I have a very wide, bulbous nose that deviates significantly to the left. I'd like to make it straighter and significantly more narrow and defined because I believe that would look best with my face, which is relatively narrow in general. However, my nasal skin is very thick, which I've heard could limit how much my nose can be reduced. Ideally, I'd like to end up with a thin, elegant nose with a pointy tip (like the model pictured). Is that a realistic goal?
Can a Wide, Crooked, and Bulbous Nose with Thick Skin Be Corrected? (photo)
Doctor Answers 11
Refining a wide, crooked, bulbous nose
The bulbous tip can be refined through tip suturing techniques and cartilage removal. A crooked nose is straightened with both medial and lateral osteotomies. Lateral osteotomies will also address wide set nasal bones and narrow the nasal pyramid. Thick skin can be a limiting factor on how much refinement can be achieved in the nasal tip. Cortisone shots will most likely be required in the first few months after surgery to prevent excessive fluid accumulation and scar tissue formation in the nasal tip and supratip area.
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Crooked nose thick skin.
To straighten your nose, the nasal septum and bones need to be straightened. Narrowing your tip is usually done with sutures, and definition is added with cartilage grafts. In dealing with thick skin, it is important to place a good cartilage graft in the nasal tip that will promote better draping of the skin. I have attached a link below to photos of such a patient. This patient and the two that follow in the gallery have thick skin and wide tips.
I feel your nose can be markedly improved by straightening it out and making it narrower with better definition. But, with thicker skin it would be not feasible to give it very fine and sharp features. You must be realistic in your expectations and aim for a nose that still fits your face. Remember the model’s nose may look great on him, but if transposed to your face may completely look out of place.
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Your posted photo shows the deviation and skin you describe but the tip is not that bulbous. You can make it straighter and refine the tip but you can never make it like the model in the second photo and may not be able to make it completely straight. That is an unrealistic expectation. The model's bone structure and skin characteristics are completely different from yours.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
With thick skin you have some limitations to the result but I have seen thicker skin patients. Straightening the nose is reasonable, albeit never expect it to be completely perfectly straight. Cartilage and the like have memory and there still may be some bend or irregularity in it after surgery. But your requests are reasonable as long as you do not expect the nose to be too thin with fairly thick skin.
Deviated nose can be made straight.
Your nose is not as bad as you think. The tip probably cannot be made so pointy (although a lot of refinement can be achieved with internal sutures). I don't thin you would really want it so pointy. It looks somewhat fake and effeminate.
Crooked and thick skinned nose.
Your nose can be much improved but not just like the model. Patients who have realistic goals of IMPROVEMENT and not perfection are happy with the results of a good rhinoplasty.
Thick skin and rhinoplasty
Agree with previous posts. However, your nose can be improved, but not to the degree of the photo you posted. That model appears to have very thin skin, and I do not believe your results will match that.
Best of luck,
Thick Skin and Rhinoplasty
Narrowing of the tip in a patient with thicker nasal skin can generally be accomplished but the technique often varies slightly as compared to thin skinned individuals. The amount of cartilage that can be removed may be more limited in order to maintain enough cartilage for longterm support to avoid cartilage warping in the tip during tissue contracture associated with the healing process. Suturing techniques in the tip can help narrow the nose without additional cartilage removal. Cartilage grafting may also be used to support the tip position with a strut graft or as an onlay or tip graft to give more definition. A qualified rhinoplasty surgeon will have all the options in his/her surgical armamentarium and can discuss this with you preoperatively to guide you to a realistic expectation based on your individual findings. Straightening of the nose would be accomplished with osteotomies (bone cuts) which would not be affected by skin thickness. It is best to remember that the goal of rhinoplasty should be to balance your nasal appearance with your overall facial aesthetics and it may not be realistic or even desirable to try to "match" the look of another.
Thick skinned nose
Thick skinned nose with a bulbous tip can be corrected. It actually makes it safer for long term results. If any cartilage develops a point over time called 'bossa' it will be hidden well by a thick skinned nose as opposed to a thin skinned nose.
If you look closely at the model's photo he has a wide nose. It looks good on him because his jaw is wide as well. Its all about proportions. You want your nose to match your facial aesthetics. A pointy nose is not necessarily a pretty nose.