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Roe reported on 5 patients who had an endonasal hump removal. This 1891 article was titled " The Correction of Angular Deformities of the Nose by a Subcutaneous Operation." 2 In 1892, Robert F. Weir, a professor of surgery in New York City, published an article titled "On Restoring Sunken Noses Without Scarring the Face."? Weir claimed to have performed a reduction rhinoplasty in 1885, 2 years before Roe published his first accounts. This article describes hump removal, nasal shortening, tip modification, and narrowing of the base through alar base wedge excisions ("the Weir incision"). In 1898, Jacques Joseph, considered by many to be the father of modem rhinoplasty surgery, presented his endonasal techniques to the Medical Society of Berlin.' During the question period, an American doctor in the audience asked Joseph if he were aware that Roe had previously described a similar procedure. I. Even if Joseph was not the first to perform co smetic 110 rhinoplasty, he was the first surgeon to dedicate a career to the cosmetic enhancement of the most prominent facial feature. A creative man who began his career in orthopedic surgery, he defined the essential steps of the procedure: reducing the hump, narrowing the bony vault, shortening the nose, and modifying the tip. He also invented the necessary instruments, many of which are still found on surgical instrument trays a century later.' Late 19th-century American cosmetic surgery was not limited to rhinoplasty, however. In 1881, Robert Talbott Ely, a staff member of the Manhattan Eye, Ear, and Throat Hospital in New York, performed an otoplasty for protruding ears on a 12-year-old boy.' World War I marked the appearance of plastic surgery as a medical specialty.l-' Trench warfare and modem weaponry produced many horrible facial injuries. The treatment of these deforming injuries was advanced by improved anesthesia techniques, utilization of antiseptic surgery techniques, and the availability of the electric light bulb to illuminate the surgical field and body cavities. The terrible destructive effects of war brought surgeons of different backgrounds together for rehabilitation of the facially disfigured. Rhinologists, oral surgeons, general surgeons, dental surgeons, ophthalmologists, and neurosurgeons collaborated in these efforts. Many surgeons who were to become the fathers of plastic surgery arose to recognition. These surgeons included Sir Harold Gillies, who was born in New Zealand and trained as an otolaryngologist; Vilray Blair, an orthopedic surgeon from Saint Louis; Robert Ivy, a general surgeon from Philadelphia; Lee Cohen, an American otolaryngologist; and Varaztad Kazanjian, an Armenian immigrant who studied dentistry at Harvard Dental School and worked on the staff of Massachusetts General Hospital. l.2 The efforts of these men laid the foundation for the specialty of plastic and reconstructive surgery. Among these surgeons, Cohen, an otolaryngologist who had studied in Europe, was performing rhinoplasty surgery prior to his reconstructive efforts in World War I. Following World War I, 3 surgeons who were later to practice in the United States had the common experience of training with Jacques Joseph in Berlin. Jacques Maliniac, born in Poland and trained in France, served in the Russian army, where his wartime experience drew him to the new area of plastic surgery. Gustave Aufricht was born in Hungary and trained in Budapest and Berlin. Joseph Safian, a general practitioner from New York, learned about Jacques Joseph's work at the time of his discharge from the United States Army. These 3 men studied with Joseph in Berlin in about 1921. They all eventually practiced their surgical craft in New York and were influential in the establishment of both plastic and cosmetic surgery as recognized areas of medicine. 1.2 One of the men who had most to do with the dissemination of information on plastic and cosmetic surgery was neither an otolaryngologist nor a surgeon. The American Journal of Cosmetic Surgery Vol. 16, No.2, 1999 Prior to World War I Simon Fomon had conceived of the idea of teaching 'a refresher course for physicians preparing for state medical board examinations. His review covered all areas of medicine and surgery. In 1920, his collected materials resulted in the publication of the 5-volume Medicine and Allied Sciences.' Fomon's interest soon focused on facial plastic surgery and rhinoplasty. He made at least 2 trips to Europe between the late 1920s and early 1930s. He spoke and read German and visited Berlin, Paris, and Vienna, so one may assume that he met, observed, and studied with Joseph. In 1939, he published Surgery of Injury and Plastic Repair, an attempt to document all known plastic and cosmetic surgery techniques.' Fomon began to teach courses on rhinoplasty and otoplasty in 1940. The first course was held in Boston and attracted 2 otolaryngologists. About 1942, Fomon moved to New York and began to conduct the lecture series that evolved into the "Fomon Course."? Soon after the formation of this course, its graduates founded a society named the American Academy of Facial Plastic Surgery. A year later, the American Otorhinologic Society for the Advancement of Plastic and Reconstructive Surgery (later shortened to American Otorhinological Society for Plastic Surgery) was founded.? 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