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Is It Possible to Thin the Skin with a Closed Rhinoplasty?

As far as i know the reason for a bulbous tip are thick skin, and large cartilages. Now my question is, is it possible to thin the skin with a closet rhinoplasty? to achieve adequate drapping over the refined structure? And is thinning of the skin necessary? cause i heard its dangerous? Thanks Lidia

Doctor Answers (14)

Thinning nasal skin through closed rhinoplasty

+1

It is possible in some cases to thin the skin through closed rhinoplasty.  It really depends on whether there is an excess buildup of scar tissue versus purely granulation tissue from the previous surgery.  It also depends on how many previous rhinoplasties have been performed and the degree of scar tissue formation in the tip.  The healing process with thick olive oily skin is less predictable and may require taping of the nasal dorsum and cortisone shots to help the bulbous tip reduce in size during the postoperative healing phase.


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 54 reviews

Thin Nasal Tip Skin in Closed Rhinoplasty

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The nasal tip skin can be thinned with a closed rhinoplasty to try to improve the results achieved when operating on a bulbous tip. Make sure you have an experienced rhinoplasty surgeon to determine if this is necessary because tip circulation can be compromised with this technique. Don't pick the technique, pick the surgeon.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Rhinoplasty for bulbous tip

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surgery is always dependent onthe surgeons experience:

  1. it is usually easier to get a more defined tip  open
  2. yes the skin can be thinned either way
  3. it is safer open
  4. how is your surgeon shaping the cartilage
    1. sutures
    2. trimming alone
    3. grafts

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 15 reviews

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Thinning skin during rhinoplasty to improve bulbous tip

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Depending on your surgeon's preference the nasal tip skin can be thinned using either approach. I tend to prefer using an open approach in these cases to make sure symmetric removal is done. Thinning does need to be done conservatively; in many cases what is able to be removed is a fibrofatty layer of tissue that adds bulk to the tip.

That being said thinning of the tip is not always necessary and in many cases the tip can be refined nicely without thinning the skin. Addressing lower lateral cartilage orientation and size is often an important step in improving tip bulbosity.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Thinning the skin in rhinoplasty

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Thinning of the fat beneath the skin is what you are talking about. Careful removal of small amounts of fat beneath the skin of the nasal tip can and should be done in specific noses in order to get the best results. It can be done much more liberally in closed rhinoplasty. The circulation must always be respected.

Ronald Schuster, MD
Baltimore Plastic Surgeon
4.5 out of 5 stars 21 reviews

Thick skin and rhinoplasty

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Thick skin can make tip rhinoplasty contouring difficult to apppreciate. However, thinning the skin is usually not recommended because it can cause irregularities and even skin necrosis if not done conservatively.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Is It Possible to Thin the Skin with a Closed Rhinoplasty?

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 I think you may be confusing two different aspects of Rhinoplasty and dealing with the skin.  In thick skin, there's an increased subcutaneous layer (sub Q) that hides the shape of the nasal tip making it appear wider than it would with thin nasal skin.  Closed Rhinoplasty can, to a limited, extent due to the limited dissection of the tip area, remove this excess sub Q tissue.  An Open Rhinoplasty, if appropriate (limits of how much the tip is already roated before surgery), is the best approach to completely remove this thickened tissue layer.  In a primary Rhinoplasty an Open Rhinoplasty should carry a negligible increase in complications over a Closed Rhinoplasty in an experienced Rhinoplasty Surgeons hands, IMHO.

 Now, a separate issue is nasal skin resurfacing using procedures like Lasers and Chemical Peels that are applied externally to the surface of the nasal skin to thin the skin.  Thses should not be performed at the same time as any Rhinoplasty (open or closed) as this added skin disruption does place the skin at added risk of healing poorly.  Resurfacing should be avoided for a full year after any Rhinoplasty, IMO.  Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Thinning of nasal skin

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The nasal skin can be thinned with open or closed technique.  This needs to be done with caution due to possible skin vascular compromise.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 4 reviews

Closed

+1

If your surgeon has enough expreience with the closed technique, then skin thinning can be done. The real problem is taht scar tissue often forms negating the thinning process

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

Thinning is best done with the open approach

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In my rhinoplasty consultations, i discuss with patients the merits and demerits of the closed versus the open approach.  By your question, i am gettting the sense that you a picking surgeons by the technique that they use presumably for a quicker recovery time.  I would choose a surgeon based more on their expertise in nasal surgery and the consistency of their results.

In regards to your specific question, the open approach allows much easier and precise thinning of the skin.  This critical step must be done very evenly to give you tip definition and to avoid compromising blood supply.

 

Pramit Malhotra, MD
Ann Arbor Plastic Surgeon
5.0 out of 5 stars 31 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.