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Ancient surgical technique still used to rebuild noses today

When facial surgeon Sam Most, MD, first contacted me about doing a story on one of his favorite procedures called the "forehead flap," which he uses for major nose reconstructions, he sent along photos of what a patient looks like prior to surgery.

The photos make it clear real fast how unfortunate it is to lose your nose. The nose is the focal point of the face. It’s what people notice first. The numbers of people losing their noses due to skin cancer is on the rise, and many, are left wearing uncomfortable, unflattering prostheses for years.

Enter surgeons like Most, part artist, part scientist — a sculptor of noses. According to Most, it’s the most difficult facial plastic surgery procedure. And key among the many necessary tools needed to succeed is the "forehead flap" — a procedure that originated with cobblers in ancient India. My article tells the story of this fascinating surgery, which was first introduced into Western medicine in 1794:

Most is quick to recount the historical significance of the forehead flap, Most is quick to recount the historical significance of the forehead flap technique, which originated in India probably before the birth of Christ but wasn’t widely known to Western medicine until 1794 with the publication of a letter to the editor in Gentlemen’s Magazine of London. The letter provided the first account in English literature of the procedure.

At the time, India was a colony of the British. A sultan, angry at the occupation, offered bounties for the amputated ears, noses and hands of British sympathizers. The letter describes the nasal reconstruction of an Indian bullock driver who, having been imprisoned by the sultan, had his nose and one of his hands cut off for delivering supplies to British troops. It goes into detail how the driver’s nose was rebuilt 12 months later, after he joined the Bombay Army of the East India Company.

Most has been using the ancient procedure at Stanford for 15 years now, and has even published research on how to improve upon it. All this proved lucky for Gary Saxon, a business owner in Redwood City, Calif. who had the majority of his nose removed by dermatologists trying to eliminate an invasive basal cell carcinoma. The very next day, Most was there to rebuild Saxon's nose with much success. As my story describes:

Gary Saxon has a nice nose. A gray beard covers his chin, and heavy eyebrows shade his eyes, but nothing hides his nose. It holds a position of prominence, sticking right out there in the middle of its owner’s slightly grizzled face, like noses do. It’s well-sculpted and well-proportioned — with a slightly turned-up tip that compliments Saxon’s positive perspective on life. And best of all, it works.

Saxon is lucky. A year ago, all he had was a bloody hole where his nose used to be.

Previously: Rebuilding Cassie's smile: A lung transplant patient's struggle with skin cancer, Stanford reconstructive surgeon Jill Helms reminds us that "beauty isn't defined by our faces alone" and Pigs to the rescue: How salt pork stops nose bleeds,
Image courtesy of Sam Most

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