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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).