A brief history of nose jobs

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From Clueless to Vanderpump Rules, pop culture has long been fluent in the nose job and its post-op bandages. Rhinoplasty techniques have become so advanced that guessing who has had one is nearly impossible. But the normalisation of nose jobs and their increasingly natural-looking results have been a long time in the making. 

Nose reconstruction surgery dates as far back as the sixth century BCE, when Indian physician Sushruta outlined the forehead flap method for rebuilding noses. The surgery was performed on patients who’d lost their noses as a form of criminal punishment. Noses continued to suffer at the hands of bloody warfare and violent duels, but the science of their repair didn’t see much development in the West until the 16th century. Europe was knee-deep in a mass outbreak of syphilis that left hordes of sufferers with rotting and disfigured noses. Reconstructive nose jobs were performed as an attempt to disguise these symptoms and counteract the stigma of the disease.

Around the same time, Italian surgeon Gaspare Tagliacozzi introduced a new method of reconstructive rhinoplasty using skin from the patient’s upper arm. Tagliacozzi promoted his ‘Italian Method’ – which required that the patient’s upper arm remain strapped to their nose for two weeks – as an alternative to the significant facial scarring of the ‘Indian Method.’ But Tagliacozzi’s method had a downside of its own – in cold climates, the new nose would sometimes turn purple and fall off. Because of this, the ‘Italian Method’ soon fell out of use. 

These early nose jobs were performed to replace, or give the appearance of replacing, something that was lost by way of trauma or disease. It wasn’t until the late 19th century that purely aesthetic rhinoplasty was born – performed to redesign intact noses, rather than replace missing ones. In 1887, American otolaryngologist John Orlando Roe documented what is considered the first modern rhinoplasty on a patient who suffered emotional distress stemming from a ‘pug nose’.

Roe’s technique was performed inside the nose, thereby eliminating external scarring, and ensuring the secrecy of his work. Around the same period in Berlin, German-Jewish surgeon Jacques Joseph used a similar method to diminish the noses of European Jewry. These groundbreaking early rhinoplasties belong in a category of global firsts for the fledgeling field of aesthetic facial surgery.

In the years following, enhanced focus on facial appearance – and the potential to augment, or ‘improve’ it – gave way to a movement of commercial ‘beauty doctors’, who advertised services such as paraffin injections to alter the appearance of one’s nose. The injection of paraffin, also used in proto-boob jobs, proved to be unstable and unsafe. Advancements in surgical techniques became a necessity after World War I brought back a population of injured and severely disfigured soldiers in need of facial reconstruction. Thus, the atrocities of war further encouraged innovations in facial plastic surgery for the nose and beyond. 

Today, nose jobs are so common that they’re hardly news-worthy. Procedures take only a couple of hours and healing takes about a week. Rhinoplasty, colloquially known as a nose job or nose reshaping surgery, refers to the surgical procedure of manipulating bone and cartilage to alter the shape and sometimes the size of the nose. The focus of a nose job can be cosmetic (to narrow, straighten, etc.) or functional (to correct internal problems and improve breathing), or both.

Depending on patient circumstances and desired results, the surgeon will perform either an open or closed rhinoplasty, the difference being the placement of the incision. A closed rhinoplasty means that all incisions are made inside the nose, whereas an open rhinoplasty requires a small incision on the underside of the nose, which may leave a scar. 

Nose jobs are the third most popular cosmetic surgery in the US – behind boob jobs and liposuction – with 213,000 nose reshaping procedures performed last year (a 2 per cent decrease from 2017), as per the most recent data from the American Society of Plastic Surgeons (ASPS). In the UK, stats from the British Association of Aesthetic Plastic Surgeons (BAAPS) show the procedure ranking lower in popularity, yet the 2,831 nose jobs performed in 2018 account for a 3 per cent jump up from the previous year. US costs for a cosmetic rhinoplasty procedure average at about $5,350, where UK costs range from £4,500 to £7,000.

Reasons for getting your nose done are personal and far-reaching. “Noses are a prominent feature of the face. Patients who notice an imbalance in facial proportions may find that a nose job is just what they need to achieve a more balanced look,” says ASPS President, Alan Matarasso, M.D., F.A.C.S. Matarasso often hears people say: “It’s like having a foot that’s too big for your body.” 

“Noses are a prominent feature of the face. Patients who notice an imbalance in facial proportions may find that a nose job is just what they need to achieve a more balanced look. It’s like having a foot that’s too big for your body” – Alan Matarasso, M.D., F.A.C.S

Historically, the size, shape, and proportion of one’s nose were looked to as a reflection of their whiteness. Beginning in Europe in the late 19th and early 20th centuries, some of the first cosmetic nose jobs sought to repair the so-called defect of Jewish ‘nostrility.’ Without the ethnic signifier to give them away, patients could ‘pass.’ Over a century later, reasons for going under the knife may be less politicised and more nuanced, but vestiges of the old days remain. 

Helen (29) had her nose done five years ago. Raised in a small Pennsylvania coal town, Helen was always keenly aware of her half-Iranian heritage. “I was always really, really, really aware that I looked not exactly white,” she says. Before surgery, Helen had what she calls a Roman, or hook nose. “To me, it looked overtly Middle Eastern,” she explains. Nose jobs have been historically popular among Iranian and Irianian-American women. 

In the past, rhinoplasties often produced what looked more like nose jobs than actual noses. That ‘done’ look, Matarasso explains, has become less common as surgical techniques have advanced. "Most patients nowadays want a natural-appearing nose. They do not want it scooped out, turned up, or pinched in – sort of that appearance that people may have had in the 60s and 70s. They want a nose that looks like they were born with it." 

Having said that, people’s sense of aesthetics sometimes vary regionally, so that in some areas, patients may want their noses to look a little more ‘done’. But where boob job trends can be quantified by implant size, regional trends in natural vs done-looking noses are more or less anecdotal. 

One of those anecdotes comes from Helen, who saw this play out in her own family, when her mother and brother both got their noses done in Dallas, Texas just weeks before she had hers done in New York. "Their noses just looked like really Who-ish to me," she recalls. “They were very upturned, and it really did look like someone had just taken a butter knife and swiped through a soft substance to get this really perfect slope of a nose.” Helen discussed this with her surgeon beforehand and together they decided to leave a bit of character, which is why she still has a tiny bump on her nose. Because, she says, “you’re never born with a truly perfect sloped nose.” 

“Everyone from Janet Jackson, Iggy Azalea, Tyra Banks, Ashlee Simpson, Courtney Love, and Lisa Kudrow have all spoken openly about their nose jobs. Some, like Cameron Diaz and Jennifer Anniston say that they underwent the surgery to correct internal health problems”

The ‘ideal’ nose is continually evolving. In America, nose jobs made a name for themselves against the backdrop of 19th-century immigration. In spite of the nation’s African American and growing Jewish and Irish immigrant populations, the ‘white’ body ideal, and the nose that came with it reigned supreme. Small and sloped remained en vogue through the early 20th century, where the changing face of nose jobs and the evolution of aesthetic ideals are perhaps best seen through the era’s most famous faces. 

Celebrity faces and the secrets (and sometimes surgeons) behind them have long captured public interest, but they’re also a window into our shared cultural fears and misgivings about our noses. In 1923, Jewish comedian and vaudeville star Fanny Brice had her nose refined in a surgery that was covered by the New York Times. Though Marilyn Monroe never spoke about it publicly, X-rays show that the 1950s film icon did indeed have a nose job. Joan Rivers wrote a book on her surgeries, in which she devotes an entire chapter to her first-hand knowhow on nose jobs. Michael Jackson had so many nose jobs that some say he wore a prosthetic nose to cover his resulting lack of cartilage. Vanderpump Rules star Jax Taylor took audiences on a ride through the saga of his first, second, and third rhinoplasties. 

Everyone from Janet Jackson, Iggy Azalea, Tyra Banks, Ashlee Simpson, Courtney Love, and Lisa Kudrow have all spoken openly about their nose jobs. Some, like Cameron Diaz and Jennifer Anniston say that they underwent the surgery to correct internal health problems. Lil’ Kim opened up about having her nose done twice, the second surgery to correct damage after her nose was broken by an abusive ex-partner. Dirty Dancing actor Jennifer Grey has publicly lamented her decision to go under the knife, telling Mirror in 2012 that her rhinoplasty changed her face so drastically that she became literally unrecognizable to the point of anonymity. "It was the nose job from hell. I’ll always be this once-famous actress nobody ­recognises because of a nose job.”

These are just the celebrities who choose to publicise their surgeries, and not everyone does. But that doesn’t stop tabloids and gossip rags from making guesses. Feeling entitled to know what work a celebrity has or hasn’t had done is one thing, but our obsession with other people’s faces transcends just curiosity. It’s not uncommon for rhinoplasty patients to come to their pre-op appointments armed with photos of celebrities whose noses they want to emulate. From a surgeon’s perspective, that’s not all bad. 

Generally speaking, Matarasso finds reference photos – celebrity or otherwise – to be a useful resource. Patients come in asking for a ‘straight nose,’ but what does that really mean? Looking at a photo together, he says, “you get a sense of how much you’re going to file that nose down.”

Which celebrity noses he gets asked for the most fluctuates based on who’s in the public eye at any given moment. "When Kate Middleton got married, everybody wanted Kate Middleton’s nose, when her sister-in-law got married, you had people that liked her nose. It very often reflects popular culture." The only cause for concern? When patients come in asking to look like a celebrity. “Because it’s not just the nose that makes someone look like another person.”

As a culture, we’ve made a habit of gauging a person’s beauty by their proportions and dimensions, the angle of their nose, it’s length and straightness. Noses and our feelings about them evoke generations-old values and insecurities. For centuries, they’ve been inextricably intertwined with racialised standards of beauty. More recently, a notable decline in the popularity of nose jobs may mean that we’ve begun to feel differently – or simply that we’ve found new and less invasive alternatives.

Last year, ASPS reported a 45 per cent decrease in the number of nose reshaping surgeries performed in 2018 as compared to 2000. Decreased surgery statistics may be due to the rising popularity of non-surgical alternatives, namely: the liquid or non-surgical nose job. The method works by injecting filler into areas of the nose in order to camouflage, or balance specific features of the nose. A liquid nose job usually takes 30 minutes or less, and requires little-to-no downtime. Leave for your lunch break and return with a “more balanced” face. 

The convenience and low-commitment nature of a non-surgical nose job may make it an appealing alternative to traditional surgery. But the procedure is only temporary – with results lasting from around six months to a year and a half – meaning, at an average cost of $1,050 per treatment, continued liquid nose jobs will quickly out-cost traditional surgery. When it comes to which option is best for which nose, Matarasso says, “the vast majority of noses need a surgical rhinoplasty.” After all, an injection nose job can only add to the nose, so removing a bump or narrowing a bridge isn’t in the cards. 

“On the other hand, in recent years cultural ideals have shifted toward an ethos of body positivity and inclusivity. Fitting in is less sought after than standing out. Perfection is just beginning to go out of style. There’s even a micro-trend of LA patients getting injections to create a ‘reverse nose job’ effect,”

On the other hand, in recent years cultural ideals have shifted toward an ethos of body positivity and inclusivity. Fitting in is less sought after than standing out. Perfection is just beginning to go out of style. There’s even a micro-trend of LA patients getting injections to create a “reverse nose job” effect, in other words, adding minor bumps back to their post-rhinoplasty noses. Helen reflects on the years since she had her nose job: “A lot has changed about the political climate and accepting people. And my nose just wasn’t cool five years ago.” 

Would having grown up just a few years later, and coming of age in a more inclusive world have changed Helen’s initial feelings about her nose? "I still would’ve disliked it, but I think maybe I would have been able to cope with it a little bit more or have it make sense to me." She imagines that having social media in her youth also may have helped her to see that there were other people who looked like her, who were valued. 

As far as what’s next? The future of surgical rhinoplasty is full of possibilities, says Matarasso. When he began his career in plastic surgery, a nose job patient stayed at least three nights in a hospital and wore a plaster splint for a couple of weeks. “Now the patient comes in at eight o’clock in the morning – surgery could take about an hour. They have a melted piece of plastic that protects the nose for a week. And by lunchtime, they’re home." It’s the type of progress he couldn’t have predicted 30 years ago. One thing’s for sure: As non-surgical nose jobs grow in popularity and imperfection becomes less of a dirty word, the good old-fashioned nose job will continue to improve for those who want it.