History, education and training

Two-sentence lead. Rhinoplasty training still follows an observe-and-assist apprenticeship (73.9% of senior residents had never performed a key step more than five times), so 3D-printed models, lamb heads, chicken breast, and cadavers are being validated as practice substitutes; one 3D model nearly doubled resident skill scores in a single session. The dorsal-preservation techniques now returning date to the late 19th and early 20th centuries as an alternative to Joseph's resective hump removal, and nasal reconstruction itself runs from Indian cheek flaps around 600 BC through the Brancas, the Vianeos and Tagliacozzi's 1597 book.

Key points

• Simulator systematic review, 17 studies (1984-2021), 4 to 24 participants each: 8 cadaveric (3 human), 1 live animal, 2 virtual, 6 3D models; animal and human simulators raised trainee confidence significantly; no automated evaluation method exists and few simulators are validated [37172948]
• 3D-printed rhinoplasty model: 53 surgeons, 100% said it aided learning; 91% (n=48) rated realism excellent or very good vs cadaver; 20 residents improved OSAT from 11.7/40 (SD ± 1.80) to 21.6/40 (SD ± 1.79), P<.0001 [40129179]
• Lamb head model, 21 heads measured: lateral crura 17.8 × 11.6, interdomal distance 8.1 mm, domal width 3.7 mm, upper lateral cartilage 31.1 mm lateral / 21.2 mm medial, nasal bones 63.9 mm long × 16 mm wide; 8 further heads used for preservation practice (high-strip in 5, Cottle in 3) [34983078]
• Chicken breast, especially sternal cartilage, as a substrate for practicing preservation techniques and grafting without cadaver tissue [39288904]
• Residency education scoping review, 13 studies: 3D-printed models and simulators most common, then cadaver labs, structured programming, video tools; outcomes measured by confidence surveys and knowledge tests [41629468]
• Video standards review, 114 intraoperative videos: 49 full-length open, 20 full-length endonasal, 17 tip, 8 opening, 7 graft fashioning, 7 osteotomies, 6 cartilage harvest; upward camera angle most used, endoscopic least; many angles obstructed by staff or fail to show deep structures [32101478]
• Online patient materials: 75 articles averaged grade reading level 10.31 (range 5-20; 95% CI 9.83-10.79) vs the recommended 5th grade; physician-authored videos more reliable (JAMA benchmark P<0.001) with higher Global Quality Score (P<0.001); education videos more reliable than patient-experience videos (P=0.01) [33844930]
• Dorsal conservative technique arose in the late 19th and early 20th centuries as an alternative to Joseph's resective method, preserving the keystone area and the upper lateral cartilage-septum connection; it has been "reborn after several years" [33621985]
• History review spanning millennia; authors state that past narrators "have determined many of today's truths" and acknowledge omissions [31470461]
• Preservation rhinoplasty in facial plastic surgery fellowships: national survey of training and clinical integration, title only on file [42695808]
• Resident survey, 138 Canadian and US plastic surgery residents (62 junior, 76 senior): 72% of seniors and 95% of sixth-years reported adequate exposure vs 13% of juniors; 75% of seniors took part as observer or first assistant, 25% as co-surgeon; 73.9% had not performed a key step more than five times; hardest steps osteotomy 76.1%, caudal septum and spine 65.2%, tip sutures 55.8%; 73.9% said a simulator would help [31568292]
• History of reconstructive rhinoplasty: cheek advancement flaps in India around 600 BC; forehead flap probably 16th century, described by Manuzzi in the 17th century and reaching the West through the Gentleman's Magazine in 1794; the Brancas in 15th-century Sicily (cheek then arm flaps), the Vianeos in Calabria, and Tagliacozzi's 1597 book at Bologna [24918702]
• Periorbital ecchymosis after closed rhinoplasty, 183 patients photographed at days 1, 2 and 7, quadrant color scoring by three physicians: excellent interobserver reliability; bruising dominated the medial quadrants at days 1-2 and the lower lateral quadrants by day 7; no demographic or clinical predictor [37448765]
• Skin necrosis after hyaluronic acid filler, 7 cases: every patient had a cosmetic rhinoplasty more than 3 years earlier, a lesson now written into filler teaching [29506052]

Techniques and terms named

3D-printed model [40129179], objective structured assessment of technical skills (OSAT) [40129179], face / content / criterion validity [40129179], lamb head model [34983078], high-strip technique / Cottle technique [34983078], chicken breast sternal cartilage model [39288904], cadaver laboratory [41629468], virtual simulator [37172948], live animal simulator [37172948], low-cost open rhinoplasty simulation model [39636439], intraoperative exoscope [33155856], camera angle standards [32101478], JAMA benchmark criteria / Global Quality Score [33844930], readability scores [33844930], online education during COVID-19 [34846171], Joseph resective technique [33621985], dorsal conservative technique / keystone area [33621985], resident exposure survey [31568292], maneuver-specific simulation [31568292], Indian cheek flap and forehead flap [24918702], Branca, Vianeo and Tagliacozzi [24918702], quadrant ecchymosis scoring [37448765], post-rhinoplasty filler necrosis [29506052]

Numbers to remember

• OSAT 11.7/40 to 21.6/40 after one 3D-model session, n=20 residents [40129179]
• 17 simulator studies over 1984-2021; participant counts 4 to 24 [37172948]
• 114 rhinoplasty videos reviewed; upward camera angle most common [32101478]
• Patient articles read at grade 10.31 vs recommended grade 5 [33844930]
• Lamb interdomal distance 8.1 mm; domal width 3.7 mm; nasal bones 63.9 × 16 mm [34983078]
• 13 studies on resident rhinoplasty education [41629468]
• 73.9% of 138 residents never performed a key step more than 5 times; 73.9% want simulators [31568292]
• Hardest steps: osteotomy 76.1%, caudal septum 65.2%, tip sutures 55.8% [31568292]
• 183 patients scored for ecchymosis at days 1, 2 and 7 with excellent agreement [37448765]
• Reconstructive milestones: 600 BC cheek flap, 1597 Tagliacozzi, 1794 Gentleman's Magazine [24918702]

Numbers

What is still contested or missing

• Simulators are mostly at the development stage; few are validated and none has automated assessment [37172948]
• Video teaching material shows "extensive variability in camera angles" and many insufficient views [32101478]
• Patient-facing text exceeds recommended reading level; physician videos "lack important information" [33844930]
• Letters on video standards [32749869, 32749858], the fellowship survey [42695808], the low-cost model [39636439], a 3D model [36083277], COVID-era online education [34846171], and the exoscope evaluation [33155856] are title-only on file [32749869, 32749858, 42695808, 39636439, 36083277, 34846171, 33155856]
• Resident exposure survey is self-reported with an unstated response rate [31568292]
• History narratives depend on secondary sources; the authors of one review say past narrators fixed many present truths [31470461, 24918702]
• Ecchymosis scoring found no risk factor in 183 closed cases, which leaves the prevention literature without a validated baseline [37448765]

Papers used

• Gill P et al.. Surgical Training Simulators for Rhinoplasty: A Systematic Review. Facial Plast Surg 2024. PMID 37172948. DOI 10.1055/a-2092-6564
• Arancibia-Tagle D et al.. History of Dorsum Conservative Techniques in Rhinoplasty: The Evolution of a Revived Technique. Facial Plast Surg 2021. PMID 33621985. DOI 10.1055/s-0041-1724031
• Çelikoyar MM. Re: "Video Standards for Rhinoplasty Education: A Review and Recommended Guidelines" by Hakimi et al. Facial Plast Surg Aesthet Med 2020. PMID 32749869. DOI 10.1089/fpsam.2020.0330 (title only)
• Hakimi AA et al.. Response to Çelikoyar re: "Video Standards for Rhinoplasty Education: A Review and Recommended Guidelines". Facial Plast Surg Aesthet Med 2020. PMID 32749858. DOI 10.1089/fpsam.2020.0360 (title only)
• Hakimi AA et al.. Video Standards for Rhinoplasty Education: A Review and Recommended Guidelines. Facial Plast Surg Aesthet Med 2020. PMID 32101478. DOI 10.1089/fpsam.2020.0006
• Khetpal S et al.. Rhinoplasty Education During Residency: Discussion of Current Barriers, Challenges, and Opportunities for Improvement. Aesthetic Plast Surg 2026. PMID 41629468. DOI 10.1007/s00266-025-05539-8
• Vargas D et al.. Preservation Rhinoplasty in Facial Plastic Surgery Fellowships: A National Survey of Training and Clinical Integration. Plast Reconstr Surg 2026. PMID 42695808. DOI 10.1097/PRS.0000000000013425 (title only)
• Rehman U et al.. Bridging the Gap in Rhinoplasty Training: The Effectiveness of 3D Printed Models in Surgical Education. Aesthet Surg J 2025. PMID 40129179. DOI 10.1093/asj/sjaf045
• Freire L, Dolci JEL. Rhinoplasty Training: An Innovative Learning Approach Using Chicken Breast. Facial Plast Surg 2025. PMID 39288904. DOI 10.1055/s-0044-1790260
• Rosenbaum A et al.. Training in Open Rhinoplasty: Interdisciplinary Development and Validation of an Original Low-Cost Simulation Model. Facial Plast Surg Aesthet Med 2025. PMID 39636439. DOI 10.1089/fpsam.2024.0181 (title only)
• Kreicher KL et al.. Development of a Three-Dimensional Printed Model for Rhinoplasty Simulation in Surgical Education. Facial Plast Surg Aesthet Med 2023. PMID 36083277. DOI 10.1089/fpsam.2022.0042 (title only)
• Apaydin F et al.. Lamb Head as a Training Model for Septoplasty and Rhinoplasty. Facial Plast Surg 2022. PMID 34983078. DOI 10.1055/a-1731-0332
• Patel MJ et al.. Analysis of Online Patient Education Materials on Rhinoplasty. Facial Plast Surg Aesthet Med 2022. PMID 33844930. DOI 10.1089/fpsam.2021.0001
• Martin EC et al.. The Transition to Online Rhinoplasty Education Amid COVID-19: Surgeon Perspectives and Areas of Improvement. Facial Plast Surg Aesthet Med 2022. PMID 34846171. DOI 10.1089/fpsam.2021.0282 (title only)
• Hakimi AA et al.. Evaluation of a High-Definition Intraoperative Exoscope in Rhinoplasty Education and Workflow. Facial Plast Surg Aesthet Med 2021. PMID 33155856. DOI 10.1089/fpsam.2020.0479 (title only)
• Adamson PA, Gantous A. Once Upon a Rhinoplasty: The History of the "Queen" of Facial Plastic Surgery. Facial Plast Surg 2019. PMID 31470461. DOI 10.1055/s-0039-1693443
• Zammit D et al.. Reevaluating the Current Model of Rhinoplasty Training and Future Directions: A Role for Focused, Maneuver-Specific Simulation. Plast Reconstr Surg 2019. PMID 31568292. DOI 10.1097/PRS.0000000000005911
• Mazzola IC, Mazzola RF. History of reconstructive rhinoplasty. Facial Plast Surg 2014. PMID 24918702. DOI 10.1055/s-0034-1376868
• Mizrachi M et al.. Periorbital Ecchymosis Post Closed Rhinoplasty: Natural History, Risk Factors, and Validation of a New Scoring System. Plast Reconstr Surg Glob Open 2023. PMID 37448765. DOI 10.1097/GOX.0000000000005112
• Robati RM et al.. The Risk of Skin Necrosis Following Hyaluronic Acid Filler Injection in Patients With a History of Cosmetic Rhinoplasty. Aesthet Surg J 2018. PMID 29506052. DOI 10.1093/asj/sjy005