenticeship model: learning by watching and assisting rather than by doing; the model the training literature is trying to supplement. [31568292, 37172948]
  • Face, content and criterion validity: the three tests a training simulator has to pass: does it look right, does it teach the right thing, does skill measured on it transfer. [40129179]
  • OSAT (objective structured assessment of technical skills): the scored observation used to measure whether a trainee actually improved. [40129179]
  • Cadaver, lamb head, chicken breast, 3D-printed model: the four substrates in current use for hands-on practice, in descending order of fidelity and cost. [34983078, 39288904, 36083277, 40129179]
  • JAMA benchmark criteria and Global Quality Score: the instruments used to rate whether online patient material is reliable and educational. [33844930]
  • Exoscope: a high-definition camera system over the operative field, used to give a room the surgeon's view. [33155856]

The papers this rests on

The 49 papers everything above was written from. Every one links to its abstract, its authors and its DOI.

  1. PRS
    1970PMID 4912556
  2. PRS
    1972PMID 19140287
  3. APS
    1976PMID 24173725Abstract
  4. SAMJ
    1982PMID 7051367Abstract
  5. APS
    1986PMID 3526833Abstract
  6. PRS
    1987PMID 3809276Abstract
  7. MS
    1999PMID 11624564Abstract
  8. OHNS
    2007PMID 17967632Abstract
  9. PRS
    2007PMID 17572582Abstract
  10. IJOH
    2008PMID 23120515Full text
  11. JPRA
    2011PMID 22078732
  12. APS
    Sushruta: father of plastic surgery
    Champaneria MC, Workman AD, Gupta SC
    2014PMID 23788147Abstract
  13. FPS
    2014PMID 24918702Summary
  14. JLO
    2015PMID 25858011Abstract
  15. FPS
    2016PMID 26862968Summary
  16. JAMA FPS
    2017PMID 28542698
  17. JPRA
    2018PMID 29685841Abstract
  18. FPS
    2019PMID 31470461Summary
  19. PRS
    2019PMID 31568292Summary
  20. PRS
    2019PMID 31568293
  21. PRS-GO
    2019PMID 30859024Full text
  22. FPSAM
    2020PMID 32053420
  23. FPSAM
    2020PMID 32101478Summary
  24. APS
    2021PMID 33876283Summary
  25. COOH
    2021PMID 34074876Full text
  26. ENTJ
    2021PMID 32397810Abstract
  27. FPS
    2021PMID 33621985Summary
  28. FPSAM
    2021PMID 33155856
  29. FPS Clin
    2021PMID 33220834Abstract
  30. FPS
    2022PMID 34983078Summary
  31. FPSAM
    2022PMID 33844930Summary
  32. FPSAM
    2022PMID 34846171
  33. PRS
    2022PMID 34958652
  34. APS
    2023PMID 36266550Full text
  35. FPSAM
    2023PMID 36083277
  36. FPS
    2024PMID 37172948Summary
  37. ASJ
    2025PMID 40129179Summary
  38. FPS
    2025PMID 39288904Summary
  39. FPSAM
    2025PMID 39636439
  40. FPS Clin
    2025PMID 40253115
  41. JCS
    2025PMID 39504428Abstract
  42. ASJ
    2026PMID 42455863
  43. ASJO
    2026PMID 42358659Full text
  44. APS
    2026PMID 41629468Summary
  45. ACPE
    2026PMID 41038749Abstract
  46. PRS
    2026PMID 42695808
  47. JMB
    Great teachers of Gaspare Tagliacozzi (1546-1599)
    Gurunluoglu R, Gurunluoglu A, Arton J
    2017PMID 26385976Abstract
  48. SCNA
    1971PMID 4930522
  49. PRS
    1995PMID 7638303Abstract

What is still contested

  • Priority claims are unresolved and probably unresolvable: Roe against Joseph for aesthetic rhinoplasty, the Vianeo family against Tagliacozzi for the Italian method. This site states the disagreement rather than picking a winner. [3526833, 41038749, 20489395]
  • Preservation's own history is being written backwards by people who practise it, which is a reason to read those three papers alongside each other rather than separately. [32397810, 33621985, 33220834]
  • Simulator studies are small, 4 to 24 participants across seventeen studies, and almost none measure whether skill transfers to a real operation. [37172948, 40129179]
  • No study on file measures rhinoplasty training against patient outcomes. The endpoint is always the trainee's confidence or a scored task.
  • Rhinoplasty exposure during residency is variable and self-reported; there is no register of how many operations a graduating resident has actually performed. [31568292, 41629468]
  • Video is now the main teaching medium and its standards are one paper old. [32101478]
  • The historical scholarship in this archive is European and North American; the Indian, Chinese and Japanese literatures are represented by a handful of papers, and one 2024 study of the Japanese colonial era in Korea is the only account here of rhinoplasty as an instrument of empire. [38775493]

Written by rhinoplasty.cc from the PubMed abstracts, 2026-09-09. Not medical advice.

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Septum, valve and airway

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Cleft, trauma and reconstruction

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Preservation rhinoplasty

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Open topic

Every paper, by year

35 papers. The 49 above are not repeated.

20265 papers · 3 above
  1. APS
    PMID 40877600Summary
  2. APS
    PMID 40826294Summary
20254 papers · 4 above
20241 papers · 1 above
20232 papers · 1 above
  1. PRS-GO
    PMID 37448765Summary
20225 papers · 4 above
  1. ASJ
    PMID 35554489Summary
20213 papers · 3 above
20204 papers · 2 above
  1. FPSAM
    PMID 32749869
  2. FPSAM
    PMID 32749858
20193 papers · 3 above
20182 papers
  1. ASJ
    PMID 29788065
  2. ASJ
    PMID 29506052Summary
20173 papers · 1 above
  1. FPS
    PMID 28962063
  2. PRS
    PMID 28953723Summary
20162 papers · 1 above
  1. FPS
    PMID 26862969Summary
20141 papers · 1 above