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Rhinoplasty and Thick Skin

asked 1 year ago by Eleiria
Latest answer by William Portuese, MD
Question viewed 506 times
Tags: female, thick skin

Hello! My nose is quite big especially at the tip. I have thick skin and although I accepted that I'll never have a small nose, I want to have a narrow tip and smaller ala. But I've heard that when the ala is cut off, stretched and sewn back after the excess taken away, skin tends to pile up above the tip after a few months resulting in a humpy look. Is that true and is there anything to prevent it? Should I settle for a conservative surgery that won't reduce the length of my nose to avoid this?

16 answers to Rhinoplasty and Thick Skin

Rhinoplasty and thick skin.

You need to see an experienced rhinoplasty expert. You can have the tip narrowed but with a method that prevents tip rotation and the bridge slightly trimmed. The skin can be defatted as well. So you can have a good , better-looking nose.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Rhinoplasty in thick skinned patients

You are correct in stating that tip rhinoplasty in thick skinned individuals tends to be limited in its effect. The nasal skin won't shrink effectively when the cartilage is shaved or narrowed. having said that, I believe you will get some benefit from surgery as long as you are not expecting a profound change. Your results may take more than one year to show, and you will most likely need some steroid injections during the post operative period. Consult with a surgeon and... more

Maurice M. Khosh, MD
New York Facial Plastic Surgeon

Rhinoplasty and Thick Skin

You understand the limitations of rhinoplasty in patients with thick skin. With proper techique, the tip can be reduced and contour improved without decreasing the length of your nose. I encourage you to consult with an experienced surgeon who will clarify what can be achieved, describe the operation, and explain recovery. It sounds like your expectations are very realistic.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon

Rhinoplasty and thick skin concerns

You're correct that drastic decreases in nasal size are difficult to achieve in patients with thick skin. I do believe that improvements can be made to the areas you are concerned about, though. Visit with an experienced rhinoplasty surgeon so your options can be more fully explained. Also, preoperative computer morphing can be done to simulate what type of changes are realistic.

Thomas A Lamperti, MD
Seattle Facial Plastic Surgeon

Rhinoplasty

It's hard to say for sure without feeling the tip but it appears the large size is a combination of the thick skin and also large tip cartilage. I think you could de-project the nose so it doesn't stick out as far and make the tip smaller. It doesn't appear that you would need a nostril narrowing type procedure.

David E. Kim, MD
Beverly Hills Plastic Surgeon

Can I have a Rhinoplasty if my skin is thick

You shouldn't reduce the length of your nose as this equates to tip rotation and your photos show the nasal tip to be rotated at the aesthetically ideal 115 degrees. Shortening the nose would make the nasal tip rotate to 120 degrees or higher and look unnatural. The nasal tip should be reduced and shaped but the alae themselves are quite thick and are typically not reduced externally as this can cause excessive (and visible) scars and deformed alar shape. IMHO, you should... more

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon

Rhinoplasty and Thick Skin

Thick nasal tip skin is a challenge which need aggresive thinning in order to achieve adequate redraping over the refined tip cartilages. This is the only way you can get a refine tip. Will need to get post operative steroid injections to avoid excessive scar tissue formation. Look at the before and after photos to see what can be achieved with this technique.

Mohsen Tavoussi, MD, DO
Huntington Beach Facial Plastic Surgeon

Rhinoplasty and thicker skin

What you say about rhinoplasty and thick skin can be true. There is a limit as to how much the skin envelop can shrink and conform the the smaller framework after rhinoplasty, and it does take more patience and time for full results to appear. However rhinoplasty at its best is conservative, and computer imaging may guide you to how small changes can really add up to a great result. Best of luck, peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon

Good result possible

You should be able to get the results you need. The key is to find a surgeon that is experienced in making the correct diagnosis (and explaining to you what you need and why) as well as performing the surgery. Thick skin does limit the overall "refined" look achievable but you should be able to get a nice improvement. You may not need alar base excisions, but even if you do, it should not lead to the problem you describe when done properly. It will take months for... more

Colin Pero, MD
Dallas Facial Plastic Surgeon

www.drpero.com

Thick skin

From the pictures you submitted, it appears that the tip is bolbous, this can be adressed with cartilage grafts in your case to compensate for the thick skin. This should give you a less round nasal tip from the front view, but the thickness of the skin will not change, so your expectations must be appropriate. As for the alae width, it does not partcularly look too wide. Some patients think that by naroowing this area the alar base will appear thinner from the side view. This will not... more

Michel Siegel, MD
Houston Facial Plastic Surgeon

houstonfaces.com

Rhinoplasty and thick skin

Thick skin is problematic to deal with in the field of rhinoplastic surgery. Thick skin obscures the end cosmetic result. There are some additive techniques that can be performed after the rhinoplasty to help with this. Cortisone injections can be placed into the tip and lateral sidewalls of the tip to further refine it. Blenderm tape can be placed across the bridge of the nose to help keep local pressure on the super tip area of the nose. During the surgical... more

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

Tip can be improved

The length of your nose should not be reduced anyway as then the nasolabial angle will look unnatural.Tip can be moderately reduced in thik skinned patients & the result takes about a year to come.Please remember that a size 3 nose tip can be reduced to size 2 but never to size 1.Your expectations from the procedure are spot on.

Anup Dhir, MD
India Plastic Surgeon

Thick skin

Your thick skin will prevent you from having a small delicate nose. however there are options to give you some refinement and improvement. Sometimes adding structure to shape the skin will create the illusion of refinement and produce a nice pleasing shape. Get several opinions about reshaping as opposed to removing tissue.

Michael L. Schwartz, MD
West Palm Beach Plastic Surgeon

www.palmbeachface.com

Nose big at the tip

I agree with most of the comments posted by the surgeons on this post. However, I do want to mention that the photos taken by point and shoot or phone cameras tend to make the tip look bigger than it actually is. You should have an experienced rhinoplasty surgeon examine your nose so he or she can see and feel the nasal structures. Only then an expert opinion can be given.

Joseph Shvidler, MD
Tacoma Facial Plastic Surgeon

Thick skin and rhinoplasty

Thick skin noses are sometimes difficult to deal with. Certainly tip work and dorsal line work can be done, but the refinement of the tip may not be as noticeable as with a thin nasal skin envelope.