Background: The shape of the nose is almost as different as each person’s personality. Not only is the nose different amongst each person but there are well known nasal shape differences amongst various races and cultures. The differences in nose shapes between different ethnic groups around the world is well recognized and is seen in the various shapes and proportionate relationships of the nasal bridge, the tip and the nostrils.
Often called an ‘ethnic nose’ this term implies any nose that is associated with different non-Caucasian races and deviates from the classical nasal anthropometric measurements, angles and ratios. This generally refers to a more straight dorsal line without a hump, a nasal tip that is not too wide or under- or projected and nostrils that are not too flared. Obviously what is deemed aesthetically desireable in nose shape is open to interpretation and has been highly influenced by the disproportionately large number of plastic surgeons practicing in the U.S. and the influence of contemporary culture and media.
The Greek nose has been classically described as being perfectly straight from the top to the bottom when viewed in profile without a hump or bump. At the time, it was thought of as as perfect nose shape. This is well illustrated in the statue of Michaelangelo’s David. (although close inspection does show a slight dorsal hump) It is speculated that the classic Greek nose never really existed, however, as a characteristic (straight) of the noses of ancient Greece but was really an aesthetic nose shape idealized that way in art. In reality, Greeks usually have a bump on the bridge of their nose and often are viewed as overall medium to large noses. The Greek nose fits into the larger category of Mediterranean noses which has many shape nuances within it.
Case Study: This 26 year-old Greek female wanted to improve the shape of her nose. She felt it was too big and was disproportionate to the rest of her face. She wanted the hump reduced and the tip narrowed but she did not want too much of a change. Her family was very concerned that the nose changes would be so great that she would not look like herself anymore. Presurgical computer imaging was done to get a feel for how much change would be acceptable.
Her surgery was performed through an open rhinoplasty approach under general anesthesia. The high septum was reduced after separating the upper lateral cartilages up to the nasal bones. The bony portion of the hump was reduced by rasping. The upper lateral cartilages were put back to the reduced septum. A small reduction of the upper end of the caudal septum was done. The tip was reduced by a cephalic trim dome suturing. Finally the width of the upper part of the nose was narrowed by low lateral osteotomies.
Her tapes and splint were removed after one week. She had the expected amount of swelling and some bruising under the eyes….but no pain. Within two weeks after surgery all bruising was cleared and the improvements in the nasal shape were already seen. The tip area continued to improve its shape as the swelling slowly receded. By six months after surgery, she had her likely maximal improvement and reduction of most of the swelling. While it is still possible that more tip refinement will occur, any further tip narrowing will be a bonus at this point.
An ethnic rhinoplasty, as in a Greek nose, generally implies the creation of a straight dorsal line and a more narrow nasal tip with or without tip elevation. Because of thicker nasal skin which is often present, the risk of too great a change or making too small of a nose is very unlikely to ever happen. Conversely the concerns are usually the opposite…can enough change be done to make a visible difference. This is often controlled by the thickness of the nasal tip skin and whether it will shrink down adequately over reshaped nasal tip cartilages.
Case Highlights:
1) Many Greek noses have a hump that creates a convex dorsal line. This makes the nose look too big.
2) With this cartilaginous hump overgrowth often comes a wider and overprojected tip as well. This makes the nose tio lack refinement.
3) An open rhinoplasty can effectively reduce an osteocartilaginous hump, straighten the dorsal line and narrow the nasal tip for an overall more balanced nose.
Dr. Barry Eppley
Indianapolis, Indiana