Grecian Nose

The Problem

From the outset, one might have a predisposed perception, based on Hellenistic period artifacts and images of a straight-lined nose joining the forehead to the nasal dorsum when seen in profile view. Or one of a feature distorted by folk art paintings or caricatures. Actual real-life evidence shows differently. Depending on which part of Greece they originate from, Greeks can have different physical characteristics. That is evident in facial structures, skin color, height, or hair color, and is mainly due to geolocation and climate.

Greeks have many kinds of features as a result of mixing between Hellenic tribes since antiquity, and nowadays, occasionally mixing with other ethnicities. However, research has been conducted on Greek DNA that connects the overwhelming majority of modern Greeks to their ancient ancestors. This allows one to safely assume that Greek anthropological facial features were steadily maintained through time to present day. In the context of aesthetic rhinoplasty, this does not, however, constitute a particular issue as these noses are mainly described as of White to Mediterranean type.

The Background

The morphology of the Greek or Grecian nose as it is seen in everyday life and in clinical practice today is not far from the one depicted in anthropological classics on this subject; however, one must also take into account facial measurement reference points such as vertical profile of the orbit, intercanthal distance, and the convexity of the eyeball when observing these features. Other important features to consider are not only facial height and width but also general stature and height of the subject.

It must also be noted that, in terms of critical observation, clinicians are the least critical in comparison to patients who in turn appear to be less critical than lay people.

Mainly, two broad types of nasal shapes can be discerned in Greece: the most common is an attractive, well balanced nose in terms of the phi number, i.e., a Greek-White-Mediterranean type of nose with a variable, pleasing intercanthal distance and a frontonasal angle of about 110 to 135 degrees with a thin to fairly average White type of skin. The second type is thick skinned, with a wider White nasal pyramid and corresponding height with varying degrees of alar flare, usually in this instance, at or slightly above one-fifth of facial width.

The Indications

Greek patients will come requesting in order of frequency—but not necessarily strictly in the following order:

• Hump reduction

• Posttraumatic nasal restructure

• Airflow improvement

• Width reduction

• Length reduction

• Nostril reduction

• Tip reshaping

The Patient

Consent to (1) disclosure of personal details, (2) complete prior medical history, (3) clinical photography, and (4) written recording of the consultation are obtained. This is followed by thorough appropriate clinical assessment together with the required recognition of body image disorder, dysmorphophobia, or the presence of any other psychiatric disorder.

After standard past medical history taking, the patient’s wishes and expectations are concisely recorded in writing. We then proceed with a physical examination (inspection and palpation, soft tissue, bony and cartilaginous structure evaluation, and indispensable facial measurements) while simultaneously discussing with the patient their clinical examination findings and what would be surgically achievable. Any other alternative is also mentioned at that time. This is followed by standard photography for rhinoplasty. Our standard practice is to discuss with the patient on a monitor screen what is attainable and what is beyond expectations. Our practice is to ask the patient to return for a second and, if necessary, a third consultation in order to consolidate the preoperative plan. We do not hand out printouts and we do not send 3-D images and/or simulations electronically. All documents are signed by the surgeon and countersigned by the patient at the time of consultation.

The most common issues we encounter in practice are those of:

• Nasal hump

• Septal deviation (usually visible)

• Long nasal bones (and cartilaginous complex) in relative comparison to tip projection

• Long nose relative to columella height

• Columella droop

• Poor nasal tip definition

• Thick nasal skin envelope