Reconstruction of the nose--a historical review

As the central and most prominent part of the human face, the nose contributes to determine the beauty of a person significantly. Certain ancient populations, particularly in India, had the common tradition to cut off a person's nose as an act of humiliation to thieves and prisoners of war or vengeance for some real or fancied wrong. To erase the signs of this cruel disfigurement, the ingenuity of surgeons conceived different solutions over the centuries, therefore the birth and evolution of plastic surgery strictly parallel the art of replacing missing noses. Nasal restoration by means of a skin flap taken from the arm is an operation of Italian origin, whereas by a skin flap taken from the forehead is an operation of Indian origin. This review highlights the development of this interesting and at the same time challenging surgical technique. Currently, the forehead flap is considered the solution of choice due to the excellent colour match. However, for the success of the repair it is essential to have the forehead flap of a correct size and shape depending on the defect. Nowadays, the operation has achieved excellent results due to the accuracy of technical details. Defects of the nasal tip require replacement of the different layers, mucosa, framework and cover. Donor areas must be carefully selected to leave minimal local morbidity, whereas recipient sites are treated aesthetically so as to obtain the most successful type of repair. In conclusion, the lesson from our forefathers has positively influenced the evolution of nasal reconstruction techniques.