first nose job

Sculpting Identity: A History of the Nose Job

For centuries, people have used nasal surgery to protect, or improve, their place in society. An Object Lesson .

All anxieties live in our bodies, but anxieties about our bodies feel particularly urgent. And since famous bodies are used to sell salve—cosmetics, waist-shapers, soft drinks—meant to soothe those anxieties, we’re almost constantly embracing standards that even celebrities cannot maintain without intervention. Often, that comes in the form of cosmetic surgery.

Scores of Americans are remaking their bodies. According to the American Society of Plastic Surgeons, 15.6 million cosmetic procedures were performed in 2014 . Plastic surgery sells norms of youth and beauty by offering consumers opportunities to recreate their appearance. It promises to fix socially undesirable physical features or delay the point at which we begin to show aging, a process framed by youth-centered culture as a slide into decrepitude, cultural irrelevancy, and death.

But these procedures entail an internal tension: Their results exist to be viewed, yet they are also meant to remain invisible, undetectable. The plastic surgeon is a sculptor who can remake the body in a way that looks natural while not betraying the artifice of their work. However, they don’t always succeed. It’s when plastic surgery is visible—think of Michael Jackson’s infamous nose—that social fears of disfigurement manifest as revulsion.

The shape of the nose, in particular, is imbued with assumptions about one’s character and place in society. Various efforts to fix undesirably shaped noses by way of plastic surgery have been employed over two millennia. In Venus Envy: A History of Plastic Surgery , Elizabeth Harken details one of the first recorded rhinoplasty procedures, performed in ancient India in the sixth century B.C. A flap of skin from the patient’s cheek was repurposed to mold a new nose. However, it wasn’t until a European syphilis epidemic in the late 16th century that cosmetic nasal surgery garnered much attention in the West. One of the unfortunate symptoms of advanced syphilis is soft-tissue decay, which affects the nose and leaves a gaping hole in the middle of one’s face. Such a disfigurement carried the social stigma of disease and infection, even if the afflicted had lost their nose by another means. Different methods were employed to recreate noses. One of the most popular procedures involved taking skin from the patient’s arm and grafting it to their face in an effort to make a new nose (or something resembling one, anyway).

Given its prominence on the face, even healthy noses can shame their bearers. The pseudoscience of physiognomy, which experienced a modern revival in the 19th century, claimed that the shape of the nose could tell you about a person’s moral character. As Gabrielle Glaser explains in The Nose: A Profile of Sex, Beauty, and Survival , a straight nose signified refinement, while a “hawk” nose signified a cunning moral character. (This perpetration of this myth was not just pseudoscientific, but anti-Semitic as well.)

It was not until the late 19th century that plastic surgery began to gain popularity in North America. Americans wishing to cure themselves of socially undesirable features such as large noses, undistinguished jaw lines, or any features that did not conform to contemporary ideals of beauty could readily find a doctor who would cut and sculpt their face. These pioneers of cosmetic surgery included patients who went under the knife to remove racial signifiers. Procedures included making eyes, lips, and noses look less foreign, a dirty word in the early lexicon of American racism.

By the turn of the 20th century, advancements in war—poisonous gases, sniper rifles, and trench warfare—had made the jaws, lips, and noses of soldiers newly vulnerable. Facial injuries prompted surgeons to experiment with techniques to replace lost or damaged appendages. Soldiers such as John Bagot Glubb, who was also a scholar and renowned author, were offered surgery to fix facial disfigurements. Murray C. Meikle documents the mixed blessing of Glubb’s fortune in Reconstructing Faces: The Art and Wartime Surgery of Gillies, Pickerill, McIndoe and Mowlem : “As most of my lower jaw had gone, I was shown an album of photographs of handsome young men and asked to choose the chin I would like to have!”

Even with these medical advancements, plastic surgery could only do so much. During World War I, London General Hospital established the Masks for Facial Disfigurement Department . The Tin Noses Shop, as the soldiers called it, brought together American and European doctors and sculptors who worked to create individualized metallic masks, which then covered deformed or missing jaws, eyes, lips, and noses of wounded men. Though separated by a century, photographs of these men echo those of present-day celebrities with excessive or mask-like plastic surgery.

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In his book Making the Body Beautiful , Sander L. Gilman argues that by the 1920s, the reconstructed faces of war veterans helped the public begin to accept cosmetic surgery. Although the benefits of medical advancements made in reconstructive surgery during the war were available internationally, plastic surgery began its boom in the United States during this time. The society that would later become the American Association of Plastic Surgeons was founded in 1921, right after the war and during the rise of a consumer culture that sanctions the exchange of money for beauty (and noses). The popularity of cosmetic surgery grew quickly, assisted by the normalizing presence of reconstructive procedures among veterans.

While modern war destroys noses by mishap, cultures have long employed nasal mutilation as a punishment. During the middles ages, a woman’s hacked-off nose was a sign of disobedience or sexual promiscuity. In A Social History of Disability in the Middle Ages , the historian Irina Metzler explains that adultery was punishable by severing the nose in the Kingdom of Jerusalem of the 10th century. But even half a millennium earlier, the Vandal king Gaiseric “ordered his Gothic wife’s nose and ears mutilated, having accused her of plotting against him.”

These atrocities are still committed. In 2010, Aesha Mohammadzai’s nose-less face was featured on the cover of Time magazine under the warning, “What Happens If We Leave Afghanistan.” Mohammadzai’s story is a harrowing account of life under Taliban rule. When she was 12, her father sold her to a Taliban fighter to pay off a debt. After she attempted to run away, her Taliban family cut off her nose and ears, leaving her for dead.  She was rescued by aid workers, who then brought her to the United States.

Mohammadzai’s post-Afghani life and the reconstruction of her nose have been widely covered in the press . CNN’s Jessica Ravitz documented Mohammadzai’s American integration, where she received a degree public of attention typically reserved for celebrities:

In sunny Southern California, she bounced between lavish homes in gated communities. She was trotted out at a pricey gala dinner in Beverly Hills, where she debuted her prosthetic nose, a preview of what the surgery would do for her. She walked the proverbial red carpet, met Laura Bush and was honored by California’s then-first lady, Maria Shriver.

When the time came for Mohammadzai to begin a marathon of surgeries, T he Daily Mail updated its readers on reconstruction efforts , detailing the various procedures required to build her new nose. The techniques employed were similar to those used in ancient India: doctors used skin from her face to provide tissue for her new nose. Unlike celebrity body shaming or botched surgery rubbernecking, Mohammadzai’s reconstructive process has garnered positive attention. Four years after the Time cover story, the media continues to document her progress. The tenor of this coverage harkens to Victorian freak shows, in which indigenous peoples from Britain’s imperial conquests were displayed in Europe as primitive savages in need of saving. Media coverage of Mohammadzai similarly casts Western culture and technology as both civilizer and savior.

The aesthetic value assigned to a person’s nose reflects historical and cultural beliefs on beauty, disease, race, war, and gender. The nose’s prominence—projecting from the face for all to see in the flesh—turns out to make it a potent symbol, whether the for the sake of consumer culture, ideals of beauty, the violence of war, or the power of the state.

• Students & Professionals

History of Medicine: Ancient Indian Nose Jobs & the Origins of Plastic Surgery

Think plastic surgery is a modern luxury? Think again. It turns out that the roots of cosmetic and reconstructive procedures go back more than 2500 years. It's a common misconception that the "plastic" in "plastic surgery" refers to an artificial material when it actually derives from the Greek word,  plastikos , meaning "to mold" or "to give form."

During the 6th Century BCE, an Indian physician named Sushruta – widely regarded in India as the ‘father of surgery’ – wrote one of the world’s earliest works on medicine and surgery. The Sushruta Samhita documented the etiology of more than 1,100 diseases, the use of hundreds of medicinal plants, and instructions for performing scores of surgical procedures – including three types of skin grafts and reconstruction of the nose.

Skin grafts entail transplanting pieces of skin from one part of the body to another. Sushruta’s treatise provides the first written record of a forehead flap rhinoplasty, a technique still used today, which a full-thickness piece of skin from the forehead is used to reconstruct a nose. At that time, patients in need of that procedure generally included those who had lost their noses as punishment for theft or adultery.

Today, surgeons use skin grafts to restore areas that have lost protective layers of tissue due to trauma, infection, burns, as well as to restore areas where surgical intervention has created a loss of skin, as can happen with melanoma removal. Some grafts include blood vessels and muscle, such as in reconstructive breast surgery.

Amazingly, these techniques are all explained in the Sushruta Samhita .

Click here to learn more about trauma surgery.

Check out other interesting stories in our "History of Medicine" Series:

• Assassins, Embroidery, and the Origins of Vascular Surgery
• First Measurement of Blood Pressure
• Woman of Honor

The Nose Job Dates Back to the 6th Century B.C.

But for a long time, the nose was built up instead of shaved down

Maris Fessenden

Former correspondent

The rhinoplasty, colloquially known as the nose job, is now popular enough that it’s considered minor plastic surgery. Still, the procedure earns comment when the proboscis being shaped is a famous one and plenty of people express concern over the current boom in cosmetic surgeries . Yet nose jobs aren’t new. The earliest recorded schnoz shaping happened in ancient India in the 6th century B.C., reports Tiffany Hearsey for The Atlantic . 

The report is related by Elizabeth Harken in her book Venus Envy: A History of Plastic Surgery . The ancient Indian procedure included taking a flap of skin from the patient’s cheek and reshaping it into a new nose. The ayurvedic physician Sushruta describes that procedure in his Sushruta samhita , now considered a foundational Sanskrit text on medicine.

Still, rhinoplasty didn’t enter the limelight in the West until syphilis struck Europe in the late 16th century.

Hearsey writes:

One of the unfortunate symptoms of advanced syphilis is soft-tissue decay, which affects the nose and leaves a gaping hole in the middle of one’s face. Such a disfigurement carried the social stigma of disease and infection, even if the afflicted had lost their nose by another means. Different methods were employed to recreate noses. One of the most popular procedures involved taking skin from the patient’s arm and grafting it to their face in an effort to make a new nose (or something resembling one, anyway).

People have long sought out rhinoplasties to address cosmetic concerns and conform to society’s beauty ideals. Some of that led people to try and make their features look less like that of a racial minority in America (still a motivating factor today ). 

But not all nose jobs were motivated by beauty standards. Facial surgery experienced a real boom during the two World Wars, as soldiers with injuries to their jaws, lips and noses became the proving ground for surgeons experimenting with reconstruction techniques. 

In her book, excerpted by The New York Times , Harken writes of surgeons who pioneered ways to build up noses, rather than reduce them. So-called "saddle-nose" could be caused by syphilis, but also could be inherited or caused by trauma or infection. A surgeon observed in 1926 that " "Many persons with a saddle nose ... are suspected of having inherited disease and are greatly handicapped, both in their social and business relations."

Building up the nose presented the challenge of figuring out what to build with. The human body rejects many substances, such as ivory, that were used for other protheses. For a time, surgeons in the early 20th century settled on paraffin, but over time the substance tended to move, especially if people spent time in the sun and frequently caused cancer.

Then, as now, plastic surgery was sometimes ridiculed, but still the demand increased. A pioneer in the field, Charles Conrad Miller, noted that the serious surgeon should not turn away patients seeking facial surgery. The rise of unskilled, untrained "surgeons" to fill that need presented a professional dilemma. Harken writes:

For this, Miller blamed neither the charlatans nor the gullible patients, but the physicians who did not take seriously their patients' needs. "Physicians cannot longer disregard the effect of the `Beauty Columns,'" Miller insisted. "Every practitioner who laughs at the patient who questions him regarding an operation for improving the appearance of the face takes the chance of seeing that patient return from the advertiser disfigured for life." Although he voiced some sympathy for those physicians whose refusal to perform cosmetic operations reflected their personal convictions, Miller believed that it was too late to turn the tide of public interest: "the demand for featural surgeons is too great on the part of the public."

As surgeons have perfected the procedure, its popularity has only grown. The American Society of Plastic Surgeons reports that rhinoplasty is the second most popular procedure, with 217,000 noses reshaped in 2014 out of a total 15.6 million cosmetic procedures. The surgery that earned the top spot? Breast augmentation.

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Maris Fessenden | | READ MORE

Maris Fessenden is a freelance science writer and artist who appreciates small things and wide open spaces.

A brief history of nose jobs

From scooped-out, turned-up, pinched-in noses to bump-adding injections, below a comprehensive guide on how nose jobs have evolved over time.

Welcome to Beauty School , the corner of Dazed Beauty dedicated to learning. From guides to histories, this is where we shed light on past subcultural movements and educate our readers on current trends and various goings-on.

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.”

Bella Hadid: Then and Now pic.twitter.com/qW6sn5AtI9 — celebface (@celebfaceINSTA) September 13, 2018

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. 

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The First Nose Job Took Place In The 6th Century, And There's More About The Surgery You Don't Know

When did nose jobs become popular? The first cosmetic nose job didn't happen until the late 1800s, but the procedure dates back 2,500 years. Around the 6th century BCE, an Indian doctor wrote about a process for grafting a flap of cheek skin over the nose.

Unlike other early medical practices causing more harm than good, such as leeching or rubbing animal dung into wounds, methods used by ancient plastic surgeons were surprisingly effective and modern (but incredibly painful).

For centuries, people didn't get nose jobs for vanity reasons. Instead, the procedure helped patients who lost their noses due to war wounds or disease. By the 16th century, when Europeans associated a sunken nose with syphilis, people wanted to avoid social stigma . So surgeons developed lengthy grafting procedures to repair lost or disfigured noses. Or, if patients didn't want to undergo the procedure, they could buy a prosthetic nose like Tycho Brahe. 

Though the term "rhinoplasty" to describe plastic surgery of the nose didn't emerge until the 1820s, and the term "nose job"  in 1944, nose alteration for medical or cosmetic reasons has roots in ancient history.

An Indian Surgeon Allegedly Pioneered The Procedure

The first nose job in history dates back to the 6th century BCE. The Hindu Sanskrit writings of Suśruta, an Indian physician, detail the process of surgically restoring damaged or missing noses. Suśruta's patients included people disfigured by disease or wounded in battle.

The doctor used a method similar to what modern plastic surgeons do: he surgically created a flap of skin and rotated it to cover the damaged nose. Surgeons continued to use Suśruta's method in India for more than 2,000 years, well into the 19th century.

A Nose Job In The 16th Century Took Five Weeks

In a 1597 surgery book by Gaspare Tagliacozzi, professor of anatomy and surgery at the University of Bologna, described how to create a nose for men who suffered facial injuries in battle. The surgeon attached skin from the patient's upper arm to his head, forcing the patient to remain in place for three weeks while the arm skin grafted to the nose.

The patient then waited another two weeks before the surgeon formed the flap of skin into a nose-like shape, completing the nose job.

Indian Doctors Grafted Butt Skin To The Face

For centuries, to replace defects on the nose, Indian surgeons would  transplant skin from other parts of the body. Some texts recommended cutting off skin from the buttocks to attach to the face. To prepare the thicker butt skin, doctors used an unusual method: they flayed the skin with a whip so the skin would swell and bruise, then cut off the skin to graft to the face.

Some believed the whipping produced a thinner skin layer, which would have a better chance of healing and grafting to the nose.

Syphilis Made Nose Jobs Popular

During Europe's major outbreak of syphilis , long before effective treatments emerged, the disease carried a social stigma. It caused disfigurement, hair loss, and soft-tissue decay , which could destroy the suffering patient's nose. By the 16th century, Europeans associated facial disfigurements with disease and infection, driving the desire for nose jobs.

At the time, the most common procedure grafted arm skin to the patient's face to create a new nose.

At First, People Didn't Want Nose Jobs For Cosmetic Reasons

Dating back to the 6th century BCE, nose jobs were not for cosmetic reasons, but rather due to a  serious disfigurement or injury , such as from war, brutality, or disease. The procedure was painful and time-consuming, likely deterring many from undergoing a nose job. The first known  nose job for cosmetic purposes  did not occur until the late 1800s.

Long before the advent of anesthesia, the tools used for early nose jobs, which included gripping devices and knives, underscored the surgery's gravity. 

Surgeons Sliced Living Flesh And Stretched It Over The Nose

Suśruta's 6th-century BCE text explained how to create an artificial nose : 

First the leaf of a creeper, long and broad enough to fully cover the whole of the severed or clipped off part, should be gathered; and a patch of living flesh, equal in dimension to the preceding leaf, should be sliced off (from down upward) from the region of the cheek, and - after scarifying it with a knife - swiftly adhered to the severed nose.

The text then recommended a "cool-headed physician" wrap up the area and let the patient rest. If the procedure succeeded, the skin would graft to the nose. 

Women Suffered Nasal Disfigurement As Punishment

For centuries, women accused of wrongdoing underwent  nasal disfigurement  as punishment. In the medieval period, for example, a woman might lose her nose for disobedience or because some viewed her as sexually promiscuous. A Vandal king at the fall of Rome thought his wife was plotting against him, so he ordered disfigurement of her nose and ears. 

In Jerusalem during the 10th century, women who committed adultery could be punished by cutting off their nose. For these women, a nose job was perhaps worth the pain.

Rulers Disfigured Their Enemies, Driving The Demand For Nose Jobs

Facial defects or disfiguration  as a result of war or political fallout led to the need for nose jobs. Some rulers humiliated their enemies by cutting off their noses. In cultures believing in bodily resurrection, cutting off someone's nose could permanently handicap them in the afterlife.

In regions as widespread as pre-Inca Peru and Roman Scotland, people suffered from facial disfigurement, which drove the need for nose jobs. 

To Recover, Nose Job Patients Had To Drink Butter

According to  Suśruta's ancient manual , after adhering a flap of skin to the patient's nose, the physician should "insert two small pipes into the nostrils to facilitate respiration, and to prevent the [adhered] flesh from hanging down." The physician then dusted the area with restorative powders and sesame oil.

Meanwhile, the patient, while waiting for the procedure to work, had to drink clarified butter and take purgatives.

For Centuries, Nose Amputation Was A Common Punishment For Criminals

Many societies cut off criminals' noses  as punishment. In the ancient period, pharaohs used this form of punishment under the Code of Hammurabi and Egyptian law; during the medieval period, nasal disfigurement helped identify people found guilty of treason.

During the Tudor era in England, anyone who spread lies about the king could have their nose or ears amputated, and a 16th-century pope scared off highway robbers threatening Rome by decreeing any man caught robbing people would have their nose cut off.

The punishment stood for so many centuries that individuals with nose deformities from disease or war injuries may have pursued nose jobs to avoid misidentification as a criminal.

Prosthetic Noses Were An Alternative To Painful Surgery

In the 16th century, Gaspare Tagliacozzi introduced European doctors to his procedure for grafting arm skin to the nose, a five-week-long ordeal many patients understandably wanted to avoid. An alternative was a  prosthetic nose  made of gold or silver. Ambroise Paré , a French surgeon, suggested using prosthetic devices to hide nose deformities or injuries; the devices attached to the face with a string around the head.

Astronomer Tycho Brahe , who lost part of his nose in a 1566 duel, wore a skin-colored metal prosthetic nose. A grave robber stole it after Brahe died.

The Peak For Cosmetic Nose Jobs Was Likely In The Past

The first nose job for cosmetic purposes did not occur until the late 1800s. The procedure became common for Hollywood actors and actresses around the 1930s. By 2000, over 400,000 Americans had nose jobs annually.

Since then, however, the number has fallen, according to MarketWatch , with around 225,000 Americans undergoing the procedure each year. 

Nose Shape Supposedly Indicated A Person's Character

Around the 19th century, some wanted to change their nose because certain nose shapes were allegedly  more desirable , a standard often laced with racial undertones. The public considered straight or small noses, for example, as more refined and attractive, while more prominent or curved noses suggested a cunning look or a lack of moral character. 

Members of some ethnic populations, such as European Jews, had nose jobs to make them look " more American ."

• Weird History

Lists about the pre-historic, ancient, medieval, olden, and not-that-long-ago days of medicine, when doctors made bizarre assumptions and prescribed totally insane treatments that made sense at the time...

Your Nose, Part 5: The Process Of The Modern Rhinoplasty

March 26, 2013

Famous Noses of History

March 12, 2013

A Historical View Of Noses And The First Nose Jobs

Part 4 from Your Nose: A History of the Nose, Rhinoplasty and the Attitudes that Shape our Perception, in Five Parts (Excerpted from Dr. Adamson’s book Fabulous Faces, available on Amazon.com , and edited for our blog).

The Historical Relationship Between Nose and Character In her book The Nose: A Profile of Sex, Beauty and Survival , American journalist Gabrielle Glaser (the proud owner of a magnificent nose) describes how the nose was central to the eighteenth-century revival of the pseudoscience of physiognomy (judging character on the basis of appearance). Swiss theologian Johann Kaspar Lavater published essays in which he analyzed his subjects’ noses, foreheads, eyes, and chins. According to Glaser, a quick glance at anyone was all Lavater needed to understand a person’s morality, intelligence, and religiosity.

Lavater’s strange preoccupation caught on. The writing of Honoré de Balzac, a nineteenth-century master of literary realism, is full of plotlines that hinge on the size and shape of his characters’ noses. Many of his novels and short stories are collected within La Comédie Humaine . It contains no fewer than 400 references to noses. The “realism” of his descriptions leaves room for doubt.

In The Vicar of Tours , Mlle. Gamard, an unhappy woman, runs a boarding house for priests and has no friends. Why? The answer was as plain as the nose on her face. “Her aquiline nose was of all her facial characteristics the one that did most to express the despotism of her ideas, just as the flattened angle of her forehead betrayed the narrowness of her mind.”

Another Frenchman, Edmond Rostand, built a classic play, Cyrano de Bergerac , around a nose. “A great nose indicates a great man,” said Cyrano, “genial, courteous, intellectual, virile [and] courageous.”

The First Nose Job Ours is an old profession. The first rhinoplasties were performed not decades ago, not centuries ago, but more than 2,600 years ago.

The place was India. The surgeon was Sushruta , a teacher of medicine. He was a busy guy. That’s because adulterers not only got thrown out of their houses but also had their noses cut off. Sushruta could put things right. He compiled the first step-by-step guide to rhinoplasty. • Gather a vine leaf big enough to cover the severed piece of nose. • Slice from the cheek a patch of living flesh equal to the size of the leaf. • Scarify the severed piece of nose with a knife and quickly apply the cheek skin to the area. • Insert two small pipes in the nostrils to allow breathing and to keep the graft from hanging down. • Dust the nose with pulverized sappanwood, licorice root, and barberry to aid healing. • Bind the severed nose piece back in place with cotton, and sprinkle it with sesame oil. • When healing is complete, trim off the excess skin. And, Sushruta might have added, don’t cheat on your spouse!

Next week, we wrap up our series with an overview of the Modern Rhinoplasty .

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The Complete Guide to Rhinoplasty

By Erin Nicole Celletti

Photography by Thomas Prior

Note: This article contains images of a surgical procedure being performed.

Interest in plastic surgery is at an all-time high, but stigma and misinformation still surround the industry and its patients. Welcome to Life in Plastic , a new series by Allure that aims to break down cosmetic procedures and provide all the information you'll need to make whatever decision is right for your body — no judgment, just the facts. Here, we're covering everything you need to know about rhinoplasty.

Considering a permanent way to transform the size, shape, or appearance of your nose? You're not alone. In fact, the 2017 Plastic Surgery Statistics Report by the American Society of Plastic Surgeons lists the procedure as the third most popular cosmetic surgery, with 218,924 recipients. If you're considering joining them, here's everything you need to know about rhinoplasty — initial consultation to post-op.

Commonly referred to as a nose job, rhinoplasty is a procedure that "sculpts the shape of the nose externally for cosmetics, and internally for breathing," says Deepak Raj Dugar , a board-certified plastic surgeon in Beverly Hills. The goal, he says, is to give a "natural look to the nose, as if it was never touched, that balances the patient's face perfectly."

The first step in the rhinoplasty process for prospective patients begins in the office of a board-certified plastic surgeon for a thorough consultation. Following paperwork and initial photographs, the surgeon chats with the patient about any cosmetic concerns and "studies the inside of their nose for breathing issues," says Dugar. "I then morph the patient's photos on the iPad directly to show them the intended goals of surgery."

Patients may also be shown other patients' before-and-after photos for noses that are similar to their own size and shape. "If they are a good candidate, I let them know. If they aren't, I also let them know," says Dugar. "It's the most honest 30 minutes of their life."

Adam Kolker , a board-certified plastic surgeon in New York City, explains that patients experiencing one or more of the following conditions might seek rhinoplasty:

• Dorsal hump: A bump at the bridge of the nose
• Nasal width: A nose that is too wide or too narrow
• Asymmetry: A nose that is twisted or deviated
• Prominent nasal tip: A nasal tip that is round, bulbous, fatty, or disproportionate to the rest of the face
• Drooping nasal tip: The angle between the upper lip and lower nose that is less than 90 degrees
• Post-traumatic deformities: Shape aberrations after nasal injury
• Nasal airway problems: Internal valve collapse and septal deviation

Key factors that also help determine the ideal candidate include nasal maturity (if the nose is mature enough — usually over the age of 15), emotional maturity (patients thoroughly understand implications, risks, and purpose of the surgery), having realistic expectations (understanding both goals and limitations of the procedure), and an absence of body dysmorphia.

The last on that last, Dugar explains, is something lots of patients have issues coping with. "We all [experience body dysmorphia] to some extent, but some [patients] cross the normal spectrum," says Dugar. "It's our duty as surgeons to counsel them and avoid letting patients guide us into wrong ethical decisions."

Like any surgical procedure, preparation is helpful for both a smooth surgery and recovery. To help reduce things like swelling, bleeding, and bruising (especially in patients who travel via plane for the procedure), Dugar recommends a "strict regimen of [applying] arnica [a homeopathic herb that can help decrease bruising and pain] preoperatively, as well as avoiding caffeine, alcohol, and smoking one month prior to surgery."

Rhinoplasty is typically performed on an outpatient basis and can be done in one of two ways: open or closed. Both approaches involve incisions being made within the internal nostril region, but the open rhinoplasty approach adds an external incision (a few millimeters) on the undersurface of the columella (i.e. the tissue that divides the nostrils), says Kolker.

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That external cut leaves a permanent scar, says Dugar. The skin of the nose is then "undraped" (similar to opening the hood of the car, says Dugar) so that the inner structures of the nose become visible. "This allows you to do massive changes to the nose and take things apart more readily and reconstruct the nose," says Dugar. "This is necessary for botched or revision [previously operated on] noses, or noses with very difficult anatomy."

With closed rhinoplasty, "all of the incisions are made inside the nose, which means no external cuts and no risk of scarring," Dugar says. It is through these internal incisions that the nose is then shaped and sculpted for subtle changes. "We don't alter the face, yet we soften and improve the overall balance," he says of the procedure.

Ultimately, the plastic surgeon will select the most appropriate rhinoplasty incisions based on the specific structural modifications required for the patient, according to Kolker.

When considering rhinoplasty, or any other cosmetic and elective procedure for that matter, there are risks to keep in mind. Gary Breslow , a board-certified plastic surgeon in New Jersey, explains rhinoplasty is not without risks, although it is considered a very safe procedure. "The biggest risk of rhinoplasty is a poor outcome, which is why rhinoplasties have the highest revision rate of any plastic surgery procedure performed," he tells Allure .

Poor outcome might mean that the cosmetic appearance is not what was desired, and sometimes it might even be worse than pre-procedure. Breslow gives some examples. "Cartilage grafts are often used in cosmetic procedures, and these grafts may move and become visible," he says. "Rhinoplasty to correct a crooked nose runs the risk of not straightening the nose completely," he says. "Because cartilage has 'memory,' there is also the risk of the nose becoming crooked again over time."

There's also your breathing to consider. "Cosmetic rhinoplasties also run the risk of worsening breathing in a patient who had no issues before surgery," Breslow says. He adds that even when the procedure is performed for breathing issues, there is still the risk that breathing might not improve, and may get worse after surgery. Other risks include those often associated with surgery, such as bleeding, infection, and risks of anesthesia, but Breslow notes these risks are "extremely small." As always, speak to your doctor about your own potential risk factors.

In terms of recovery, it largely depends on the type of rhinoplasty, but for both open and closed procedures, downtime is typically a one- to two-week period. "Most patients have a rapid recovery within five to six days [for closed procedures]," says Dugar. After five to six days, you can remove the splint from your nose and go out in public, if desired . Once the splint is removed, there is often little to no bruising, which is ( nothing a little concealer can't cover up ). "You can be out to dinner the same evening without any telltale signs of surgery," says Dugar.

While initial recovery is generally quick, healing can continue for the next one to three years. "It is a slower healing process than most people think because the skin isn't being cut like it is in a face-lift or tummy tuck," says Dugar. "The skin has to shrink to the new, underlying framework, which can take one year for the bridge and three years for the tip."

At the same time, Breslow says that while rhinoplasty might have a reputation for being painful, the pain factor is not as serious as some people think. "Although there is generally a significant amount of swelling and bruising after the procedure, patients are generally very comfortable with little pain," he says, adding that the pain patients do experience is usually very well managed with prescribed medications.

As with most plastic surgeries, the total cost of the procedure and recovery can vary greatly depending on the region and physician. Dugar explains that other variables include the skill level of the surgeon, whether it's being done open or closed, and if it is a primary or a revision case. Kolker agrees that costs can vary widely and can include fees from surgeons, anesthesia, and hospital and ambulatory surgery centers.

He says that in total, rhinoplasties can range from approximately $6,000 to $15,000. However, for those with documented breathing problems, "surgery of the septum, internal valves, or turbinates that can be performed at the same time as aesthetic refinements may qualify for insurance coverage, but for the functional portion of the procedure only," Kolker says.

Dugar says rhinoplasty is "extremely common amongst the younger demographic," and that rings especially true in the case of Ruby Priscilla Cruz, 19, a patient of Dugar's who shared her rhinoplasty experience with Allure .

"I couldn't be happier with the results," Cruz says. "The first week I had discomfort because I was unable to breathe through my nose because of the packing and cast, but other than that, the healing process was smooth and painless."

For a smooth procedure with happy results like Cruz's, Breslow stresses the importance of finding the most-qualified doctor. "The ability to precisely and accurately manipulate and restructure the nose to achieve an aesthetically pleasing result, while maintaining or improving functional breathing issues, requires a skill set and expertise that takes many years for a surgeon to acquire," he explains, adding that correcting a botched rhinoplasty is even more difficult.

"Choosing the correct plastic surgeon is the one factor that a patient must get right when considering having a rhinoplasty," stresses Breslow. Therefore, doing your research is imperative.

If you're considering undergoing a rhinoplasty procedure, seek out a board-certified plastic surgeon for an initial consultation.

For more plastic surgery trends:

• Plastic Surgery Trends for 2018 Are Being Shaped by Social Media
• The Complete Guide to Breast Augmentation
• The Four Biggest Plastic Surgery Trends for 2018

Now watch as a dermatologist explains lip injections:

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• Patient Care & Health Information
• Tests & Procedures
• Rhinoplasty

• Locations of the nasal bone and cartilage

Your nose is supported by bone (at the back and bridge) and by cartilage (in the front).

• Rhinoplasty results

At left, a woman's nose before rhinoplasty. On the right, the same woman pictured one year after the surgery.

Rhinoplasty (RIE-no-plas-tee) is surgery that changes the shape of the nose. The reason for rhinoplasty may be to change the appearance of the nose, improve breathing or both.

The upper part of the structure of the nose is bone. The lower part is cartilage. Rhinoplasty can change bone, cartilage, skin or all three. Talk with your surgeon about whether rhinoplasty is appropriate for you and what it can achieve.

Your other facial features, the skin on your nose and what you would like to change are considered when planning the procedure. If you're a candidate for rhinoplasty, the surgeon will develop a personal plan for you.

Sometimes part or all of a rhinoplasty is covered by insurance.

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Why it's done

Rhinoplasty can change the size, shape or proportions of the nose. It may be done to fix issues from an injury, correct a birth defect or improve some breathing problems.

As with any major surgery, rhinoplasty carries risks such as:

• A bad reaction to the anesthesia.

Other possible risks specific to rhinoplasty include but are not limited to:

• Problems breathing through the nose.
• Permanent numbness in and around the nose.
• The possibility of an uneven-looking nose.
• Pain, discoloration or swelling that may last.
• A hole in the wall between the left and right nostrils. This condition is called septal perforation.
• A need for additional surgery.
• Change in the sense of smell.

Talk to your health care provider about how these risks apply to you.

How you prepare

Before scheduling rhinoplasty, you meet with a surgeon. You talk about things that determine whether the surgery will work well for you. This meeting usually includes:

• Your medical history. The most important question is about why you want the surgery and your goals. You also answer questions about your medical history. This includes a history of nasal blockages, surgeries and any medicines you take. If you have a bleeding disorder, such as hemophilia, you may not be a candidate for rhinoplasty.

A physical exam. Your health care provider does a physical examination. Your facial features and the inside and outside of your nose are looked at.

The physical exam helps determine what changes need to be made. It also shows how your physical features, such as the thickness of your skin or the strength of the cartilage at the end of your nose, may affect your results. The physical exam is also important for determining how rhinoplasty will affect your breathing.

• Photographs. Photographs of your nose are taken from different angles. The surgeon may use computer software to change the photos to show you what kinds of results are possible. These photos are used for before-and-after views and reference during surgery. Most importantly, the photos let you have a specific discussion about the goals of surgery.

A discussion of your expectations. Talk about your reasons for surgery and what you expect. The surgeon can review with you what rhinoplasty can and can't do for you and what your results might be. It's normal to feel self-conscious talking about your appearance. But it's important that you're open with the surgeon about your desires and goals for surgery.

Looking at the overall proportions of the face and profile is important before having rhinoplasty. If you have a small chin, the surgeon may speak with you about surgery to build up your chin. This is because a small chin can create the illusion of a larger nose. It's not required to have chin surgery, but it may better balance your facial profile.

Once the surgery is scheduled, find someone to drive you home after the procedure if you're having an outpatient surgery.

For the first few days after anesthesia, you may forget things, have a slower reaction time and impaired judgment. Find a family member or friend to stay with you a night or two to help with personal care as you recover from surgery.

Food and medications

Don't take medicines that have aspirin or ibuprofen (Advil, Motrin IB, others) for two weeks before and two weeks after surgery. These medicines may make you bleed more. Take only the medicines approved or prescribed by your surgeon. Avoid herbal remedies and over-the-counter supplements.

If you smoke or vape, stop. Smoking and vaping can slow healing after surgery and can result in tissue death. You could also get an infection.

What you can expect

Each rhinoplasty is customized for the person's specific anatomy and goals.

During the procedure

You're given medicine to put you into a sleep-like state for the surgery. This is called anesthesia. The kind of anesthesia you get depends on how complex your surgery is and what the surgeon prefers. Ask your surgeon which type of medicine is most appropriate for you.

• Local anesthesia with sedation. This type of anesthesia is usually used in an outpatient setting. It's limited to a specific area of your body. A pain-numbing medication is injected into the nasal tissues, then you are given medicine through an intravenous (IV) line, which is a small tube placed in a vein in the hand, neck or chest. This medicine makes you groggy but not fully asleep.
• General anesthesia. You receive medicine, called anesthetic, by breathing it in or through an IV line. General anesthesia affects your entire body and causes you to be asleep during surgery. General anesthesia requires a breathing tube.

Rhinoplasty may be done inside the nose or through a small external cut, known as an incision, at the base of the nose, between the nostrils. The surgeon will likely readjust the bone and cartilage underneath the skin.

The shape of the bones or cartilage in your nose can be changed in several ways. It depends on how much needs to be taken out or added, the nose's structure and available materials. For small changes, cartilage may be taken from deeper inside the nose or from the ear.

For larger changes, cartilage from a rib, implants or bone from other parts of the body can be used. After these changes are made, the skin on the nose and tissue are put back, and the cuts are sewn together.

Sometimes, the wall between the two sides of the nose, known as the septum, is bent or crooked. This is called a deviated septum. It can be straightened during surgery to make breathing easier.

After the surgery, you're in a recovery room. You're watched while you wake up. You might leave later that day or, if you have other health issues, you might stay overnight.

After the procedure

After the surgery, you need to rest in bed with your head raised higher than your chest. This reduces bleeding and swelling. Your nose may be stuffed up because of swelling. It could also be from the splints put inside your nose during surgery.

Most of the time, the internal bandages stay in place for 1 to 7 days after surgery. A splint may be taped to your nose for protection and support. It's usually in place for about one week.

You may have a little bleeding and drainage of mucus and old blood for a few days after the surgery or after removing the dressing. A drip pad — a small piece of gauze held in place with tape — may be put under your nose to absorb drainage. Change the gauze as directed by your health care provider. Don't put the drip pad tight against your nose.

You may be given other instructions to further lower the chances of bleeding and swelling. These should be followed for several weeks after surgery:

• Avoid intense physical activities such as aerobics and jogging.
• Take baths instead of showers while you have bandages on your nose.
• Don't blow your nose.
• Sneeze and cough with your mouth open.
• Avoid certain facial expressions, such as smiling or laughing.
• Eat high-fiber foods, such as fruits and vegetables, to keep from getting constipated. Constipation can cause you to push hard, putting pressure on the surgery site.
• Brush your teeth gently to keep your upper lip from moving.
• Wear clothes that fasten in the front. Don't pull clothing, such as shirts or sweaters, over your head.

In addition, don't rest eyeglasses or sunglasses on your nose for at least four weeks after the surgery. They can put pressure on your nose. You can use cheek rests or tape the glasses to your forehead until your nose has healed.

Use SPF 30 sunscreen when you're outside, especially on your nose. Too much sun may cause permanent discoloration on the skin of the nose.

You may have some short-term swelling or black-and-blue coloration of your eyelids 2 to 3 weeks after the surgery. Swelling of the nose can last longer, sometimes up to a year. Eating less sodium will help the swelling go away faster. Don't put anything such as ice or cold packs on your nose after surgery.

Your nose changes throughout your life whether you have surgery or not. For this reason, it's hard to say when you have reached your final result from the surgery. However, most of the swelling is gone within a year.

Very small changes to your nose's structure — even just a few millimeters — can make a big difference in how your nose looks. Most of the time, an experienced surgeon can get results both of you are satisfied with. But in some cases, the slight changes aren't enough. You and your surgeon might decide to do a second surgery to make more changes. If this is the case, you must wait at least a year for the follow-up surgery because your nose can go through changes during this time.

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Frequently Asked Questions

How is rhinoplasty different from septoplasty.

Rhinoplasty is a surgery to change the shape of the nose. Both breathing and the nose's shape are related. A rhinoplasty can be used not only to change the way the nose looks but also to improve breathing.

Septoplasty is a surgery to improve breathing. It straightens the wall inside the nose that divides the nasal passages into a right and a left side, known as the nasal septum. When the septum is crooked, it can make it harder to breathe through the nose. A septoplasty is often done at the same time as a rhinoplasty.

Is rhinoplasty a simple operation?

No. Rhinoplasty is a difficult operation. This is due to several factors. First, the nose is a complicated 3D shape that is in the middle of the face. Changes made during rhinoplasty often are very small. But these changes can make a big difference in the way the nose looks and functions. Because these changes are small, so is the margin for error.

Swelling and the placement of local anesthetic in the skin distort the nose during surgery. That can hide many of the small changes made. Rhinoplasty also doesn't have a regular plan or set order of steps. Surgeons personalize each operation to the needs of the patient.

Will I need to stay in the hospital?

Nearly everyone who has rhinoplasty is able to safely leave the hospital the same day as the surgery. In rare cases, you may stay in the hospital for one night if you're having a hard time with nausea or have other health problems that need to be monitored.

How long is the recovery period?

Plan to take a week off from work, school or other duties. You will feel better each day during the first week. One week after surgery, people usually feel like they are themselves again.

After surgery, there will be some swelling. The swelling can take many months to go away. Most people stop noticing it after a couple of months. People are usually back to doing most activities after a week and all activities after 2 to 4 weeks.

Are there risks?

All surgeries have risks. Fortunately, rhinoplasty risks are small and complications are rare. Your health care provider talks to you about the risks and benefits before the operation.

Does insurance pay for a rhinoplasty?

Sometimes insurance pays for a rhinoplasty, but it depends on the insurance policy. Before scheduling surgery, your health care provider's office can help you get prior written authorization from your insurance company. This isn't a guarantee of coverage, but it's the only way to be sure that rhinoplasty is a covered benefit. Sometimes insurance pays for a part of a nasal surgery, but not other parts. You can contact the business office to find out how much the operation will cost.

How much does rhinoplasty cost?

The cost of a rhinoplasty depends on several things, including the complexity of the surgery, the surgeon's training and experience, and geography. At Mayo Clinic, the cost of surgery will be the same no matter which surgeon you choose.

Can I see what my nose might look like after surgery?

Before the surgery, some surgeons use simulations to show what you may look like after surgery. Your provider takes photographs of several views of your face. These photos can be changed to give you an idea of what your nose might look like after surgery.

Is rhinoplasty painful?

Not for most people. One day after surgery, most people rate their pain between 0 and 4 out of 10.

Will you pack my nose?

No. Packing can be very uncomfortable. But you'll likely have some soft splints in your nose. These splints have a hole in them so you can breathe through them, at least for a few days. They can be easily removed at the one-week visit.

How long will I be bruised?

Bruising is not common. Any minor bruising usually lasts about a week.

What should I look for in a surgeon?

Most rhinoplasties are done by plastic surgeons, facial plastic surgeons or otolaryngologists, also called ENTs. Training and board certification in one of these specialties is a good starting point. You'll probably want a surgeon who often does rhinoplasty.

Find a surgeon with a good reputation among patients and other providers. Experts publish articles about rhinoplasty in medical journals and often speak at educational meetings.

Make sure that your surgery will be performed in an accredited surgical facility or hospital. You likely should also feel comfortable with your surgeon. Look for a surgeon who can help you understand what is going to happen during your surgery.

Rhinoplasty care at Mayo Clinic

• Rhinoplasty: Nose surgery. American Society of Plastic Surgeons. https://www.plasticsurgery.org/cosmetic-procedures/rhinoplasty. Accessed Dec. 4, 2022.
• Nasal surgery: Fixing form and function. American Academy of Otolaryngology-Head and Neck Surgery. https://www.enthealth.org/be_ent_smart/nasal-surgery-fixing-form-and-function/. Accessed Dec. 4, 2022.
• Septoplasty: Deviated septum correction. American Society of Plastic Surgeons. https://www.plasticsurgery.org/reconstructive-procedures/septoplasty. Accessed Dec. 4, 2022.
• Flint PW, et al., eds. Rhinoplasty. In: Cummings Otolaryngology: Head & Neck Surgery. 7th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Dec. 4, 2022.
• Nose surgery. The Aesthetic Society. https://www.theaestheticsociety.org/procedures/head-face/nose-surgery. Accessed Dec. 6, 2022.
• Townsend CM Jr, et al. Plastic surgery. In: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed Dec. 6, 2022.
• AskMayoExpert. Rhinoplasty. Mayo Clinic; 2021.
• Rubin JP, et al. Open technique rhinoplasty. In: Plastic Surgery, Volume 2: Aesthetic Surgery. 4th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Dec. 6, 2022.
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Plastic Surgery

Rhinoplasty: What to expect before and after a ‘nose job’

November 30, 2018

What is rhinoplasty?

Rhinoplasty, commonly known as a “nose job,” is a popular option for patients unhappy with the size or shape of their nose. In addition to the procedure’s well-known cosmetic benefits, however, rhinoplasty has evolved to have much more versatile applications, such as to improve nasal function after a traumatic injury or illness or to help with breathing problems that affect sleep and the ability to exercise.

The goal of rhinoplasty is to revise the nose to the patient’s desired appearance and functionality, keeping in mind skin type and the entire face architecture. Our plastic surgeons combine the science and art of rhinoplasty to give patients effective, lasting results.

Fast facts about rhinoplasty

In general, candidates for rhinoplasty should be done growing. Facial growth in teens and young adults, for example, can affect the look and function of the nose over time. The exception would be pediatric patients who have a facial birth defect, such as cleft palate . Additionally, patients should be in good overall health and should not smoke because smoking can lead to poor blood flow and increase the risk of tissue damage. Rhinoplasty is possible for teens who understand the procedure and have full parental consent. Ideally, girls should be at least 15 or 16 years old before having a procedure; boys should be at least 17 or 18. If combined with a septoplasty (straightening of the septum) , this procedure can improve not only a patient’s self-confidence but also breathing.

Before the rhinoplasty

Prior to rhinoplasty, the surgeon should ensure the patient fully understands the procedure and its risks and benefits. While rhinoplasty is a safe procedure, it’s important that the surgery is done by an expert. At UT Southwestern, we use 3D imaging prior to surgery to show patients how their nose might look after surgery. The plastic surgeon can print models of the nose as it looks before surgery alongside the expected appearance after surgery. This is an educational tool and not a guarantee of the results. However, it can help patients and the plastic surgery team better communicate the goals of surgery. We’ve found that the ability to visualize the anticipated results also helps patients feel more comfortable about going into surgery. We also have the option to provide 3D print models that can show before and after results.

Reshaping Your Nose and Face with Rhinoplasty

Dr. Bardia Amirlak, a board-certified plastic surgeon at UT Southwestern, discusses how our plastic surgeons use 3D imaging and printing to simulate the natural-looking nose patients want and how rhinoplasty helps make that simulation a reality.

If goals of rhinoplasty involve facilitating better breathing as well as improving appearance, the procedure might include removal of the nasal hump, reshaping of the nose tip, reshaping or resizing of the nostrils, or increasing or decreasing the nose’s overall size and projection. 

How long does a rhinoplasty take?

Rhinoplasty generally takes 1.5 to 3 hours and is usually an outpatient procedure. In “closed rhinoplasty,” incisions are made within the nostrils – a technique that has a limited ability to make changes. In “open rhinoplasty,” an incision is made across the tissue between the nostrils as well as within the nostrils. These incisions heal very well and are barely visible. 

If additional cartilage is needed to augment the nose, it is frequently taken from the patient’s nasal septum. In secondary or revision rhinoplasty – which is done to correct deformities caused by a previous procedure – this cartilage might be taken from an ear or rib, though sometimes approved cadaver cartilage might also be used. Because of the cartilage needs and potential for scarring, revision rhinoplasty is a more difficult procedure to perform, so it’s important that it’s done by a highly skilled plastic surgeon.

Liquid rhinoplasty, or nonsurgical rhinoplasty, is a series of office-based procedures done while the patient is awake. Injectable hyaluronic acid fillers are used to alter the shape and size of the nose without invasive surgery.

The art of ethnic rhinoplasty: A nose job that preserves your cultural identity

• Al Aly, M.D.

August 5, 2021

Do you have questions about rhinoplasty?

Schedule a consultation with one our board-certified plastic surgeons by calling 214-645-2353 .

Request an appointment

Recovery after rhinoplasty

Following surgery, most patients experience mild to moderate discomfort that can be controlled with medication. However, the first part of the recovery period can be somewhat awkward at work and in social settings due to possible bruising under the eyes and the use of a splint. Patients should expect to wear splints on the inside and outside of the nose for about a week after rhinoplasty to protect the nasal bones and cartilage. Additionally, patients should avoid strenuous activity such as jogging or swimming for two to three weeks and avoid wearing glasses for four to five weeks.

The nose is a complex structure made of delicate cartilage and bone. A small change to one part of the structure affects the rest of the nose, so rhinoplasty requires expertise to achieve a natural, functional outcome. If you’re considering rhinoplasty, call 214-645-2353 to schedule a consultation or request an appointment online .

Learn more:  Click here to watch an informational video about rhinoplasty

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Jennifer Grey Opens Up On Nose Job That Made Her ‘Completely Invisible’

Senior Reporter, HuffPost

Jennifer Grey was not having the time of her life after her rhinoplasty.

In interviews published Monday, Grey — who is releasing her memoir “Out of the Corner” on May 3 — told The New York Times and People about the two nose jobs she got after she starred in the 1987 smash hit “Dirty Dancing” and how they drastically changed her appearance.

“After Dirty Dancing, I was America’s sweetheart, which you would think would be the key to unlocking all my hopes and dreams,” Grey writes in her memoir, according to the Times. “But it didn’t go down that way.”

In the memoir, Grey recalls that after “Dirty Dancing,” there were still not “a surplus of parts for actresses who looked like me.” She was apparently told that her nose was “a problem.”

“My so-called ‘problem’ wasn’t really a problem for me, but since it seemed to be a problem for other people, and it didn’t appear to be going away anytime soon, by default it became my problem,” she writes, according to the Times. “It was as plain as the nose on my face.”

Grey told People that she was “completely anti-rhinoplasty” and “resisted” the surgery most of her life.

“I really thought it meant surrendering to the enemy camp,” Grey said. “I just thought, ‘I’m good enough. I shouldn’t have to do this.’ That’s really what I felt. ‘I’m beautiful enough.’”

Grey noted that her mother, actor Jo Wilder, had gotten the surgery, as did her father, Oscar-winning actor Joel Grey, and that the “Ferris Bueller’s Day Off” star sympathized with her parents’ reasons.

“I understand it was the 50s. I understand they were assimilating,” Grey told People of her Jewish parents. “I understood that you had to change your name and you had to do certain things, and it was just normalized, right? … You can’t be Jewish. You know, you can’t look Jewish. You’re just trying to fit into whatever is the group think.”

Grey says her mom loved her but suggested she get a rhinoplasty for the sake of her acting career.

After consulting with her mother and three plastic surgeons, Grey underwent two surgeries to “fine-tune” her nose. The second surgery was meant to correct an irregularity caused by the first, but she said it left her nose “truncated” and “dwarfed,” according to the Times.

Grey told People she knew she had made a mistake — she refers to it as “schnozzageddon” — when she ran into actor Michael Douglas at a premiere after her second surgery and he didn’t recognize her.

“That was the first time I had gone out in public. And it became the thing, the idea of being completely invisible, from one day to the next. In the world’s eyes, I was no longer me.”

Grey also recalled when an airline employee looked at her driver’s license, didn’t recognize her, but noted she had the same name as Jennifer Grey … the actor.

When Grey told the employee, “Actually, it is me,” she said that the woman responded: “I’ve seen ‘Dirty Dancing’ a dozen times. I know Jennifer Grey. And you are not her.”

“Overnight I lose my identity and my career,” Grey wrote in her memoir, according to the Times.

But the actor — who is arguably as famous for her plastic surgery as her beloved role as Baby Houseman in “Dirty Dancing” — says she’s tired of others controlling her narrative and is ready to claim it for herself.

“That’s a new feeling,” she told People. “To take myself out of the corner — and to recognize that I have been putting myself there, through story, through narratives that weren’t giving me the best life. The story I was telling myself about how I got here was not a great story. And not entirely true. I hadn’t seen the ways in which I’d made choices.”

Read Grey’s full interviews at The New York Times and People .

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How Much Plastic Surgery Did Michael Jackson Have Done? Watch His Face Transform Over Time

When Michael Jackson passed away in 2009, his death left behind many unanswered questions about the eccentric pop star’s alleged plastic surgery . Throughout his career, his dramatic transformation made him infamous as fans wondered exactly how much surgery he had and why his skin had become white.

In a 2003 documentary with Martin Bashir, Michael confessed to only having a nose job. “I’ve had no plastic surgery on my face, just my nose,” he said. “It helped me breathe better so I can hit higher notes. I am telling you the honest truth, I didn’t do anything to my face.”

Deal of the Day

As for his fair complexion, Michael told Oprah Winfrey back in the early ’90s that he suffered from vitiligo, a skin condition that created pale blotches on his body. His dermatologist Dr. Arnold Klein confirmed that in 2009.

“His was bad because he began to get a totally speckled look over his body,” Klein said. “[It was] all over his body, but on his face significantly [and] on his hands, which were very difficult to treat.”

However, other experts have claimed Michael had a lot more done than just a nose job and skin lightening. Click through the gallery to see how his face transformed over the years.

Getty Images

Michael got his first nose job in 1979. He claimed he got the surgery not because he wanted a smaller nose but because he broke it during a dance rehearsal and needed an operation.

Second Nose

However, Michael wasn't satisfied with his first nose job and got it done a second time to correct it.

Dr. Steven Hoefflin, Michael's plastic surgeon, said the second nose job left him with breathing difficulties and "required further work."

In 1988, Michael's chin suddenly sprouted a cleft.

Dr. Wallace Goodstein, who worked alongside Michael's surgeon throughout the '90s, said Michael came in for procedures “every two months."

"It was about 10 to 12 surgeries in two years, while I was there," he said in 2009.

Nose (again)

Throughout the '90s, Michael's nose got noticeably thinner and his skin got whiter. Michael told Oprah Winfrey at the time that his lighter skin was because of vitiligo, a skin condition.

Overall Face

Michael's friend, illusionist Uri Geller , said Michael confessed to him that he was changing his appearance to "not look like his father."

His face had transformed so much by this time that it became hard to decipher which procedures he had done, however, according to Dr. Goodstein, he “had multiple nose jobs, cheek implants and he had a cleft put in his chin. He had eyelid surgery … You name it he had it.”

"My job is to try to make people happy," Michael's surgeon Dr. Hoefflin said in 2001. "In the case of high-level entertainers, the result may not be what the average person would want. But remember, these are performers who want to create a certain image for a special reason."

Nose Profile

After so many nose procedures, Michael's nose started to cave in. “I rebuilt [his nose] … using fillers,” Dr. Arnold Klein revealed in 2009 to Larry King . “I used hyaluronic acids, and they worked very well. It’s an arduous procedure, because you don’t want to put too much in. And you have to do it exactly, so you can flow the material so it’s perfectly smooth.”

In 2015, a documentary called The 10 Faces Of Michael Jackson claimed the late singer had more than 100 procedures done on his face.

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The Nonsurgical Nose Job: Everything to Know

• About the Procedure
• How It Is Done
• Surgical vs. Nonsurgical Nose Jobs

Frequently Asked Questions

A nonsurgical nose job, also called nonsurgical rhinoplasty or liquid nose job uses dermal fillers to change the nose's appearance. Unlike surgical rhinoplasty , a nonsurgical nose job can be done in minutes with minimal recovery time, fewer risks, near-instant results, and at a fraction of the cost.

Nonsurgical nose jobs are not permanent. They address minor cosmetic changes without changing the size or function of the nose.

This article will discuss what nonsurgical nose jobs do, what they don't, and how they compare to surgical nose jobs.

RobertoDavid / Getty Images

Everything You Need to Know About Nonsurgical Nose Jobs

Surgical nose jobs are well-known, but what about a nose job that is noninvasive? Nonsurgical nose jobs are a good option for some.

Who Is a Good Candidate for a Nonsurgical Nose Job?

Because it is noninvasive, not requiring incisions, sutures, or anesthesia , a nonsurgical nose job can be safe for most people.

A nonsurgical nose job may be a good option for people who:

• Have cosmetic concerns about their nose, such as a bump, asymmetry, or a drooping nose tip
• Don't want, or are not good candidates for surgery
• Want to try out changes to their nose without the commitment of a permanent surgery
• Have realistic goals and understand that results from a nonsurgical nose job are less dramatic than surgical rhinoplasty
• Do not have interior issues that need correcting, such as breathing function or a deviated septum
• Are not allergic to any of the components of the fillers used

Targeted Areas

Nonsurgical nose jobs target external areas of the nose only.

Some of the changes a nonsurgical nose job can make include:

• Diminishing the appearance of a bump on the nasal bridge
• Making the nasal bridge appear straighter or giving it more definition
• Smoothing small indentations or contour irregularities
• Improving nose/facial symmetry
• Giving the appearance of lifting the nose tip
• Changing the appearance of high nostril rims

How Much Does it Cost?

The cost of a nonsurgical nose job depends on factors such as:

• The expertise and qualifications of the person performing the procedure
• In what geographic location the procedure is being done
• How much filler is needed
• Type of filler used
• The time and effort the procedure requires

According to the 2020 statistics from the American Society of Plastic Surgeons, the average cost per syringe of common dermal fillers used in nonsurgical nose jobs is:

• Juvederm Ultra, Juvederm Ultra Plus, Perlane, Restylane , Belotero (hyaluronic acid): $684
• Radiesse (calcium hydroxylapatite ): $717

Nonsurgical nose jobs are not covered by health insurance , but many plastic surgeons offer financing plans.

Choosing a Plastic Surgeon Nonsurgical Rhinoplasty

The most important part of preparing for a nonsurgical nose job is choosing the right person to perform the procedure. Do your research, and don't be afraid to ask questions.

Some things to look for include:

• Certified by the American Board of Plastic Surgery and/or the American Board of Facial Plastic and Reconstructive Surgery
• Has specialized training in plastic surgery and a thorough understanding of facial anatomy
• Member of the American Society of Plastic Surgeons
• If an office-based surgical facility is accredited by a nationally (or state) recognized accrediting agency or state-licensed or Medicare-certified
• Before and after photos of nonsurgical nose job procedures the surgeon has performed

How Does Nonsurgical Rhinoplasty Work?

Dermal fillers work by increasing the volume of the skin . This smooths skin, lifts tissue, and "covers up" aesthetic concerns a person may have.

For instance, if a person wants to straighten the appearance of their nose, filler injections can be used to " plump up " the area around the bump.

What Are Types of Dermal Fillers?

Hyaluronic acid is a commonly used filler for nonsurgical nose jobs.

Brand names include:

Hyaluronic acid is naturally found in the body, particularly in soft connective tissues and the fluid surrounding your eyes. It is also found in some cartilage, joint fluids, and skin tissue. Hyaluronic acid fillers can be reversed using an enzyme called hyaluronidase.

Risks and Side Effects

When performed by a qualified professional, nonsurgical nose jobs are considered low risk, with serious complications being uncommon.

Depending on factors such as the filler used, complications from dermal fillers may include:

• Bleeding at the injection site
• Skin eruptions that resemble acne
• A wound and possible scarring caused by damage to the skin
• Infection at the injection site
• Lumps or being able to feel the filler under the surface of the skin
• Skin rash with itching
• Skin redness

Very rarely, the filler may be unintentionally injected into the blood vessels instead of under the skin, which can block blood flow. Also, rarely the filler can compress the local blood supply. If either of these occurs, it can cause skin death and scarring . It can also lead to permanent vision loss. Having had previous nose surgery can increase these risks.

How a Nonsurgical Nose Job Is Performed

Knowing what the procedure is like can help you decide whether it is right for you. Here is what you may expect.

Preparing for Treatment

You will consult with the plastic surgeon on a date before the procedure. Discussion subjects during the consultation may include:

• Your goals and expectations for the procedure
• Your medical history, medical conditions, allergies, medications including vitamins and herbal supplements, and alcohol, tobacco, and drug use
• Past treatments such as soft tissue fillers, Botox , laser therapy, facial procedures or surgery
• Your options for treatment and recommendations
• What the procedure entails
• The type of filler recommended
• Expected results
• The risks and potential complications of the procedure
• Any questions you may have

The surgeon may also:

• Perform an examination to look for pre-existing health conditions or risk factors that may exclude you as a potential candidate for the procedure
• Take photos
• Measure your face

What Is the Procedure Like?

A nonsurgical nose job takes about 20 to 30 minutes and is known for being a procedure than can be "done during your lunch hour."

The procedure has four main steps:

1: Facial assessment and mapping :

• The areas to be augmented are determined and examined.
• Points may be marked as injection sites.
• Photos may be taken.

2: Cleansing and anesthetizing :

• Injection sites are cleaned with an antibacterial agent.
• Anesthetic ointment or a very cold instrument to chill the skin may be used to lessen injection site pain.

3: Injection :

• The fillers are injected into the determined sites.
• Results are evaluated.
• Additional filler is added as needed.

4: Clean up and recovery :

• Markings are cleaned off.
• If there is swelling or discomfort, an ice pack may be offered.

After Treatment

Recovery following a nonsurgical nose job is minimal. Most people can return to work and their normal activities immediately.

Restrictions that may be given for up to a week following the procedure include:

• Avoiding strenuous exercise
• Avoiding wearing glasses
• Avoiding touching or rubbing your nose
• Making sure to sleep on your back

Many people see results on the same day of the procedure, and some changes can often be seen immediately.

Nonsurgical Nose Job vs. Traditional Rhinoplasty

Surgical nose jobs and nonsurgical nose jobs are both distinct procedures with unique benefits, risks, and downsides.

Benefits of Nonsurgical Nose Job

Benefits of a nonsurgical nose job include:

• Minimal recovery time, no missed work
• Minimal side effects
• Minimal pain
• Quick procedure
• Quick results
• Changes are not permanent and may be reversible
• Benefits last about 12 months
• No anesthesia needed
• Can be done safely in outpatient clinics
• Can be used to have a preview of results or make decisions for a future surgical nose job

Drawbacks of Nonsurgical Nose Job

Downsides of a nonsurgical nose job can include:

• Results are more subtle
• Only works for external issues, and cannot correct interior concerns such as nasal function or a deviated septum
• Needs to be repeated every one to two years to maintain results
• Cost over time with repeated procedures can total more than the price of a surgical nose job
• Not covered by insurance

Benefits of Traditional Rhinoplasty

Reasons to choose a surgical nose job may include:

• Can change external and interior concerns
• Can correct medical problems such as breathing impairment or structural concerns
• Results can be more dramatic , such as a change in the size of the nose in addition to shape
• Results are permanent
• May be covered by insurance if correcting breathing impairment

Drawbacks of Traditional Rhinoplasty

Downsides to a surgical nose job can include:

• Higher risk of complications, including anesthesia risks, infection, breathing difficulties, changes in skin sensation, scarring , and other risks
• Longer recovery time (swelling usually subsides within a few weeks, but may come and go during the first year after the surgery)
• More painful
• Higher cost (the average price is $5,483, according to the American Society of Plastic Surgeons, plus additional costs for anesthesia, hospital or surgical facility costs, medical tests, prescriptions, and other expenses)
• Results are not reversible
• Can take up to a year to see full results

A nonsurgical nose job is a procedure that changes the nose's external appearance through the strategic injection of dermal fillers. Nonsurgical nose jobs are noninvasive, considered low risk, have a minimal recovery period, and provide quick results. In addition, they are not permanent and may be reversible depending on the filler used.

Results from a nonsurgical nose job are less dramatic than a surgical nose job, but the procedure is also much simpler. If you decide to pursue a nonsurgical nose job, research well when choosing your surgeon and ask lots of questions.

Depending on which type of filler is used, a nonsurgical nose job can last about 12 to 18 months.

Everyone's pain threshold is different, but nonsurgical nose jobs are not considered painful. Numbing agents and/or local anesthetic can be used to make the injections more comfortable.

A nonsurgical nose job changes the appearance and shape of the outside of the nose. It does not change the size of the nose or any significant internal structures.

Sahan A, Tamer F. Non-surgical minimally invasive rhinoplasty: tips and tricks from the perspective of a dermatologist . Acta Dermatovenerologica Alpina Pannonica et Adriatica . 2017;26(4). doi:10.15570/actaapa.2017.29

Kagan Institute. Who is a good candidate for a non-surgical nose job?

American Society of Plastic Surgeons. How a nonsurgical rhinoplasty can provide amazing results .

Victorian Cosmetic Institute. How can I get a smaller nose with non-surgical rhinoplasty?

American Society of Plastic Surgeons. How much do dermal fillers cost?

American Society of Plastic Surgeons. What questions should I ask my plastic surgeon about dermal fillers?

American Society of Plastic Surgeons. What types of dermal fillers are available?

Baser B, Singh P, Shubha P, Roy PK, Chaubey P. Non-surgical rhinoplasty and use of hyaluronic acid based dermal filler-user experience in few subjects . Indian J Otolaryngol Head Neck Surg . 2021;73(1):52-58. doi:10.1007/s12070-020-02100-8

American Society of Plastic Surgeons. What are the risks of dermal fillers?

Chen Q, Liu Y, Fan D. Serious vascular complications after nonsurgical rhinoplasty: a case report . Plastic and Reconstructive Surgery - Global Open . 2016;4(4):e683. doi:10.1097/GOX.0000000000000668

American Society of Plastic Surgeons. What should I expect during a consultation for dermal fillers?

American Society of Plastic Surgeons. What are the steps of a dermal fillers procedure?

American Society of Plastic Surgeons. How much does rhinoplasty cost?

American Society of Plastic Surgeons. What is rhinoplasty?

American Society of Plastic Surgeons. What should I expect during my rhinoplasty recovery?

American Society of Plastic Surgeons. What are the risks of rhinoplasty?

By Heather Jones Jones is a freelance writer with a strong focus on health, parenting, disability, and feminism.

Is a Non-Invasive Nose Job Right for You?

I t wasn’t that long ago that cosmetic surgery was the only option for women who wanted to “freshen” their appearance. Hospital stays, anesthesia, scarring, and long and sometimes painful recovery times were all just part of the process. Along with a hefty price tag, there was also a stigma that surrounded these elective procedures, especially when it came to nose jobs. Women who had rhinoplasty often claimed “deviated septum” to justify the post-surgery bandages and bruising rather than cop to cosmetic enhancement.

Fortunately, in today’s modern world, women have more options for facial rejuvenation , even some that don’t involve going under the knife. Dermal fillers are growing in popularity because they can mimic the results of common cosmetic surgeries like rhinoplasty. According to plasticsurgery.org , the request for “liquid rhinoplasty” has boomed in recent years.

“Non-surgical rhinoplasty has definitely become a more commonly requested procedure,” says Marta Paul, a multi-award-winning Medical Aesthetic Practitioner and founder of Nova Aesthetics in San Antonio, Texas. She attributes that fact to society’s desire for instant gratification and more natural-looking results.

“The effects are immediate,” she describes. “It’s a great alternative if you are hesitant about having surgery or you’d just like to see what you’d look like with a new nose before committing to the permanent effects of surgery.”

How is a Non-Invasive Nose Job Done?

Liquid rhinoplasty is typically performed by injecting small amounts of Hyaluronic Acid filler like Juvéderm or Restylane into the areas of the nose where you want to reshape, refine, fill in, or lift.

“We can hide bumps, help straighten, correct crooked bridges, turn up the tip, and create an overall refining of the nose and its contours,” explains Paul.

The relatively painless procedure is performed in your practitioner’s office, usually with a topical numbing cream or a local anesthetic added to the filler. The whole process typically takes less than an hour. In fact, some patients call it a “lunch-hour nose job” because they return to work immediately with little to no “tell-tale” signs.

Pros and Cons of a Non-Invasive Nose Job

While the lack of downtime and instant results are two of the biggest reasons people choose liquid rhinoplasty, other pros make this procedure an excellent alternative to surgery. For starters, there’s the cost. The American Society of Plastic Surgeons statistics estimate the average cost of rhinoplasty at $5,483, and that’s not including anesthesia, hospital costs, medications, and other fees that add up quickly. In contrast, liquid rhinoplasty ranges anywhere from $800 to $1500, depending on what state you live in, making it a more affordable option for many people.

Another plus is that, unlike a surgical nose job, the non-surgical option is reversible. If you don’t like the results, you aren’t stuck with them. When you consider that your nose is the most prominent feature on your face, that’s a big deal.

“We can dissolve the fillers instantly, and you are back to the nose you started with,” assures Paul.

The biggest downside to the procedure is that fillers do wear off, and you will need to repeat the procedure every two or three years. Another deterrent is that while a liquid rhinoplasty can address many cosmetic issues, it can’t change the size of your nose or correct any breathing issues.

“If you have a bulbous nose or are wanting to shrink the size of your nose, then a traditional rhinoplasty is going to be a better option,” advises Paul. “We can add filler to hide or correct imperfections, but we can’t make the nose smaller.”

She also cautions against having the procedure if you’ve already undergone multiple surgeries.

“Someone who has had several rhinoplasties will not have the blood supply needed in the nose,” she explains, adding that she typically turns away patients who fall into this category.

Risks and Rewards

Although it is considered non-invasive, there are still risks associated with a liquid rhinoplasty, the most common being bruising and soreness.

“Any swelling or bruising will go away between 5-7 days,” says Paul.

A very rare complication is vascular occlusion, which occurs when the filler is accidentally injected into an artery. If not caught and treated immediately, this can lead to tissue necrosis, where the tissues die due to lack of blood flow. That’s why it is imperative that you don’t put your nose in just anyone’s hands!

“The nose is the most high-risk area of the face to treat with fillers, so you want to make sure that you’re going to someone who has been injecting for many years,” cautions Paul. “Your chosen practitioner should be well-versed in facial anatomy, have a crash cart on hand, and be able to quickly recognize an adverse reaction.”

Understanding the risks is the first step in reaping the rewards. Do your research. Ask your practitioner for references or before and after photos of their work. Find out how many liquid rhinoplasties they have performed.

When done correctly, liquid rhinoplasty can be an excellent way to put your best face forward. When you look good, you feel good, and that confidence is the biggest reward of all.

Do No-Injection Instant Fillers Work?

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Contour Your Face with Buccal Fat Removal

The post Is a Non-Invasive Nose Job Right for You? appeared first on Prime Women | An Online Magazine .

Job of Moscow

Our father among the saints Job ( + 1607) was the first Patriarch of Moscow and All Russia. He is commemorated by the Church on June 19 and April 5 .

• 1 Early life
• 3 Patriarchate
• 6 External link

St Job was born into the family of pious tradesmen in Staritsa near Tver in the 1530s. His baptismal name was John. As a teenager, John knew most of the biblical texts by heart and strove to become a monk . His father, however, insisted on his marriage . Once, John asked his father's permission to see his confessor in the Uspensky Monastery in their native town of Staritsa (Tver Oblast). Upon his arrival, John immediately took monastic vows and assumed the name of Job. He spent fifteen years in the cloister and finally became its abbot in 1566 with the help of Ivan the Terrible , who had made Staritsa his residence in times of the Oprichnina (secret police).

In 1571, Job was transferred to Moscow and appointed abbot of the Simonov Monastery . In 1575, he became the abbot of the Novospassky Monastery. In 1581, Job was appointed bishop of Kolomna.

Known as a person of mediocre mental abilities, he, nevertheless, managed to draw attention of Boris Godunov by his talent for reading the longest of prayers by heart in a very expressive manner. During the reign of Feodor I (whose government was controlled by Boris Godunov), Job was appointed archbishop of Rostov and Metropolitan of Moscow and All Russia in 1587.

Realizing the necessity of strengthening the ecclesiastic authority in Russia , Godunov managed to persuade the Patriarch of Constantinople Jeremias II to establish a patriarchate in Russia. On January 26 , 1589, Job was elected the first Patriarch of Moscow and All Russia. He exercised all his influence and played a major part in Boris Godunov's ascending to the Russian throne.

Patriarchate

Job did not approve, however, Godunov's proposal to open a university in Moscow with foreign professors because he believed their influence and non- Orthodox faith would cause "heterodoxy" and endanger the authority of the Russian Church. Under Job's supervision, the Russians corrected books for divine service and prepared them for publishing.

He assisted in glorification of some of the Russian saints , ordering the celebration of the memory of Basil Fool for Christ in 1588, as well as that of Joseph Volotsky and others. Job also favored the construction of new cathedrals and monasteries and Christian missionary activities in the recently conquered Astrakhan Khanate and Siberia. After the mysterious death of tsarevich Dmitry Ivanovich in 1591, Jove accepted the noncriminal version of his demise, supporting Boris Godunov every step of the way.

After the invasion of False Dmitriy I and sudden death of Boris Godunov on June 1 , 1605, there was an uprising in Moscow.

Job was known as a harsh critic of False Dmitriy I, and he tried to persuade the people of Moscow to remain loyal to the deceased tsar. The armed supporters of the impostor burst into the Cathedral of the Dormition, and a boyar named P.F. Basmanov declared Job a traitor. Job was sent into exile to his monastery in Staritsa, where he went completely blind and finally died a very sick man in 1607.

In 1652, Job's relics were transferred to the Cathedral of the Dormition of the Moscow Kremlin, where they remain to this day. Patriarch Job was glorified as a saint by the Russian Orthodox Church in 1989.

External link

• Translation of the relics of St Job the Patriarch of Moscow and All Russia - OCA web site.
• Repose of St Job the Patriarch of Moscow, and All Russia - OCA web site.
• List of primates of Russia
• 16th-17th-century bishops
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A jackal's nose for the job

Watch the video of Jackal-dog hybrids working at Moscow's Sheremetyevo Airport:

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Text by Victoria Zavyalova. Edited by Joe Crescente, Alastair Gill. Design and layout by Victoria Zavyalova. Images credits: Aeroflot press service, Ruslan Fayzulin / Russia Beyond The Headlines. © 2015 All Right Reserved. Russia Beyond The Headlines [email protected]

Watch CBS News

Never-before-seen photos and details about the man accused of murdering four Idaho college students

By Peter Van Sant

January 7, 2023 / 11:02 PM EST / CBS News

Under a dark Idaho sky, investigators flew Bryan Kohberger to the college town of Moscow. Police delivered him to the Latah County Jail. On Jan. 5, in an orange jumpsuit, his face vacant, the 28-year-old made what will likely be his first of many appearances in this court.  

He stands charged with the murder of four students from the University of Idaho: Kaylee Goncalves, Madison "Maddie" Mogen, Ethan Chapin and Xana Kernodle. Investigators say he stabbed them to death in the home the women shared. 

JUDGE: The maximum penalty for this offense, if you plead guilty or be found guilty is up to  death and imprisonment for life. Do you understand?  

BRYAN KOHBERGER: Yes.  

Kohberger has not yet entered a plea.

In an affidavit , investigators laid out their understanding of the grim details about the night of the killings:  They say the killer left his DNA on a "leather knife sheath" found on a bed next to Maddie Mogen. And, most hauntingly, they say a surviving roommate thought she heard crying and "saw a figure clad in black clothing and a mask."    

The man walked past, as she stood in "frozen shock."  She locked herself in her room.  

The investigation is fast-moving. Authorities have not disclosed a motive or if he had a connection to the students, but we are learning more about just who Bryan Kohberger is.   

WHO IS ACCUSED KILLER BRYAN KOHBERGER?

Just 15 days before his arrest, Bryan Kohberger and his father were driving home from Washington State University for winter break to the family's home in Pennsylvania.

OFFICER (body cam video): Hello MICHAEL KOHBERGER: How you doing? OFFICER: How ya'll doin today?

The journey interrupted by two traffic stops, almost 10 minutes apart, in Indiana for tailgating.

MICHAEL KOHBERGER (to officer): We're gonna be going to Pennsylvania, a couple more miles. OFFICER: Oh, OK. MICHAEL KOHBERGER: …to the Pocono Mountains. We're a little, we're slightly punchy. We've been driving for hours. 

Police body cam video shows Kohberger and his father talking calmly with an officer about the trip.

OFFICER: Hours? And days? BRYAN KOHBERGER: Hours. MICHAEL KOHBERGER: Hours. Well, we've been driving for almost a day. OFFICER: Do me a favor and don't follow too close, OK?  

Then they are released with a warning.

Kohberger had been at the university since August, studying to get his Ph.D. in criminology. He was also a teaching assistant in the Department of Criminal Justice. He lived in an apartment complex on campus and had an office there.

According to the newly released affidavit, Kohberger had applied for an internship with the Pullman Police Department in the fall. He wrote in his application essay that "he had interest in assisting rural law enforcement agencies with how to better collect and analyze technological data."

Benjamin Roberts took four classes with Kohberger.

Benjamin Roberts : He seemed very comfortable around other people. He was very quick to offer his opinion and thoughts. And he was always participating fairly eagerly in classroom discussions.

He says Kohberger appeared highly intelligent.

Peter Van Sant : Does anything else come to mind that Bryan said to you in the past that today you think might be of interest?

Benjamin Roberts : There was a comment that he made, and it was kind of a flippant guy talk thing. At one point, he just idly mentioned, you know, "I can go down to a bar or a club and pretty much have any lady I want."

Kohberger arrived at the university after earning his bachelor's in psychology and master's degree in criminal justice at DeSales University in Center Valley, Pennsylvania.  

While at DeSales, authorities say Bryan Kohberger posted this survey, approved by the university, on the website Reddit asking ex-cons about the crimes they committed. One question he asked: "Before making your move, how did you approach the victim or target?

James Gagliano : This could be a piece of circumstantial evidence.

James Gagliano is a retired FBI Supervisory Special Agent and CBS News consultant.

James Gagliano: The fact that the suspect was interested in pursuing a Ph.D. in criminal justice and was especially interested in … the mental state that people who had committed murders in the past … yes, it could be interesting to note. But I know a lot of researchers that study those things, too, that would never commit a quadruple homicide.

And if Kohberger was involved in these murders, genetic genealogist CeCe Moore questions why he would be so careless as to allegedly leave his DNA at the crime scene. 

CeCe Moore : People are talking about how smart he supposedly is. And I just can't see how that could be true, because any student of forensic science or criminology would have to know that it's virtually impossible not to leave your DNA behind at a very violent, intimate crime scene like this.

CeCe Moore : You know, Ted Bundy thought he was smart. But he wasn't that smart, as it turns out.

After the murders, Roberts says Kohberger appeared disheveled, tired and chattier than usual.

But nothing could prepare Roberts for what he learned o f Kohberger's arrest.

Benjamin Roberts : Looking back over the last four months, I feel like there should have been signs that I should have seen. And I didn't ... I was blindsided.

Jason LaBar : This is out of character for Bryan, these allegations.

Monroe County public defender Jason LaBar represented Kohberger before he was extradited to Idaho.

Jason LaBar : The family would want the general public to know that Bryan is a caring son and brother —that's he's responsible, that he is devoted to them.

In a statement the family said, "we care deeply for the for the four families who have lost their precious children" ... and that they "seek the truth and promote his presumption of innocence rather than judge unknown facts and make erroneous assumptions."

Jason LaBar : He is innocent until proven otherwise.

LaBar says Kohberger came from a close-knit family. He grew up in eastern Pennsylvania in the Pocono Mountains. His father was as a maintenance worker and his mom worked in the school system. Bryan has two older sisters – one who works as a family therapist, and another sister who appeared in a 2011 low budget slasher film, "Two Days Back," about a group of young students viciously murdered by a serial killer. She now works as a school counselor. 

Bree : My heart goes out to Bryan's family.

Kohberger's friend, Bree, says she met Bryan at a party when they attended Pleasant Valley High School. She asked "48 Hours" not to use her last name.

Bree : Bryan was really funny. He wasn't outgoing at all. But he also wasn't shy.

She says they bonded over their love of the outdoors.

Bree : I don't necessarily remember the conversations, but you definitely remember how someone makes you feel. … I just remember feeling OK — I was just with a friend. … Just felt natural.

Bree recalls Kohberger was an average student with only a few close friends. In a yearbook photo, Kohberger's caption said he aspired to be an Army Ranger.

Casey Artnz also knew Kohberger from high school . She posted this Tik Tok following Bryan's arrest.

CASEY ARNTZ TIK TOK: "I used to be friends with Bryan Kohberger" ... "I'm in actual shock right now."

Casey Arntz : He was an overweight kid. … So, he did get bullied a lot.

But Arntz says people saw a change in Kohberger the beginning of senior year.

Casey Arntz : He lost like 100 pounds . … He was a rail. … It was after that weight loss that a lot of people noticed a huge switch in him.

Casey Arntz : My brother has since come out to say that even though they were friends, Bryan bullied him.

Casey Arntz : He had said that he would put him in like a chokeholds and stuff like that.

Bree says Kohberger started using heroin, which ended their friendship.

Bree : You just saw him becoming more self-destructive. … He really stayed secluded.

It's unclear when exactly Kohberger went into recovery, but both Bree and Casey say years after he graduated high school it appeared as if he was getting his life together. He was going to Northampton Community College and working security for Pleasant Valley School District.

Bree : He was telling me that he wanted to get sober, that he was getting sober. … And he wanted to let me know like, "I'm gonna do better. I'm gonna be better."

Bree : I'm sorry ... (emotional)

 Casey Arntz : The last time I saw Bryan was in 2017 at one of my friend's wedding. … And I gave him a hug and I said, "You look so good. Like I'm so proud of you."

And both Bree and Casey say it appeared that Kohberger had a new focus — his studies in criminology.

Bree : He wanted to do something that impacted people in a good way.

Bree: People were not his strong suit. And think through his criminology studies, he was really trying to understand humans and to try and understand himself.

Now Bree, like many who knew him, struggles to connect the person they once knew to this unspeakable crime.

Bree : I think a lot of people who were close to him are feeling this massive amount of guilt … "Why didn't I see it? Did I miss something? … Where did it go wrong?

THE YOUNG LIVES LOST

Before it was a crime scene, it was a home to five close friends. Maybe none closer than Maddie Mogen and Kaylee Goncalves.

On TikTok, the 21-year-old seniors looked like they were enjoying their final school year.

In the early morning of November 13, the two friends headed to a food truck. But their seemingly carefree existence would come to an abrupt end just hours later. Kaylee and Maddie were stabbed to death in the upstairs part of the house. A hundred miles away in northern Idaho, Kaylee's father Steve got the news.

Peter Van Sant : Steve, give us a sense of the shock of that moment.

Steve Goncalves : You just feel like you're getting crushed by a thousand pounds of weight.

Peter Van Sant : What do you want the world to know about your daughter, Kaylee?

Steve Goncalves : I want the world to know, they — they got robbed. Somebody stole from you.

Steve Goncalves says his daughter Kaylee would have made the world a better place. A general studies major, she was the middle child of five siblings. Goncalves says Kaylee was always up for a challenge.

Steve Goncalves : She grew up around two boys that were, you know, older than her. And uh, she didn't see any reason why she couldn't be as quick and fast and as good as those two boys were.

Peter Van Sant : What did she want to do with her life?

Steve Goncalves : Like most young people, it changed. She was gonna be a teacher. … But once she found out how long it was gonna take to pay back her student loans, she — she said, "Dad, you know, this thing that you do with computers seems to work pretty well."

She reportedly had a job lined up in Austin but made it clear that one day she hoped to settle down somewhere near her dearest friend Maddie Mogen.  Maddie was a marketing major, and she and Kaylee had been inseparable since the sixth grade.

Steve Goncalves : I just felt like it was more of a sistership than it was a friendship ... And she was just one of our kids.

So, it perhaps did not come as a surprise when Steve revealed at a November memorial that Kaylee and Maddie died side-by-side.

STEVE GONCALVES (memorial service): They went to high school together. … They came here together. … And in the end, they died together. In the same room, in the same bed. It comforts us. It lets us know that they were with their best friends in the whole world.

It was a belief Maddie's stepfather, Scott Laramie, repeated to another packed memorial just days later.

SCOTT LARAMIE (memorial service): The two of 'em were a force to be reckoned with. They stuck together through everything.

Maddie had a boyfriend, Jake Schriger.

JAKE SCHRIGER (memorial service): She was the first person I talked to every morning and the last person I talked to before bed.

They had been together for more than a year. Schriger says Maddie had a talent for making people laugh.

JAKE SCHRIGER (memorial service): She was really funny. Her jokes really would come outta nowhere … And just be like, "Is that the — the cute little blonde girl that just said that?"

But Maddie and Kaylee weren't the only victims.  While two other roommates were in their rooms and unharmed during the attacks, on the second floor, the killer made his way to the room of Xana Kernodle.

JAZZMIN KERNODLE (memorial service): She was my baby sister, but she was so much wiser.

Xana's sister, Jazzmin.

JAZZMIN KERNODLE (memorial service): She would always tell me she wouldn't know what to do without me. And now I have to live this life without her.

A 20-year-old junior majoring in marketing, Xana was known for being focused on her studies. So focused, she didn't make much time for dating.

JAZZMIN KERNODLE (memorial service): Xana never had a boyfriend before, and my dad and I wondered if she was ever gonna get one (laughs).

That was until she met Ethan Chapin.

JAZZMIN KERNODLE (memorial service): The way she would talk and smile about him was something I've never seen her do before.

Ethan was a 20-year-old majoring in recreation and tourism management. Jazzmin says Xana and Ethan began dating in the spring of 2022.

JAZZMIN KERNODLE (memorial service): They had something so special and everyone around them knew.

Especially anyone who followed the pair on Instagram. For Ethan's birthday, Xana posted photos of them with the caption: "Life is so much better with you in it, love you!" It would be her last Instagram post. Just two weeks later, the young couple was found stabbed to death in Xana's bedroom.

At the University of Idaho, the pain of this tragedy is felt at the root and extends hundreds of miles away to a tulip farm in Skagit Valley, Washington. It's where Ethan worked before heading to college. His boss, Andrew Miller.

Andrew Miller : So, Ethan started – it was in the spring of — of '21. … It was the best Tulip Festival.

Miller says the annual tulip festival attracts close to half-a-million visitors, and Ethan stood out in the crowd.

Andrew Miller : Well, he's a big guy wearin' a big smile, right? I think that's the part that I – that kinda struck me right away.

Ethan – a triplet – worked there with his siblings, Maizie and Hunter, and lived in a rented house on the farm with their parents. The Chapin triplets were incredibly close says Reese Gardner.

Reese Gardner :  They were best friends. … If one did something, they all did something. … It was pretty cool to see.

Including attending the University of Idaho together.

Andrew Miller : And that was the funniest thing, it was like, of course it was a package deal. Like, all three of 'em were gonna go there.

Ariah Macagba : He was excited, I think, 'cause his siblings were going with him.

Ariah Macagba says Ethan's parents had decided to live in Idaho, too. Macagba says when she heard Ethan had been murdered, she couldn't believe it.  

Ariah Macagba : I think the first thing I did was message Ethan. I was like, "Hey, you're OK, right? Like, this isn't real." (crying) And — obviously, he didn't respond.

Reese Gardner scoured the internet for information.

Reese Gardner : And I just couldn't stop reading articles and … I just wanted to know what happened, and I wanted to know why.

But in lieu of answers, Gardner turned to tulips. He had an idea: name one after Ethan.

Reese Gardner : I thought, "There's — there's no better way … to remember someone who had such a big part, a big role in those farms."

Andrew Miller : Cause Reese called me … And it was, "Hey, can this be done, and are you interested in doing it?" And I was, "Yes, and hell yes."

But creating a new tulip is a long process, so instead, Miller suggested a mix of tulips that would be a perfect tribute to Ethan: yellow and white.

Andrew Miller : Yellow, of course, because Go Vandals. University of Idaho, right? That's significant. And then white is — is an eternal color, right? And tulips come up in the spring. It is a symbol of — of hope.

With his parents' blessing, they named the mix of tulips, "Ethan's Smile."

Andrew Miller : So, this will be a nice yellow or white tulip here in about four months.

The trio planted thousands of bulbs in the state of Washington and sent a couple thousand more to the University of Idaho.

Andrew Miller : And it really is our hope that we'll be able to continue to plant and that anybody that wants to remember him will be able to have their own Ethan's — Ethan's Smile Garden. …  It's a living legacy.

Now it is up to prosecutors to get justice for these young victims .

IN SEARCH OF ANSWERS

Forty-seven days after the murders of Kaylee Goncalves, Ethan Chapin, Madison Mogen, and Xana Kernodle, authorities apprehended the man they believed was responsible.  We now know investigators had Bryan Kohberger in their sights early on but kept it close to the vest. So, in the early days, after the Nov. 13 murders, frustration swept over Moscow, Idaho.

James Gagliano : I think in this instance people were expecting a pretty quick arrest in this case, and it takes time.

Steve Goncalves, father of 21-year-old Kaylee, was trying as best he could to deal with news no one expects.

Steve Goncalves : Most things I'm prepared for. Most things as a dad, you can— you can handle. But somethin' like that, you just can't prepare for and you can't fix it.

Steve Goncalves : And, you know, just think if you do everything right, by the book, somethin' like this couldn't happen.

Peter Van Sant : Did you have any sense who might have done something like this?

Steve Goncalves : No … I didn't think anybody in her inner circles was — was capable of interacting and — and her doing something that could even deserve something like that.

As news spread of the murders, so did shock in the college community, which had not seen a homicide since 2015.

Matt Loveless : Parents drove hundreds of miles to pick up their kids to head home and stay home for the semester.

Matt Loveless is a journalism professor at nearby Washington State University.

Matt Loveless : At this point, we don't know if they're gonna come back for — the spring semester there on campus. And that same thing happened in both our communities.

James Gagliano: And, so, when parents send their kids off to school, for something to happen like this, I think it's a parent's worst nightmare

James Gagliano : And it's a place, Moscow, Idaho, where violent crime really is not an issue.

As police started their investigation, they traced the victims' final steps. The day before the murders seemed to start ordinarily. Kaylee Goncalves posted photos with her roommates and Ethan Chapin, to her Instagram account with the caption, "One lucky girl to be surrounded by these ppl everyday." That evening, Ethan and Xana attended a party at a fraternity house on campus.  Kaylee and Madison were at a bar between 10 p.m. and 1:30 a.m. They were then seen at a local food vendor, the "Grub Truck."  It is believed they all returned home by about 2 a.m. on Nov. 13.

James Gagliano : So, in examining the timeline , police know that the crime took place sometime in the early morning hours. There were also two other University of Idaho students who were inside the house when the murders took place.

It was later that morning that a call was made to 911 from one of the surviving roommate's phones to report an unconscious person.  Police arrived at the house at 11:58 a.m.

James Gagliano : Police find the victims on the second and third floor of the house in bedrooms — a horrific and a very large-scale crime scene 'cause you're gonna be dealing with a number of different floors that need to be processed, the bedrooms where the crimes actually occurred, and then ingress and egress points. How did the — how did the alleged killer get inside the house? Through a front door? Through a window? Those are all things police will be looking at.

CHIEF JAMES FRY (to reporters): No weapon has been located at this time. There was no sign of forced entry into the residence.

On Nov. 16, three days after the murders, the Moscow Police held their first press conference.

CHIEF JAMES FRY (to reporters): We believe this was an isolated, targeted attack on our victims. We do not have a suspect at this time and that individual is still out there.

Coroner Cathy Mabbutt issued her report on Nov. 17.

Coroner Cathy Mabbutt: They were all murdered through stabbing with some kind of a, probably a larger knife…

She told police some of the four victims had defensive wounds, but none had signs of sexual assault.  Police continued to work the case, aided by the Idaho State Police and the FBI.

James Gagliano : I just believe that the Moscow Police Department probably just didn't have a lot of experience in working a homicide, especially one as heinous as this one.  

After about three weeks with no arrests, and what, to the public, appeared to be no real suspects, Steve Goncalves grew more concerned that authorities weren't doing enough and that the murders would turn into a cold case. So, he says, he started working with his own team to investigate the murders.

Steve Goncalves : So, we just thought, "This is the time. Let's get it out there, and let's not let it get cold. Let's get as many resources as— as possible."

Peter Van Sant : And did you have any sense whatsoever as to what a motive … might have been for these murders?

Steve Goncalves : Pretty girls and a handsome guy. I thought, you know, that might be somethin' to do with their, you know, stalking them in the sense of that.

Meanwhile, names of possible people of interest were trickling out — including members of the community and acquaintances of the victims. But they all seemed to be part of an unfounded rumor mill, many from online sleuths.  Goncalves even had people come to him to prove they were not involved.

Steve Goncalves : We — had certain suspects take their shirts off in our kitchen to show if they had scratches. And we tried to do everything in — in our powers to make sure that if we thought somebody was ruled out, we truly — we truly felt like, you know, we — we looked at 'em.

Law enforcement would end up receiving thousands of tips, but the investigation, by outward appearances, seemed to be stalled.  Nearly a month after the murders, on Dec. 7, police were seen packing up the victims' belongings to return to the families, who had lost so much. It was the police chief behind the wheel of the U-Haul truck. That same day, a plea was made to the public.

Police were interested in speaking with the occupant(s) of a white 2011-2013 Hyundai Elantra with an unknown license plate, spotted near the crime scene, around the time of the killings.

AMANDA ROLEY | KREM REPORTER: Today's update is the first descriptive tip that we have received in several days. Detectives now want to speak with anyone who was inside a white Hyundai Elantra that was near this home on King Road around Nov. 13th.  

Police released photos of similar makes to the vehicle they were looking for.

CHIEF JAMES FRY (to reporters): We still believe there is more information to be gathered.

James Gagliano : Pushing that out to the media. Pushing that out to people on the internet. Pushing that out so that people can look for either a potential suspect, person of interest, or a potential vehicle. That goes a long way towards running down leads.

INSIDE THE INVESTIGATION

It turns out that about two weeks before the police asked the public to be on the lookout for a white Hyundai Elantra , they had already shared that information with surrounding law enforcement. And on Nov. 29, 2022, a white Elantra was located by Washington State University Police. The car was registered to Bryan Kohberger.

CBS News learned, that in mid-December, the Hyundai Elantra was tracked for several days by the FBI, using E-ZPass monitoring, fixed wing aircraft and ground support, as it was driven by Kohberger, along with his father, from Pullman, Washington, on that cross-country trip to the family's home in Pennsylvania.

On Dec. 15, the car was stopped twice in Indiana for those driving violations, by the Indiana State Police and the Hancock Sheriff's Office.

OFFICER: So, you're coming from Washington State University? MICHAEL KOHBERGER: Yeah. BRYAN KOHBERGER: Yup OFFICER: And you're going where? MICHAEL KOHBERGER: We're gonna be going to Pennsylvania.

Both agencies said at the time of the stops, "there was no information available on a suspect for the crime in Idaho, to include identifying information or any specific information related to the license plate state or number of the white Hyundai Elantra …" 

Police did not ticket Kohberger; they gave a verbal warning and the trip continued home. And then, Kohberger's holiday came to an abrupt halt . 

CBS NEWS REPORT:  A suspect is under arrest for the quadruple murder of four Idaho college students.

On Dec. 30, 2022, police made that announcement that Bryan Kohberger was under arrest for the murders. He was arrested at his family's home in Albrightsville, Pa., at 3 a.m., with approximately 50 law enforcement officers on the scene. 

MAJ. CHRISTOPHER PARIS | PENNSYLVANIA STATE POLICE: There were multiple windows that were broken I believe to gain access, as well as multiple doors.

Authorities believe Bryan Kohberger acted alone.

Jason LaBar : Bryan was very shocked by his arrest. … Bryan did not know why they were there, but he was aware of the case in Idaho.

Monroe County public defender Jason LaBar represented Kohberger in Pennsylvania as he was awaiting extradition to Idaho.

Jason LaBar : Bryan indicated to me that he was eager to be exonerated — that he was willing to go back to Idaho.

On Jan. 3, at a hearing in Pennsylvania, Kohberger signed his waiver of extradition. And on Jan. 4, was flown to Idaho, where he is in jail, charged with the four murders.

On Jan. 5, Kohberger appeared in court in Moscow with his new public defender to hear the charges read against him. He has yet to enter a plea.

JUDGE MEGAN MARSHALL:  The maximum penalty for this offense if you were to plead guilty or be found guilty is death or imprisonment for life. Do you understand?   

BRYAN KOHBERGER: Yes.

That same day, that affidavit was released that laid out startling new details about the murder investigation. According to the affidavit, one of the surviving roommates actually saw the murderer and stood in a "frozen shock phase."  She is referred to as DM in the affidavit, and told police that earlier, she heard a female voice say, 'something to the effect of  "there's someone here." And later, a male voice say, "something to the effect of "it's ok, I'm going to help you." Later she opened her door "… after she heard crying and saw a figure clad in black clothing and a mask..." She described the figure as "5'10'… with bushy eyebrows."

The affidavit states that, according to DM, the male walked toward the back sliding door and DM locked herself in her room. It was later in the morning when that call was made to 911 from one of the surviving roommate's phones, to report an unconscious person. It is unclear what occurred in the hours before police were called. It is believed the murders took place between 4 and 4:25 a.m. Police say they discovered, on the bed in Madison's room, a knife sheath with a Marine insignia.

James Gagliano : I would imagine that a — crime scene as — as grisly and ghastly as this one — that there would have been … DNA left by the perpetrator.

According to the affidavit, the knife sheath was processed and "the Idaho State Lab later located a single source of male DNA on the button snap."  They were able to link it to DNA recovered from the trash at the Pennsylvania Kohberger family home.

It is not clear, what, if any, connection Kohberger had with the victims. However, the affidavit states that by using cellular phone data, police were able to place Kohberger's cell phone near the crime scene "on at least twelve occasions before November 13, 2022. All of those occasions, except for one, occurred in the late evening and early morning hours …"

Even with these new details, many question remain. A newly issued gag order prohibits officials and others involved in the case from speaking about the murders. Also, authorities have sealed a search warrant that was carried out at Kohberger's home in Pullman, Washington.

Jim Gagliano : This is one where you don't want a mistake. You don't want something to happen during this process that's going to give the alleged suspect an opportunity to beat the case.

Now, the case will work its way through the court system as parents, who lost their children, will be looking for answers.

Steve Goncalves : We find the truth, you know. You get the truth, and then that — that'll — that'll be everything.

IN REMEMBRANCE

You can see it in the stunned, silent faces of the kids. Faces that ask "why?" without even speaking. 

Young eyes glisten, bathed in the glow of candlelight at a vigil held for the young lives lost.  A ritual all too familiar across America. The flowers, the prayers, the vows to carry on. In Idaho, they hold on tight to each other and to the memories of those loved and lost.

EMILY (memorial service): Life is so unfair and unpredictable (crying).

For Xana Kernodle's friend Emily, the wound remains raw.

EMILY (memorial service): And it tears me apart knowing I can't hug her. (Crying) So hold those you love closer. Hug them a little tighter and tell 'em you love them. We'll find justice for you, Ethan, Maddie, and Kaylee. We love you all so much.

And for Ashlin, Maddie Mogen's memory is still vibrant.

ASHLIN (memorial service): You truly will live on forever -- not only in my heart, but in the heart of so many people that were impacted by your beautiful smile, your grace, your patience, your open heart, and your craziness.

Hunter Johnson remembers a pal he could rely on — Ethan Chapin.

HUNTER JOHNSON (memorial service): Ethan was always someone you could count on to make you smile and — cheer up your mood. … And I — feel so lucky to have shared so many great memories with him (emotional).

But those who are older perhaps sense that pain that runs this deep, never goes away. Kaylee's father, Steve Goncalves.

Steve Goncalves : You don't heal from somethin' like this. … it's never gonna happen. You're never gonna be healed. You're never gonna get through this. And when they die, part of you dies.

Steve Goncalves : We're tired of all these types of crimes. We're tired of all this stuff. And — we can rally around these terrible tragedies, and … We're hopin' that as a society we come back stronger. And we — we decide to not let this be accepted anymore, you know. That's what I hope for.

Bryan Kohberger's next court appearance is scheduled for Jan. 12.

He will have a chance to enter a plea at a later date.

• Bryan Kohberger

"48 Hours" correspondent Peter Van Sant first joined CBS News in 1984.

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GOP Rep: 'Moscow Marjorie Has Clearly Gone Off The Deep End'

House Republicans had harsh words for the Georgia Peachpit as her plan failed to oust Speaker Johnson.

In a landslide vote 359-43, including a majority of Republicans refused to side with her.

Not only did she fail, but a colleague brought up "space lasers" in order to characterize her as the Qanon nut that she is

Rep. Mike Lawler of New York did not mince words:

“ Moscow Marjorie has clearly gone off the deep end, maybe the result of a space laser , but this type of tantrum is absolutely unacceptable and it does nothing to further the cause of the conservative movement," he said. "The only people who have stymied our ability to govern are the very people that have pulled these types of stunts throughout the course of this Congress to undermine the House Republican majority.”

Marge called out as a Russian stooge and a tin-foiled hat lunatic? That sounds about right.

Lawler also took aim at her MAGA lovin' cult members as well. Hopefully, if the Democrats take back the House in November, Marge will be relegated (along with Jim Jordan, James Comer, and the rest of those creeps) to social media and Newsmax.

I can imagine a scenario when many of those Freedom Caucus whack jobs leave Congress and take more lucrative jobs at faux voter fraud groups like True the Vote.

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