Dr. Timothy Greco is a facial plastic surgeon who performs rhinoplasty to help Philadelphia and New Jersey patients improve facial harmony. As a rhinoplasty specialist, his goal is to give you a result that fits the characteristics of your face without an over–operated look.
Nasal aesthetic surgery is a procedure where form and function are of equal importance. The rhinoplasty procedure should provide the patient with a pleasing appearance and improved breathing. When his New Jersey and Philadelphia rhinoplasty patients complain of difficulty with breathing in addition to an obvious aesthetic deformity, Dr. Greco can make corrections during the cosmetic procedure to treat both issues. He often performs septoplasty, which straightens the nasal septum, internal and/or external nasal valve malfunction, and enlarged turbinates to correct nasal obstructions.
Most nasal surgeries are performed by making small incisions in the nose and a small incision across the skin between the nostrils. This technique is known as an open rhinoplasty. At times the procedure may be performed without the incision between the nostrils (closed rhinoplasty). Sometimes it is necessary to make small incisions at the base of the nostrils to help narrow the nose.
If you are not happy with the results of a rhinoplasty procedure performed previously, schedule a consultation with Dr. Greco about revision rhinoplasty. Because he is double board certified in otolaryngology (ENT) and facial plastic surgery, he possesses a unique skill set to perform revision rhinoplasty. He may perform a rib-harvest technique to correct structural deformities. This technique significantly improves results for his patients with severely deformed noses secondary to previous surgery or trauma and who lack sufficient ear or septal cartilage that is necessary to provide structural support frequently needed in these types of noses.
Learn why double-board certified facial plastic surgeon Dr. Timothy M. Greco has been chosen "Best of Philly" five times by Philadelphia Style Magazine.Meet Dr. Greco
When performing a rhinoplasty surgery in Philadelphia, besides making a large nose more refined or a crooked nose straighter, Dr. Greco works to ensure that the rhinoplasty ultimately brings a person's nose in balance with the rest of the face.
As any expert surgeon who performs rhinoplasty procedures will tell you, there is technically no one "perfect nose." What may look ideal on one person may appear out of place on another. That's because the overall shape of the face and a variety of other factors - including age, ethnic background, and even personal preference - all influence the result which suits a particular scenario.
Relative extreme variations (saddle nose or pinched tip) from the norm can create eye-catching distortion to a person's appearance. In general, however, there are elements of nasal aesthetic characteristics that complement facial harmony consistently from person to person, such as a properly aligned nasal dorsum (also known as the bridge of the nose), the appropriate nasal tip projection, and pleasing width of the nose. If these elements are not in proper proportion to each other (see figure 1), a person may seek rhinoplasty to create harmony, symmetry and balance to the nose.
Aesthetic experts – from artists to sculpturists to rhinoplasty surgeons – exploring the ideals first generated by artists, scientists, and philosophers in Renaissance–era Europe have identified several components of an "ideal occidental nose" based on symmetry and even mathematical formulae. Some commonly desired traits in Caucasian female faces include a straight dorsum or bridge that leads to a slight dip (supratip break) before culminating into a narrow tip. A more masculine Caucasian nose has a strong, straight bridge leading into the nasal tip with little or no depression before the tip.
Figure 1– Nasal Ideals : A straight nasal dorsum (shown in blue) is generally considered to be visually appealing. The middle vault (rhinion) (shown in yellow) is slightly raised. A refined nasal tip with adequate projection (shown in green). How all of these elements relate to each other and the rest of the face plays a part in facial aesthetics in general and rhinoplasty in specific.
A closer examination of facial aesthetics reveals that the face can be divided into upper, middle, and lower thirds, with the upper comprising the forehead area, the middle containing the eyes at the top and nose at the bottom, and the lower third of the face including the mouth and jawline (see figure 2).
There are also four lines that run horizontally in this view: the trichion, which includes where the hairline typically begins; the glabella, which is found between the eyebrows; and a line running from the base of the nose to the menton, which ends at the base of the chin.
Following this view of the face, an ideal nose—whether natural or via rhinoplasty—extends from the top of the middle third without intruding up into the glabellar space between the eyebrows and should not proceed below the upper border of the upper lip.
Figure 2 – Facial Thirds : The idea that an aesthetically pleasing face can be divided roughly into thirds was explored in ancient Roman and Egyptian cultures and popularized by Leonardo da Vinci. A basic division reveals upper (blue), middle (yellow), and lower (green) thirds, though a more detailed breakdown may separate out the trichion (in orange) from the upper third, the glabella (in pink) from the middle third, and the menton (in purple) from the lower third.
When discussing vertical proportions, the face is often seen as being divisible into fifths, with each section containing a major feature: an ear, an eye, and the nose (see figure 3). Though the central feature that is the focus of a rhinoplasty (the nose) is only one of the five, Dr. Greco considers all of the elements for his rhinoplasty patients.
Each fifth, according to this ratio, should be the width of an eye, which should also be the span from nostril rim to nostril rim on either side of the nose. The ideal, then, according to this view of the face, is the nose being the width of an eye.
Figure 3 – Facial Fifths : Vertical demarcations create bands that divide the face into fifths. The first runs from the tip of the right ear to the corner of the right eye. The next is the width of the eye itself. The center column is the width of the nose. The next holds the left eye. The final fifth stretches from the corner of the left eye to the tip of the left ear.
People see us from multiple angles, not just head on. While the front view of a face has its proportions and divisions, a side view carries its own set of aesthetic ideals. A trusted and effective surgeon who performs rhinoplasty procedures will take all important views of the nose into account, when planning and executing this surgery.
Measurements for a face in profile typically begin with an imaginary line, (known as a Zero Meridian) drawn downward from a point just between the eyes (known as the nasion) to the point where the chin projects the farthest (called the pogonion). Modern aesthetics show that the more vertical this line is, the more aesthetically pleasing it is (see figure 4).
Another line, known as the Frankfort horizontal Line, can be "drawn" horizontally by a rhinoplasty surgeon from a specific point in the middle of the ear (known as the porion located just above the tragus) to the bottom of the eye socket (called the inferior orbital rim). This line then continues perpendicular to the Zero Meridian to end at the middle vault on the nose (a point known as the "supratip").
Figure 4 – Straight lines : Aesthetically ideal nasal angles are based on the relationship between a vertical line known as the Zero Meridian and a horizontal line (in red) known as the Frankfort Line.
With these lines intersecting at 90° angles – one perfectly vertical, one perfectly horizontal – a variety of other angles can be measured. As an expert in rhinoplasty in Philadelphia, Dr. Greco pays attention to five angles in particular: the nasofrontal, the nasomental, the mentocervical, and the nasofacial.
This angle is also known as the nasal starting point, because it marks the shift from the forehead to the nose (see figure 5). If it starts above where the upper eyelid skin crease is, a nose can appear too long; if it starts below that point, a nose can appear too short. Either extreme can be corrected via rhinoplasty.
Figure 5 – Nasofrontal angle : Ideally, the angle where the forehead (specifically, the glabella) and uppermost part of the nose (the dorsum) meet, will be about 120° to 130°.
This angle focuses entirely on the nasal tip and can determine how much of the nostrils are visible or how much the nasal tip projection is present. Nasal tip correction is a common component of rhinoplasty (see figure 6).
Figure 6 – Nasomental Angle : To determine this angle, a rhinoplasty surgeon can draw a line from the nasion between the eyes to the nasal tip. Another line is drawn from the nasal tip to the pogonion on the chin. Ideally, the angle between these two lines will be around 130°.
This angle is closely tied to the chin and greatly impacts overall facial aesthetic harmony (see figure 7). A dedicated rhinoplasty expert will aim to keep all of these relationships discussed in balance.
Figure 7 – Mentocervical Angle : The angle where the Zero Meridian intersects a horizontal line drawn outward from the base of the chin, known as the menton, should create a roughly right angle.
This angle, while based on the nose, has a great impact on the appearance of the eyes-specifically, whether they appear too far apart, too close together, or just right (see figure 8). The smaller the angle, the closer together the eyes appear. Dr. Greco encourages patients to ask about how rhinoplasty at his Philadelphia-area practice can impact their entire face including the chin, eyes and lips. He provides video imaging of the nose which allows the patient the opportunity to view the desired nose in relation to their present facial features.
Figure 8 – Nasovertical Angle : The angle where the Zero Meridian intersects a line drawn from the nasal tip to the nasion should be around 120°. Variations in these lines can be corrected by rhinoplasty if desired.
Ideally a male's nasolabial angle is 90-95 degrees, while a female's is 100-105 degrees.
Again, note that while these angles and measurements are considered by many aesthetic experts to be ideals, they are all relative to the patient. What brings balance to one rhinoplasty patient's face will not necessarily bring the same balance to another's, so each rhinoplasty must be as unique as the patient's face.
An experienced facial cosmetic plastic surgeon such as Dr. Greco approaches each rhinoplasty in Philadelphia as more than a "nose job". The nose is not an isolated feature, but must appear in harmony with the other facial features from the front and from the side. Each angle must be carefully considered and evaluated to ensure that an overall sense of proportion is maintained post-rhinoplasty, and that each element of the face complements the rest.
Since there is no "one size fits all" approach to rhinoplasty, Dr. Greco places tremendous value on consultations. An in-depth discussion between the patient and the facial cosmetic plastic surgeon is vital to creating an understanding of an individual's ultimate aesthetic goals and personal ideals long before any actual rhinoplasty surgery begins.
Years of evolution and appreciating the significance of facial harmony, as well as decades of study of the nasal anatomy and surgical techniques, do not matter if you do not end up getting the look you desire from your rhinoplasty surgeon.
When it comes to achieving a natural aesthetic result, many people who choose Dr. Greco for a rhinoplasty surgery come to him with multiple concerns including nasal hump correction and nasal tip refinement.
While patients seeking rhinoplasty in Philadelphia do so for a variety of reasons, a particular aesthetic complaint that frequently prompts people to want the surgery involves the bridge of the nose, technically known as the nasal dorsum. The central third of this part of the nose - called the middle vault - greatly contributes to a person's appearance. If this section is overly convex, it creates a nasal hump that is most visible in profile, and can impact a straight-on view of the face as well.
A dorsal hump can cause the nasolabial angle to appear inappropriate. It can also give the impression of previous trauma to the nose and can give the nose the appearance of being too large in relation to a patient's facial characteristics.
As a rhinoplasty expert, Dr. Greco is well versed in nasal hump correction, aiming to make a nose appear more in proportion with the rest of the face.
Nasal Hump Correction: Dr. Timothy Greco frequently performs rhinoplasty in Philadelphia to correct what is known as a "nasal hump."
Considered by some doctors to be the most challenging component of rhinoplasty, aesthetic nasal tip correction depends on understanding the mechanics of the nasal tip, surgical techniques, and an artistic eye.
The mechanics of the nasal tip are based upon the tripod theory (just as tripod of a camera controls the position of the camera based of the length of each leg).
While this aspect of rhinoplasty surgery involves the nasolabial angle, it also necessitates a great deal of flexibility, as the goal is to create a tip that complements the other features of the nose and face. In other words, Dr. Greco's goal when performing surgery on the nasal tip in Philadelphia is to create a tip that flows naturally with the rest of the nose.
The ultimate goal in this rhinoplasty is to give the patient a nasal tip that is symmetrical and slightly rounded. Visually, the tip intersects with the nasal components above and below, as well as to the left and right, so it should harmoniously blend with each feature while closely conforming to the lines and proportions established throughout the history of nasal aesthetics.
Since the nasal tip is the facial feature that has the greatest projection, it plays a starring role in a patient's profile and head-on view. Because of this, a rhinoplasty surgeon must consider it from all angles and perspectives. Many people who choose rhinoplasty in Philadelphia do so because they do not want a nasal tip that appears either excessively bulbous or pinched.
Nasal Tip Correction: A rhinoplasty patient may choose nasal tip correction to reduce the size of an overly large tip or change it from angling down or drooping to more closely adhering to the nasomental angle.
A small splint will be placed on the nose immediately after the rhinoplasty surgery and remain for one week at which time the splint will be removed and the nose cleaned. There may be some bruising and swelling around the eyes, which cover–up can conceal. Cold compresses and anti–swelling medication aid in rhinoplasty recovery.
No. When they talk about a "nose job", Philadelphia and New Jersey residents are just using a slang term for nasal surgery. Rhinoplasty is the technical medical term for cosmetic or aesthetic nasal surgery.
Usually there is mild discomfort with nasal surgery. Oral medication will be prescribed to help with the discomfort after rhinoplasty. Cold compresses also help with discomfort.
Dr. Greco uses a small, gentle cotton ball coated with antibiotic ointment that is placed in each nostril after rhinoplasty and is removed the next morning. This is because a special quilting suture is used to control any bleeding and greatly decrease the amount of discomfort associated with formal nasal packing. A small drip dressing will be applied after rhinoplasty surgery.
As a rule, 80 percent of the swelling is gone after two weeks; another 10 percent after two months. The tip of the nose may retain swelling longer and continued improvement in the tip can be seen over the next several months. There may be some temporary numbness of skin of the nose, which improves with time.
Most patients can be seen in public in a week, after the splint is removed. It is important to avoid strenuous activity for two weeks. At this time you can gradually work back to your usual routine, including exercise. Contact sports should be avoided for six weeks.
Yes, it should improve it! Usually the nose will be stuffy after the surgery but after several weeks improvement should be noticeable, particularly if you had significant obstruction before your surgery.
The individual goals of nasal surgery can usually be obtained in one surgery. There are times when a "touch up" procedure needs to be performed. Noses that have been fractured, crooked noses, and noses that have had previous surgery are generally more difficult to correct. These situations may require a revision procedure. Sometimes injection of fillers into the nose can be used to correct minor contour abnormalities.
There are risks with any surgical procedure; however, the risks of facial plastic surgery are minimal. Bleeding, infection, unfavorable scarring, asymmetry, septal perforation (hole in septum), and persistent nasal deformity are rare. These will be discussed during your consultation, as will ways to avoid them.