Cyrano and Pinocchio could have used it. Barbra Streisand, Jimmy Durante and Bob Hope refused it. Michael Jackson abused it.Rhinoplasty.Probably no form of cosmetic surgery is more familiar to Americans than the venerable nose job. “It’s been around since antiquity,” said Andy Stewart, a Charleston plastic surgeon. “There may have been reports of rhinoplasties in ancient Egypt.”Plastic-surgery historians cite descriptions of nose reconstructions in Egypt as far back as 3000 B.C. and in the Sanskrit texts of ancient India. The Indian judicial system created a dire need for such surgery. As punishment for adultery, unfaithful spouses had their noses cut off.The concept of nose surgery solely for the sake of beauty didn’t develop until after the mid-1890s, when anesthesia and sterile techniques made surgery safer. A German surgeon performed the first official nose reshaping in 1898. In the 1930s, an Austrian surgeon introduced cosmetic rhinoplasty to the United States.It’s a very nifty tool, the nose. We use it for smelling, sneezing, breathing, twitching, blowing, sneering, snubbing and snooping. And for centering and balancing our face.“It’s the most prominent feature of the face,” Stewart said. “In a sense, it defines the face.”“Nothing has a greater impact on how a person looks than the size and shape of the nose,” says the American Society of Facial Plastic Surgery.Which explains why so many people want to change it.Rhinoplasty consistently ranks as the top procedure plastic surgeons perform. Nationally, surgeons reshaped 356,564 snouts in 2003, most of them in the 19-to-34 age group.Fees in 2002 averaged $4,500 and ranged from $3,000 to $12,000.Evidently, those surgeons earned every penny.Despite its frequency, rhinoplasty remains a complicated, highly challenging procedure.“I don’t do that many,” Stewart said. “One reason is that they’re very difficult to do very well. I’ve taken courses just on rhinoplasty, and I plan to take more. It’s an art, the most artful of all cosmetic procedures.“When you talk about changing the nose, you’re talking about millimeters,” he said. “That’s what’s so difficult. You can change the whole appearance of the face with a few millimeters.”The surgeon has two options — closed or open rhinoplasty. The closed procedure confines incisions to the inside of the nose and offers a faster recovery. But the inability to see parts of the internal nose limits the corrections.“It’s a difficult technique, because you’re doing it by feel,” Stewart said.An open rhinoplasty employs incisions inside the nose and a small incision across the tissue separating the nostrils. The incisions allow the surgeon to separate and lift the nose skin from its bony support system so the cartilage and bone can be removed, built up, reshaped and repositioned.The surgeon then redrapes the skin over the new framework and applies a splint to hold the tissues in place until they stabilize, usually a week to 10 days.Swelling and bruising subside within 10 days.It might take months, even a year, before the nose settles into its new look. Some patients, as many as 20 percent, will need or want a follow-up surgery to refine the first effort.Most procedures take place in early adulthood. “It’s not real common for an older adult,” Stewart said. “If you’re 60, you’ve become comfortable with your nose.”At 48, Leah (not her real name) wasn’t close to being comfortable with hers. “The tip of my nose had a bulge,” she said. People had made fun of it. As I got older, it appeared to be bigger. I didn’t like the way my face was beginning to look.”Her surgeon trimmed and shortened cartilage at the tip of her nose, smoothed the top and made the nostrils smaller.She’s had other plastic surgeries — a face-lift, a brow-lift, a chin-lift, breast augmentation. Nothing pleased her more than her nose.“It’s just gorgeous,” she said.“I went back to work in less than two weeks. People knew something was different, but they couldn’t figure it out. I just looked more refreshed. That’s subtle, but if you would see a before-and-after picture, you would say, ‘Wow!’”To contact staff writer Sandy Wells, use e-mail or call 348-5173.