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.