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A young girl asks her father, where do plastic surgeons come from? What follows is a fantastical romp through pre-civilized Europe, and the medieval art and science of nosemaking. Our hero is Gavin, a young orphan rescued from a dismal existence in the Ivanhoe Workhouse for Criminally Impoverished Boys when he is apprenticed with the local Nosemaker, and eventually becomes one of the finest surgeons in Vienna, cradle of quack medicine. Using innovative skin grafting techniques and cutting edge alchemy, Gavin and his master seek only to do the Work of the Almighty by restoring small appendages lost to rat bites, dueling, and syphilis. But when they are unable to help a powerful and mutilated knight recently returned from the crusades, they find their feet over the fire...literally.