Today, we tell a story of nose and medical plastic surgery, which is a realistic and ancient story containing a tragic plot.
I. The tragic case of nose cut in Afghanistan
Last Sunday, a tragic case of nose cutting occurred in Afghanistan. 20-year-old Reza Gul, who opposed her husband’s marriage to her 7-year-old cousin as a young wife, had her nose brutally cut off by her husband.
In the photo, Reza Gul lies helplessly on a hospital bed with gauze on her nose. Next to her is her daughter.
This news reminds people of another Afghan woman, Aesha.
On the cover of Time magazine in August 2010 was Aesha, who had her nose cut off. That year, 18-year-old Aesha was caught trying to escape from her in-laws’ “clutches. She was brutally abused, having her nose cut off and her ears cut off.
Aesha’s ordeal shocked the world. She fled to the United States with the help of humanitarian organizations.
II. Fake nose
In the U.S., Aesha had a good life with no worries about food and clothing. But even though she made a happy face, everyone understood what she wanted: she wanted a nose.
The function of the nose is not limited to the sense of smell. The structure of the nose makes the air inhaled into the nasal cavity warm and moist, reducing the irritation to the lungs.
And for humans, the external nose is an organ of great aesthetic importance. The absence of the external nose can make a person look hideous. In other words, it is difficult for a person without a nose to truly integrate into society. People who lost their noses in ancient times found ways to fit themselves with a nose, even if it was a fake one. These are the fake noses that people wore in the 18th and 19th centuries.
So, soon after arriving in America, Aesha had a prosthetic nose. A bit better than the ancients, her nose did not have to come with a fixation device, it was glued to her face.
Aesha wanted a real nose.
III. History of real nose
Making a real nose is not easy.
Humans have a long history of making real noses. Of course, this is because, first of all, cutting off the nose is a very old punishment…
The punishment of cutting off the nose was prevalent in ancient India. In the sixth century B.C., the medical book “Mythology” by Sushruta, a famous Indian doctor, recorded several surgical methods. Among them was the surgical method of nose reconstruction using forehead flaps. Therefore, the use of forehead flaps for nasal reconstruction is called the “ancient Indian method”.
However, the Indian method of nasal reconstruction did not spread to the rest of the world soon afterwards.
In 1816, Carpue, a British surgeon, created a sensation by successfully reconstructing the nose with a forehead flap. Why the British? They stole it from the Indian colonies. This is the illustration from Carpue’s 1816 article “An account of two successful operations for restoring a lost nose”.
The following illustration from a 1903 surgical book gives us a clearer picture of the frontal flap nose reconstruction method. First of all, let’s give the medical professionals a little explanation. In layman’s terms, a flap is a piece of flesh that is connected to the body and fed by blood, which is the flesh of one’s own body. To reconstruct the nose with a skin flap is to use your own skin to create your own nose. At the beginning, the flap is fed by the tip of the flap that is connected to the body. After a few weeks of suturing the flap to the traumatized surface of the recipient area, a local blood supply for the flap can be formed, and then the tip can be cut off for the next step of morphological restoration. Therefore, this surgery must be performed in stages. In fact, the most important thing I would like to say about this illustration is that the drawing is so damn delicate. Notice that before the surgery, the patient’s eyes are bleary, the corners of her mouth are drooping, and she looks dejected; after the surgery, her eyes are glowing, the corners of her mouth are uplifted, and she is full of energy and confidence to return to society. (What is medical humanism? This is medical humanism! Medical humanities should not be an empty university course, but a silent integration of all medical elements.)
It can be said that throughout the twentieth century, the “ancient Indian method” has become popular, and it is still a common and mature method of nose reconstruction. Of course, many further improvements have been made on the basis of this method, so I will not go into details.
This is a wounded soldier during World War I who underwent a forehead flap nose reconstruction surgery. The nose looks so big. Oh, in fact, the long-term effect is okay.
Nowadays, this method is also used to repair the nasal subunits in many cases of partial defects of the nose. The results are quite good.
So, are there other types of nasal reconstruction methods? Yes, there are!
In 2010, a medical book published in 1597, “De Curtorum Chirurgia Per Insitionem”, by the Italian physician Gaspare Tagliacozzi, was auctioned off in England. In this book, the reconstructive surgery of the nose using an upper arm flap is described: the patient’s nasal wound is sutured together with a flap lifted from the upper arm; and before the flap’s blood supply is established, the The forearm is fixed to the head, otherwise the flap will be torn off; the book says that after a few weeks the skin of the upper arm is completely grown together with the nose, then the tip can be broken; and then after two weeks until the newly transplanted skin takes shape and looks like a new nose, the plastic surgery is complete. The book was auctioned off by a plastic surgeon for £11,000. (A relic from 1597! This price is really not expensive! If I had known this price, I would have sold my body to shoot it!)
The upper arm flap (skin tube) nose reconstruction method, which continued for centuries, still had a market in the twentieth century. The photo below is a real version of an upper arm flap (dermal tube) nose reconstruction. The most significant complication of this procedure must be – mental disorder…just kidding, but it is truly frightening to be fixed in this position for a few weeks. Therefore, this type of surgery is unlikely to become mainstream.
An illustration of a surgical work from 1831, very well drawn. The main ways of reconstructing the nose for humans are in here.
After a bunch of miscellaneous history, let’s go back to Aesha’s nose.
IV. Aesha’s real nose
Aesha wanted to have a real nose, which one did she choose? She chose the forehead flap method.
So, let’s take a look at Aesha’s real nose journey.
Wait, I’m sure some of you will ask, what’s the big bump on Aesha’s head? Let me introduce, this is the forehead expansion flap technique. If there are any new techniques in the field of plastic surgery in the twentieth century that stand out, skin expansion is certainly one of them. In Aesha’s procedure, a dilator is first placed under the forehead tissue, then saline is injected daily to dilate the skin until there is enough skin to remove the dilator and perform a nasal reconstruction. Compared with the traditional forehead flap, the dilated flap procedure has some advantages: the donor area is closed directly, the forehead scar is not obvious, and the forehead dynamics, frown, and sensation are hardly affected; the dilated flap is thinner and softer; it facilitates shaping and does not require surgical thinning; and the increased flap area facilitates repair of large defects.
After implantation of the expander, skin expansion takes a time process, and the multi-stage surgery is a kind of sharpening of the patient’s will. The moral support of family and friends during this process is also very important.
Here is a photo of Aesha’s real nose after the flap transfer, which has taken initial shape. Although the shape still needs to be adjusted, Aesha is already excited to start to “look at the mirror”.
After the fourth stage of surgery, the shape of Aesha’s nose looks more straight.
I don’t have much information on how Aesha is doing now. But it’s good that she may have integrated into society and become a normal person. This photo was taken two years ago when a netizen met her on the subway.
May she have a happy life.
V. Ending
I look at the following painting of an Afghan woman who has suffered the pain of nose cutting and surgery
Some questions popped into my head.
To what extent can a perfect plastic surgery heal this woman’s pain, both physically and spiritually?
How much more civilized are we in this era compared to ancient India, when we treat the ancient injury of nose cutting in the same ancient way?
These questions are not easy to answer.
In the midst of the confusion, I still wish 20-year-old Reza Gul the best of luck in getting a real nose as soon as possible.
The world owes her a nose.