Renaissance Rhinoplasty: The 16th-Century Nose Job

L0058567 Artificial nose, Europe, 1601-1800The 16th century was a particularly bad time for noses. In 1566, the famous astronomer, Tycho Brahe, had his sliced off during a duel and was forced to wear a replacement reportedly made of silver and gold. [1] Others lost theirs in similar fights, or to cancerous tumours that ate away the cartilage on their faces. But the biggest culprit to noses during this period was the new disease sweeping through Europe: syphilis.

Before the discovery of penicillin in 1928, syphilis was incurable. Its symptoms were as terrifying as they were unrelenting. Those who suffered from it long enough could expect to develop unsightly skin ulcers, paralysis, gradual blindness, dementia and what today is known as ‘saddle nose’—a grotesque deformity which occurs when the bridge of the nose caves into the face and the flesh rots away.

As syphilis raged throughout 16th-century Europe, the ‘saddle nose’ became a mark of shame, symbolizing the victim’s moral and bodily corruption. Some, in desperation, turned to surgeons to help disguise their deformities. One man in particular was renowned for his skills: the Italian surgeon, Gaspare Tagliacozzi.

L0032530 G. Tagliacozzi, De curtorum chirurgia per inBefore Tagliacozzi, most surgeons used the ‘Indian Method’ for nasal reconstruction. This involved cutting a nose-sized section of skin from the forehead and attaching it to the bridge of the nose to maintain a steady blood supply. The flap was then twisted into place and sewn over the damaged area, thus providing a suitable ‘replacement’ for the lost nose but leaving one’s forehead scarred.

Tagliacozzi had an entirely different approach. His process involved partially cutting a flap of skin from the upper arm, reshaping it into a nose, and then grafting it to the damaged nasal cavity (see right image). The patient’s arm would then be held in place using bandages for approximately 2 weeks while the graft attached itself to the face. Afterwards, the surgeon severed the new ‘nose’ from the arm and began reshaping and contouring the piece of skin.

A 16th-century contemporary described the surgery:

First they gave the patient a purgative. Then they took pincers and grabbed the skin in the left arm between the shoulder and the elbow and passed a large knife between the pincers and the muscle, cutting a slit in the skin. They passed a small piece of wool or linen under the skin and medicated it until the skin thickened. When it was just right, they cut the nose to fit the end of the little skin flap. Then they snipped the skin on the arm at one end and sewed it to the nose. They bound it there so artfully that it could not be moved in any way until the skin had grown onto the nose. When the skin flap was joined to the nose, they cut the other end from the arm. They skinned the lip of the mouth and sewed the flap of skin from the arm onto it, and medicated it until it was joined to the lip. Then they put a metal form on it, and fastened it there until the nose grew into it to the right proportions. It remained well formed but somewhat whiter than the face. It’s a fine operation and an excellent experience. [2]

The entire procedure could take up to 5 months, and no doubt caused considerable pain and discomfort to the patient during the process.

_*That aside, Tagliacozzi boasted of his skill, claiming that the noses he reconstructed were better than the originals. Yet when he died in 1599, so too did his method.  Over the next several hundred years, surgeons continued to prefer the ‘Indian Method’ when performing rhinoplasty, citing that Tagliacozzi’s technique left the new nose vulnerable to cold winters, when it often turned purple and fell off. On rare occasions, however, the ‘Italian Method’ was employed, such as the case of a soldier whose face was severely damaged in July 1944 (see above picture).

Unlike his surgical techniques, Tagliacozzi’s mantra persisted long after his death and is still quoted by modern-day plastic surgeons, who see him as the ‘father’ of their discipline:

We restore, rebuild, and make whole those parts which nature hath given, but which fortune has taken away. Not so much that it may delight the eye, but that it might buoy up the spirit, and help the mind of the afflicted. [3]

1. Recent forensic tests conducted on Brahe’s skeletal remains suggest that the nose may, in fact, have been made of copper.
2. Originally qtd in William Eamon, The Professor of Secrets: Mystery, Medicine and Alchemy in Renaissance Italy (2010), pp. 95-96.
3. G. Tagliacozzi, De Curtorum Chirurgia per Insitionem (1597).

23 comments on “Renaissance Rhinoplasty: The 16th-Century Nose Job

  1. I think that I will keep my nose clean

  2. David says:

    Nice post, I always make a point of checking your blog, keep up the good work.I would like to share some more tips related to Nose job and its procedure.

  3. Samanta says:

    That´s an scared description of the nose job but and advanced procedure for 16th-Century. I cant imagine how did they feel but there was no way to avoid it.

  4. […] like the ones mentioned above, sufferers could experience paralysis, blindness, dementia and ‘saddle nose‘, a grotesque deformity which occurs when the bridge of the nose caves into the […]

  5. […] non-cancerous growths that inflame the tissue – called gummas. An individual could frequently lose their nose as a result – a signature characteristic of the […]

  6. […] off during a duel and was forced to wear a replacement reportedly made of silver and gold. [1]Others lost theirs in similar fights, or to cancerous tumours that ate away the cartilage on their […]

  7. […] come across a lot of strange objects in my research: books bound in human skin, prosthetic noses made of silver, iron coffins with safety devices to prevent premature burial. But perhaps one of the strangest […]

  8. Michael Kim says:

    Hi there, I would dispute some inaccuracies in the history regarding the “Indian Method.” You wrote:

    “Before Tagliacozzi, most surgeons used the ‘Indian Method’ for nasal reconstruction. This involved cutting a nose-sized section of skin from the forehead and attaching it to the bridge of the nose to maintain a steady blood supply. The flap was then twisted into place and sewn over the damaged area, thus providing a suitable ‘replacement’ for the lost nose but leaving one’s forehead scarred.”

    I am a facial plastic surgeon who performs the forehead flap procedure so I’ve done quite a bit of research on this topic. The Indian method was developed around 600-700 BC, it was then brought over to the Western world through the British Occupation of India. A man who went by the initials “BL” wrote to a magazine called the “gentleman’s magazine” in 1794 where he detailed the Indian method and its amazing nasal reconstruction results. This was then picked up by the British surgeon Carpue who then was able to publish it for widespread dissemination. It became popular then and has been refined.

    And by the way, the scar is virtually unnoticeable even if the area is left raw and allowed to heal in on the forehead. It’s a very commonly done procedure now that has been done over the last two centuries. The “italian method” has pretty much been abandoned.

    Thanks and nice work bringing attention to a cool topic.

    M Kim MD

  9. […] Renaissance Rhinoplasty: The 16th-Century Nose Job […]

  10. […] Sweet jesus, they used to do actual, honest-to-god surgery before surgical anesthetics enjoyed widespread usage. I always forget that. Or rather, I forget to keep it in mind. This is one of my favorite examples. A nose-job by a famous Renaissance surgeon called Tagliacozzi entailed cutting off a flap of skin on the arm (!) and placing it on the patient’s nose for a considerable length of time. The method was used up until the 20th century. Here is a photo (not for the squeamish). The procedure went as follows: First they gave the patient a purgative. Then they took pincers and grabbed the skin in the left arm between the shoulder and the elbow and passed a large knife between the pincers and the muscle, cutting a slit in the skin. They passed a small piece of wool or linen under the skin and medicated it until the skin thickened. When it was just right, they cut the nose to fit the end of the little skin flap. Then they snipped the skin on the arm at one end and sewed it to the nose. They bound it there so artfully that it could not be moved in any way until the skin had grown onto the nose. When the skin flap was joined to the nose, they cut the other end from the arm. They skinned the lip of the mouth and sewed the flap of skin from the arm onto it, and medicated it until it was joined to the lip. Then they put a metal form on it, and fastened it there until the nose grew into it to the right proportions. It remained well formed but somewhat whiter than the face. It’s a fine operation and an excellent experience. Source: http://thechirurgeonsapprentice.com/2013/09/04/renaissance-rhinoplasty-the-16th-century-nose-job/ […]

  11. […] more concerned with the shape – or indeed existence – of your nose, this look at sixteenth-century rhinoplasty with Lindsey Fitzharris is well-worth sniffing […]

  12. […] for understanding the anatomy of childbearing. The Chirurgeon’s Apprentice post on “Renaissance Rhinoplasty” might not seem to have much in common with sex, but rhinoplasty fulfilled a need that was […]

  13. Kate says:

    A fascinating piece! Very similar techniques were also used during the First World War, by surgeon Harold Gillies and his team – the archives are now housed at the Royal College of Surgeons.

  14. It would be worth consulting a native Italian speaker, because Gaspare’s surname means “cuts [something].” (I wish I knew what “cozzi” means.) My guess is he was given this surname in honor of his skill. (Or perhaps derisively.)

    • How fascinating! Thanks, Leslie – I will check into it.

      • Anna says:

        Taglia translates to mean cut and also size. For example, someone would ask, “What taglia is that coat?” And in the Italian, it would more literally translate to, “What cut is that coat?”
        The Cozzi translates roughly to mean clash or collide or bump. The verb is cozzare. But if it were a bastardized word spoken in one of the many dialects, it could also have been a more risque translation because it sounds very close to cazzi or cocks. (Cazzi is used a zillion different ways in colloquial Italian.) So it could also be some sort of jokey dialect name translating to mean cock cutter or cutter of cocks. Would be very funny if that were how his name evolved. I bet that man got ribbed about his name, and it was purposely mispronounced all the time.

      • Thanks, Anna (below), for that translation! Maybe he also did circumcisions. And I think there’s a long risque association of noses with penises. I’m pretty sure the 16th century is when surnames came into use in Italy, and I know from my own research that a significant portion of them are insulting, although maybe they would have been considered just descriptive. I had a long essay on that published quite a few years ago.

  15. This is what they did to injured servicemen in WWII at Royal Victoria Hospital, E Grinstead, where they specialised in burns treatment. I think it was pioneered by Archie McIndoe.

  16. Wow – that’s a pretty advanced procedure for the 1500s. I imagine it was only available to the rich?

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