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Rhinoplasty for Patient with Thick Skin?

I read about doctors being able to ''thin the skin'' on Rhinoplasty patients with thick skin. How is this performed, and is this the same as nasal SMAS? Thank you.

Asked 28 months ago by sweetchildofmine

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Rhinoplasty in Thick Skinned Individuals

Thinning of the skin usually translates to thinning of the subdermal fat in patients having their first Rhinoplasty. It is not often needed, at least in my experience. However it is a good option in a small number of patients. In secondary Rhinoplasty patients with heavily scarred tips, thinning of the skin will probably mean thinning of pre-existent scar tissue. The key is to know where to stop - just how thin to make thins. Being too aggressive will lead to further scarring and contour... more

Jon F. Harrell, DO

Miami Plastic Surgeon

ASPS

Thinning thick skin during rhinoplasty

It is somewhat possible to thin out thick skin on a rhinoplasty; however, the scar tissue can grow back. People who have thick, oily, olive skin tend to develop subdermal keloids, hypertrophic scarring, and fluid retention in the supratip area of the nose. To help bring down the fluid retention, multiple cortisone injections during in the first three months in the postoperative phase may be necessary.

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William Portuese, MD

Seattle Facial Plastic Surgeon

Rhinoplasty is performed mostly under the skin

Since we raise the skin off the underlying bony and cartilaginous framework on the nose- most of the work is done on the underlying structures. Think of it this way- if the doctor does the work on the underlying structures of the nose and the skin is thin- then much of that improvement on the cartilage or bone will be visible. If the skin is thick then less of that improvement will be visible. A skilled surgeon can do some work on defatting the skin but that has to be done with... more

Robert F. Gray, MD

Bay Area Facial Plastic Surgeon

Thick Skin Rhinoplasty

It is difficult to achieve great definition in a nose with thick skin but shape and projection can be improved. The flat contour can be changed by preserving cartilage and adding cartillage grafts to the tip and dorsum if necessary. Many times alar reduction will thin nasal appearance. Thick skin will challenge your surgeon , but a satisfying result can be achieved.

Richard W. Fleming, MD

Beverly Hills Facial Plastic Surgeon

Rhinoplasty for patients with thick skin

Patients who have thick nasal skin can have rhinoplasty to improve the shape of their nose. However, there are limitations. The way a rhinoplasty is performed is that the skin is raised off the bony-cartilaginous framework of the nose and the framework is reshaped to give the desired external nasal appearance. However, for the nose to look good, the skin needs to fit tightly around the newly shaped framework. Because thick skin has flexibility and elasticity as thinner skin, it will not... more

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Jack P. Gunter, MD

Dallas Plastic Surgeon

ASAPS ASPS

Thinning nasal skin

Thinning nasal skin in a rhinoplasty for a patient with thick tissues is not a good idea. The skin is the important covering on the vital nasal structures. Thinning the skin may cause contour divots and irregularities that can not be corrected easily if at all.

Steven Wallach, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Thinning Nasal Skin Is Dangerous

The nasal skin is very delicate with critical blood supply. You are better off not undergoing skin thinning as it can cause skin irregularities, uneven areas and even loss of skin. Changing the shape of the cartilages can improve the shape of the nose to make it look aesthetically pleasing which is the ultimate goal. Regards

Tanveer Janjua, MD

Bedminster Facial Plastic Surgeon

"Thinning" nasal skin in rhinoplasty

Hi, Thinning the nasal tip skin is a relative misnomer. To safely reduce the thickness of the soft tissue overlying the nasal tip cartilage, conservative reduction of the fat and glandular tissue deep to the skin can be performed. Reducing the undersurface of the skin itself has significant risk associated it ; in particular, nasal tip skin death (necrosis). Best of luck. Hope this helps.

Sam Jejurikar, MD

Dallas Plastic Surgeon

Rhinoplasty for thicker skinned people requires a different approach

The nose is made out of a soft tissue (skin, fat and SMAS) which envelopes the bony bridge and cartilagenous tip. The skin in Caucasians tends to be thinner than in African Americans, Asians, people with Hispanic background. The significance to the thickness of the soft tissue enveloping the nose, in particular the skin and fatty layer is that it is more difficult to refine these types of noses. Any changes to the under surface- the tip cartilage and bone is not as visible as it is... more

Ran Y. Rubinstein, MD

Manhattan Facial Plastic Surgeon

Rhinoplasty on Thick Skinned Nose

Hi Sweet Child of Mine, I'm not sure what you've been reading, but "thinning" the skin in rhinoplasty is usually not a great idea, and may lead to diasterous results. Thick skinned noses are difficult, and usually require cartilaginous grafts to add definition. The nasal SMAS is a thin structure that likely won't have much impact on a thick, oily skinned nose. It is best to have an experienced rhinoplasty surgeon evaluate your nose to let you know what would be best for you... more

Michael A. Persky, MD

Los Angeles Facial Plastic Surgeon

Thinning the skin in rhinoplasty

In some rhinoplasty patients the skin can be thinned but this carries risks such as excessive thinning or even tissue death. Occasionally, steroids are used to thin the skin but this is not a common practice nor is it recommended in the typical patient.

Otto Joseph Placik, MD

Chicago Plastic Surgeon

ASAPS ASPS

Thick Skin Rhinoplasty

Patients with thicker skin on their nose are typically non-Caucasian. Thick skin is more predominant in African Americans, Hispanics and Middle Eastern patients. Thick skin can be a result of a thick dermis and/or fatty tissue under the skin. In order to thin out the skin, defatting and thinning of the dermis must be performed to create a more structured and less bulbous nose. The SMAS is a layer of tissue in the face that does extends into the nose, however this layer is much deeper than... more

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Oleh Slupchynskyj, MD

New York Facial Plastic Surgeon

Thick skin rhinoplasty is more difficult and should be approached with some caution

Thick skin rhinoplasty is more difficult and should be approached with some caution. For a person with thicker skin who desires a more narrow profile or tip, some defatting of the skin may be necessary. However, there are limitations as to agressive a thinning can result in skin necrosis or loss of tissue and a very poor result. Other ways to also narrow the tip or profile include the use of cartilage grafting to "tent pole" the skin or sewing the cartilages together to create a... more

Scott Trimas, MD

Jacksonville Facial Plastic Surgeon

"Defatting" the nose during rhinoplasty

Thick skin imposes certain limits on how "sculpted" the nose can be made to appear after rhinoplasty. When we talk about thinning such tissues, it's really a combination of removing some of the transverse nasalis muscle over the bridge of the nose and some of the fibro-fatty tissue over the nasal tip. In point of fact, we don't want to try to truly thin the skin, for fear of damaging too much of the subdermal plexus--part of the skin's blood supply between the subcutaneous tissues... more

David C. Pearson, MD

Jacksonville Facial Plastic Surgeon

Thick skin is a limitation in Rhinoplasty Surgery.

If you have thick skin, and weak cartilage, you may not be able to achieve the refinements you'd like to see in your tip. Thick skin can be "thinned" under direct vision utilizing the open approach. It's not nasal SMAS that's thinned; rather, it's the fat and glandular tissue that's attached to the undersurface of the tip-skin that's thinned. I hope this is helpful for you, and best regards.

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