Reconstructive nose surgery, or rhinoplasty, became more sophisticated and wide-ranging in the 20th century. In 1902 through 1904, Freer and Killian developed submucous resection septoplasty, a surgery for the correction of a deviated septum.
Lifting the mucoperichondrial tissue flaps, they made incisions to cut and move the cartilaginous and bony septum, whilst keeping the septum supported with a small margin at the dorsum and the caudad. It was a successful procedure which soon became the standard for correcting a deviated septum.
Later, in 1921, Rethi pioneered a surgery for adjusting the tip of the nose. It was an open rhinoplasty involving the incision of the columella to create access to the inside of the end of the nose. Another major advancement of the same decade, in 1929, was Peer and Metzenbaum’s procedure, the first to correct the caudal septum, located behind the forehead.
In 1947, Cottle performed a closed, or endonasal, rhinoplasty for a deviated septum, which became the norm for rhinoplasty for several years. Most advocated for closed procedures until the 1970’s, when Padovan and Goodman each spoke to the benefits of an open rhinoplasty.
In the 1960’s, a non-surgical restorative procedure was used to fill in the soft tissues of the nose. Unfortunately, the silicone gels injected directly into the skin were causing ulcers and granulomas. Therefore, to preserve the benefits of the surgery and minimize risks, Orentreich developed the “microdroplet technique,” which involved injecting tiny amounts of silicone over several visits.
Lastly, Jack Anderson wrote an article, in 1982, entitled “Open Rhinoplasty; An Assessment,” which detailed the surgeon’s improvements upon older practices. Five years later, the article “External Approach for Secondary Rhinoplasty” moved nose reconstruction forward as it described a surgical approach for repairing an initially failed nose reconstruction. Thus, at last, there was an option for those whose original surgery had not worked as planned.
