Surgery has evolved along with anatomical illustrations through the ages. Joseph Gensoul (1797-1858), an important figure of the great Lyonnaise medical tradition of the 19th century, was occupied with many different surgical diseases, mostly diseases of the face. Apart from his many contributions stand various techniques on ophthalmological, otorhinolaryngological and oral and maxillofacial surgery. In this context, two rare illustrations depicting an innovative facial surgical operation performed by the great surgeon Joseph Gensoul are thoroughly analyzed. The two illustrations represent the "before" and "after" phases of Gensoul's most eminent operation, most probably practiced for a maxillary sinus carcinoma. This surgical operation is probably the earliest recorded of its kind in the history of surgery, even though the development of maxillary surgery is connected with the practice of Irwin Moure, who also practiced a type of lateral rhinotomy about a century later than Gensoul. Surgical illustrations are closely related to the history of surgery in every corner of the world.