Perhaps no facial transformation is more disturbing than the absence of a nose, and the creators of Cinemax’s “The Knick” used such an image to maximum effect in a recent episode.

The original drama series, set in New York’s Knickbocker Hospital in 1900, tracks the life and work of pioneering surgeons and staff who push the boundaries of medicine before the age of antibiotics – or cosmetic reconstruction.

The producers relied on visual effects to create a face replacement for Abigail, a character played by Jennifer Ferrin, substituting the actor’s nose with a CG version to simulate a visage disfigured by Syphilis.

“We solved a tricky series of shots together using a combination of CGI, special effects prosthetic elements and compositing,” said vfx supervisor Lesley Robson-Foster, who’s worked on effects for “The Great Gatsby” and “Boardwalk Empire.” “Abigail’s nose was a real challenge. I was very pleased with the result, as was Steven.”

Abigail’s missing nose had to be both visually striking and subtly personalized. The lead vfx house on the show, New York-based Phosphene, deployed a variety of software.

The process started with a face cast. “First we used PhotoScan to convert photos of the cast to a detailed 3D model,” explained lead digital artist Aaron Raff.

Then lead CG artist Vance Miller proceeded to light and render a physically accurate version of Abigail’s nose-less face in V-Ray. CG Artist Kim Lee painstakingly animated all of the slight twitches and stretches of the nose cavity as Abigail moves her face and speaks to her doctor.

“Using NukeX, I integrated these renders of Abigail’s nose cavity onto the footage of the actress, maintaining photo-real lighting across shots that had Abigail moving her head from side to side and passing through light and shadow,” said Raff. “The effect had to be seamless since Abigail’s altered face stayed at the center of the frame for an extended dialogue scene.”

The creative needs of the show sometimes called for interaction of the surgical instruments within the nose cavity. In those instances, Phosphene created CG extensions for the practical surgical instruments. Phosphene then animated the side flaps of the nose to match the interaction of the CG instrument tips.

“No one ever said ‘cool’ or ‘nice work’ when they saw those shots,” said vfx producer Parker Chehak. “They always said ‘Ewww!’ Mission Accomplished.’”

“The Knick,”helmed by Steven Soderbergh and starring Clive Owen, recently committed to a second season.