Rhinoplasty for Patient with Thick Skin?

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 obscured by the thicker skin. In addition, people with thicker skin often don't have excess cartilage to remove for refinement- rather too little cartilage. Refining a nose that has these two features- thick skin and too little cartilage therefore requires adding cartilage to create a more sculpted look. One can also thin the underlying skin-fatty layer of the nose conservatively. This is not always successful as this reduction often creates scar tissue which fills in which obscures the refinements that have been performed. This can be addressed by injecting steroids into the tip of the nose during the post operative period.
In thinner skinned noses, refinement is usually created by reshaping and or conservative reduction of the tip cartilage.
My only advice is to seek out a plastic surgeon who not has a lot experience in rhinoplasty, but also in ethnic type noses where the thicker skin requires a different approach.
Good luck!
Dr. R

It’s not unusual for plastic surgeons to encounter patients with thick nasal skin.  When this situation arises the detailed sculpting of the underlying cartilage and bone that occurs with rhinoplasty may be hidden by a thick skin envelope.
            Under these circumstances, it may be reasonable to thin fat from the under surface of the skin to create more definition of the underlying nasal structures.  This maneuver can improve nasal aesthetics, but isn’t without risk.  Defatting and thinning of the nasal skin can result in skin necrosis, scarring, asymmetry and nasal contour irregularities.  For this reason, it’s appropriate to approach this maneuver with caution.

            If you’re considering defattening of your nasal tip, consultation with a board certified plastic surgeon is appropriate.  This surgeon should be able to formulate a treatment plan that addresses your concerns.

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