Quick: if I say “plastic surgery,” what procedures do you think of first? For me, it’s breast implants and liposuction and Botox. Then I wonder if Botox is really “surgery.” Then I start wondering who gets calf implants.

Jocelyn Wildenstein has all of the plastic surgery

With all of the wonderful and scary surgeries available today, I almost forget about nose jobs, which is silly, since that’s the first type of plastic surgery I learned about. “Rhinoplasty” is one of the first fancy words I learned to use in order to show off (hey, a fifth grader has to start somewhere). I attribute this all to Clueless and its mockery of nose jobs.

Because how could I not include the greatest plastic surgery joke ever?

And of course, growing up to the accompaniment of Michael Jackson’s ever-shrinking nose had a big role in shaping (pun!) my perception of plastic surgery. Oh, Michael – the smaller it got, the more I grew up.

The nose knows

But don’t look down on the humble rhinoplasty. Not only does it still serve as the gateway drug to a lifetime of fixing yourself up all pretty, but it seems to have been the very first cosmetic surgery.

Sushrutha was a surgeon and writer who lived around 600 B.C. in Benares, India. He described history’s oldest-known rhinoplasties in a Sanskrit treatise called “Sushrutha Samhita” which contains riveting materials such as descriptions of 700 medicinal plants as well as his instructions for a nose job.

Sushrutha - paving the way for Michael Jackson

The portion of the nose to be covered should be first measured with a leaf. Then a piece of skin of the required size should be dissected from the living skin of the cheek, and turned back to cover the nose, keeping a small pedicle attached to the cheek. The part of the nose to which the skin is to be attached should be made raw by cutting the nasal stump with a knife. The physician then should place the skin on the nose and stitch the two parts swiftly, keeping the skin properly elevated by inserting two tubes of eranda (the castor-oil plant) in the position of the nostrils, so that the new nose gets proper shape.

A leaf - cutting-edge medical technology in 600 BC

What’s happening here is not what you think of as a typical modern nose job, where someone wants to change the shape of their nose. Rather, Sushrutha is describing a nose reconstruction – the creation of a whole new nose. Why did he see so many noseless patients that he had to invent a surgery? Turns out that nose-amputation was a pretty common punishment for crimes – like adultery – in ancient India.

So how did Sushrutha give noses to the noseless? He cut a big flap of skin from the forehead, twisted it down and around, and sewed it on to the patient’s face in a nose-shape, using plant stems to keep nostrils separated until the whole thing healed. The new nose would remain attached to the forehead at the twist point until the skin graft took; then the twisty bit could be cut off in a follow-up surgery. Voila – at the expense of a giant forehead scar, you get a brand-new vaguely nose-shaped lump!

Maybe not actually the worse nose job after all

Believe it or not, this technique (rediscovered or, more probably, reinvented in Italy in the 15th century) remained the most popular type of nasal reconstruction surgery until the 1950’s, and is still practiced today (Google “forehead flap nasal reconstruction” for images, if you want your dreams to be haunted).

At least modern surgeons use anesthesia during the procedure, whereas Sushruta’s best recommendation was that “wine should be used before the operation to produce insensibility to pain.” Which makes me think that there might be quite a few starlets around who could kick it old-school, rhinoplasty-wise.

Lindsey Lohan - Sushruta’s ideal patient