Pod Insights Short Wave The Surprisingly Long History Of Nose Jobs About this episode Rhinoplasty is one of the most common facial plastic surgeries performed today. And it turns out, the ability to reconstruct a nose with living tissue has been known for a very long time – over 2500 years! But what spurred our ancestors to master this reconstructive technique? Well, there’s quite a range of answers – everything from adultery to duels and syphilis. Short Wave host Regina G. Barber https://www.npr.org/people/1082526815/regina-g-barber speaks with bioengineer and Princeton University professor Daniel Cohen https://mae.princeton.edu/about-mae/spotlight/crowd-control-can-we-herd-cells-sheepdogs-herd-sheep about the surprisingly long history of rhinoplasty – and how this art was lost and found throughout the ages. Want more tales of science throughout time? Email us at [email protected] mailto:[email protected] . Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave http://plus.npr.org/shortwave.
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0:16 Regina Barber? Warning: This episode contains descriptions of nose reconstruction. If you are squeamish, please listen for our heads up within the episode.
0:26 Speaker 00 You're listening to Short Wave from NPR.
0:30 Regina Barber? Hey, Short Wavers. Regina Barber here. As a reporter and a podcast host, I'm used to asking questions. And sometimes they're weird questions, and that's OK. But I'm not as used to being on the receiving end of these weird questions. And when I first met Daniel Cohen, he asked me a question that I've never been asked before.
0:50 Speaker 02 If someone, not me, were to come along and cut your nose off, and it were to fall on the floor, and then a dog came in and ate it, we can fix that. The question is, for how long have we been able to fix that?
1:05 Regina Barber? Daniel is a professor of bioengineering at Princeton. He specializes in regenerative medicine, so reconstructing, repairing, or regenerating damaged or missing tissue. And he says he asks a lot of his students this question.
1:19 Speaker 02 And most bioengineers assume the answer is more like 20 to 50 years.
1:25 Regina Barber? I thought maybe 100, 500 years tops. But Daniel told me, according to medical history, humans have known how to medically reconstruct noses with living tissue for thousands of years.
1:38 Speaker 02 The answer, as far as we can tell, goes back around 2,500 years ago, to India.
1:43 Regina Barber? And Daniel says usually this gets a reaction from the audience.
1:48 Speaker 02 Disbelief, excitement, confusion. People think it's pretty cool, but nobody really understands how that's possible.
1:57 Regina Barber? So today on the show, rhinoplasty through the ages. We get into the surprising long history of nose jobs, why people needed them, how medical experts performed them, and how their work might help scientists today. I'm Regina Barber. You're listening to Short Wave, the science podcast from NPR.
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3:31 Regina Barber? Daniel, let's start with like, why there was a need for fake noses in the first place. Can you tell me why people in the past might need a nose job or a new nose entirely?
3:42 Speaker 02 So my, my understanding was that if you go back millennia to India, there was an active practice of corporal punishment where, let's say you slept with someone else's partner and you were an adulterer, you would get part of your nose chopped off.
4:01 Regina Barber? Really? Why your nose?
4:03 Speaker 02 It's very embarrassing and visible. You can't hide it easily. So it's a deterrent. And it's supposed to say, hey, don't, don't sleep with other people's partners. Otherwise, you're going to get part of your nose chopped off. And I think the issue is that people back then are pretty much the same as people now. So there were a lot of noseless people walking around.
4:23 Regina Barber? Wow.
4:23 Speaker 02 And then as you progress through the centuries, more and more connections to missing noses come up, especially in the context of things like dueling, where it's illegal in many cases to duel, especially if you kill someone, it's really bad. But if you chop someone's nose off or damage their face, it's embarrassing for them. They can't hide it. This isn't just like a one-off thing. Like, we have all these weird accounts of this, including Tico Brahe, the famous astronomer, who lost his nose in a duel over a math proof and wound up wearing a metal nose. This is the alternative to the metal nose.
4:56 Regina Barber? Right.
4:57 Speaker 02 And then, from what I understand, additional problem popped up that was even worse, which was that we brought syphilis back from the New World as Europeans. And that has a really nasty effect where it can cause death of nasal tissue.
5:15 Regina Barber? Yeah.
5:15 Speaker 02 If you look at certain anthropological accounts, it got so rampant at certain places and times that if you walked around with a damaged nose, people just assumed-
5:27 Regina Barber? People assumed you had syphilis?
5:28 Speaker 02 Yeah, yeah. And at the time, the Italians called this the French disease. And today, the French call this the German disease. And it's-
5:37 Regina Barber? They just passed the buck.
5:38 Speaker 02 It goes around. No one wants to acknowledge it.
5:40 Regina Barber? So the solution to all these nose problems was reconstructing a nose so that people don't have these ideas about you, syphilis, or a duel, or anything like that. But the very first nose reconstruction is 2,500 years ago, at least, in India. Like, how did that work? And just a heads up to our squeamish listeners, you might want to fast-forward past this part because it's going to get a little... maybe gross.
6:06 Speaker 02 So the Indian method was produced by someone whose name I'm going to butcher, but I think it's Sashuda. And he's considered the father of modern surgery. He's considered to have written the first textbook on it. And what they pioneered was the use of skin flaps and living skin grafts from the forehead. And you could peel forehead skin down, twist, flip, cover over the nose, and use it to help integrate and restore missing parts of the nose. And I know less about the full details of that method because I haven't been able to track down a formal translation of how all of that worked.
6:43 Regina Barber? Yeah.
6:43 Speaker 02 But the first time Europeans came into contact with the Indian method was in the 1800s in an issue of Gentleman's Magazine, when a member of the British Raj reported seeing an Indian worker who had had this procedure done. So that's kind of how it... that particular version was presented to the West, let's say.
7:05 Regina Barber? So how, how did this method like change over time from, you know, using the skin graft from your forehead? Did it stay the same in Europe thousands of years later or a thousand years later?
7:16 Speaker 02 So weird is part of that story is that the method seems to have totally changed by the time it got to Europe. This aura of secrecy sort of popped up. And what happened was as far as we can tell, a copy translated of the book from Sisfrudon Surgery and this method seems to have reached Sicily probably sometime in the 1400s. And that's where it somehow seems to get picked up by Heinrich von Falls' Paint, which will lead to the paper, How to Make a New Nose for Someone When It's Off Entirely and the Dog Has Eaten It.
7:51 Regina Barber? So it makes it like 2,000 years later, it makes it to Europe?
7:54 Speaker 02 That's as far as I can tell. And even though the How to Make a New Nose paper doesn't really get published and gets lost in the secret archives of the Teutonic Knights for about 400 years. The method is continuously practiced in Italy by two sort of dueling rhinoplasty families called the Vianos and the Brancas.
8:18 Regina Barber? Okay, got it. And, and you said that like Europeans changed that method and, and they do it differently than when it was first practiced in India?
8:26 Speaker 02 The European method for reconstruction involved taking skin from the arm rather than from the forehead. And this part may be triggering for squeamish people, but two parallel incisions along the biceps and then placing an inert biomaterial like an oil soaked cotton cloth or something underneath that to stop the skin from healing again. And that produces what's called granulation. The skin starts to thicken and get squishy because it's trying to heal and it can't and there's an immune response. And so the skin really pops up.
8:58 Regina Barber? Because it's still attached to your arm.
8:59 Speaker 02 Yes, it's still fully attached. So it's hanging off like a flap. And that's super clever because the reason you do that, same as why the Indian method would keep skin attached to the forehead is you keep the blood supply there. And that's a modern technique that we call using the body as a bioreactor. You're letting the body grow itself because blood supply is one of the biggest challenges still today in this field of tissue and organ engineering. So they solved that problem by leaving the flap attached to your arm, but now they have to deal with your face. And so the connection there would be that you get the patient into the prototype of a hoodie that's got all these attachment points and straps and things on it so that you can then strap
9:42 Speaker 02 the patient's arm to their face, debride the wound on the nose, so it's reactive and healing again, and essentially kind of suture the skin flap around the face.
9:53 Regina Barber? Wow.
9:53 Speaker 02 And the patient will stay like that for a variable amount of time, but-
9:58 Regina Barber? Like with their arm up, like they're holding, wow.
10:01 Speaker 02 With their arm strapped to their face for, from what I can tell, about forty days.
10:05 Regina Barber? Forty days, that's Lent.
10:07 Speaker 02 And you've already spent a couple of weeks thickening the skin on the arm already. So not a particularly gentle process. And once that's done, you snip, snip, snip, and bada bing bada bang, you've got a nose again.
10:23 Regina Barber? And you just got a scar on your arm.
10:25 Speaker 02 Yeah, that was one of the methods. And as far as I can tell, that particular form was last performed, at least in the literature, in nineteen eighty-seven. Man shot his nose off with a shotgun. This paper has full photographs of his missing nose, his arm strapped to his face, um, and how it looks afterwards where you can't even tell.
10:44 Regina Barber? Wow.
10:44 Speaker 02 And there's numerous, uh, primary accounts of letters from patients who've had this procedure. And say, back in the fifteen hundreds, uh, it was very painful, but, uh, like the results, five stars, would do it again.
10:57 Regina Barber? We're talking about this and we're, I'm realizing that like scientists have dealt with this like issue of like regrowing tissue for thousands of years. Um, but like, what do we do now?
11:09 Speaker 02 We'll do similar things to this. There are methods where we can still use skin flaps in the same kind of way. We're just much better about, um, sterilization, pain, scarring, that sort of thing. Um, so that's a great method and it relies on the body to, again, do some of the hardest stuff like providing the blood supply and growing the squishy tissue and stuff. We also have all sorts of other techniques like bioprinting of soft materials and producing these scaffolds that are custom shaped to the size, shape.
11:43 Speaker 02 Geometries of the nose that you want, that kind of thing. You can grow parts of yourself inside your body. So if you have a missing chunk of bone in your jaw, there are cool examples where you can regrow part of that bone in a titanium cage, implanted, say, in your thigh or part of your abdomen so that it
12:02 Regina Barber? What?
12:02 Speaker 02 gets fully taken care of and protected by the body until it's ready and then you pop it back in the face.
12:07 Regina Barber? Yeah, I mean, like you said, you're studying bioengineering biomaterials. You're currently working on a project that is inspired by all this history. Can you tell me more about that?
12:17 Speaker 02 So everything we've done, as far as we can tell, has been based on this model of a scaffold, which provides structural support. So you can think about cells as having two ways to attach to the world around them.
12:27 Regina Barber? Okay.
12:27 Speaker 02 Actively. They have proteins that they use to move around and pull on things. We can call those sort of like foot proteins. Their formal name is integrins. And then they have handshake proteins, which I call handshakes because they only use them when they find another cell.
12:44 Regina Barber? Hmm.
12:45 Speaker 02 It's kind of like a secret handshake, where you do a bunch of different funny things with your hand and only someone who knows that sequence, you know, gets the secret handshake right.
12:53 Regina Barber? This whole story is about secrets. I see this now.
12:57 Speaker 02 And so we, we just started thinking about, if you don't go after attaching to something with your feet, could we attach to something with the cell's hands? So now we build things that are completely synthetic, but the surface that the cell encounters, it thinks is another cell.
13:13 Regina Barber? Oh.
13:14 Speaker 02 And it treats it as another cell and it sticks to it using the secret handshake proteins. And the cells just think it's another really weird looking cell and they do something totally different that you would never normally see.
13:25 Regina Barber? Wow, okay. So you're like tricking these cells into thinking they're like connecting with, with these friends, these similar cells, instead of a foreign material. So what, what's the end goal of this research?
13:35 Speaker 02 There's a couple of different directions that we're excited about. One of them is very simple to state, which is just improving how well an implant integrates with and fuses into the body to stop infections when an implant sticks through skin or to better attach implants to soft tissues, which we're really not very good at. And so the flip side is if we can make things that look like cells, maybe we can reprogram how tissues are growing. So maybe that helps us get better with things like regenerating missing tissues or better growing organs in a lab or something like that, where we're able to reprogram things from the inside.
14:13 Regina Barber? Wow. OK, so, Daniel, is there like a wider lesson in rhinoplasty history for anyone continuing the work or thinking about reconstructing tissue like yourself? Or in like even other lines of work? Why is it so important for you to tell this story?
14:28 Speaker 02 Oh, so many answers. It's a great question. I think that the most visceral one is everyone likes this sort of story, whether you're a scientist or a non-scientist.
14:37 Regina Barber? Yeah.
14:38 Speaker 02 And if you're a scientist and you hear this kind of story, again, you get that sense of humility, but you also get that sense of connection. We can see that there's this very long lineage where we've been working on this for a long time. Many people have contributed to these things, and each of those contributions is important in their own way. And that you, as someone working in this field, have some hope of coming up with something new and exciting, too. But if it feels hard, it's because it is hard and something we've been doing for a while.
15:07 Regina Barber? Daniel, thank you so much for this truly fascinating history lesson. I had a great time. Thank you so much.
15:14 Speaker 02 Yeah, me too. It was fantastic to get to share this. So, thank you.
15:22 Regina Barber? This episode was produced by Hannah Chin. It was edited by our showrunner, Rebecca Ramirez, and the facts were checked by Tyler Jones. Robert Rodriguez was the audio engineer. Beth Donovan is our senior director and Colin Campbell is our senior vice president of podcasting strategy. I'm Regina Barber. Thank you so much for listening to Short Wave from NPR.
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