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.

Doctor Answers 15

Rhinoplasty in Thick Skinned Individuals

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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 deformities. Best of Luck - Dr Harrell

Rhinoplasty for patients with thick skin

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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 drape as well or fit as tight. Therefore, it is more difficult to get as much sculpting or decrease in size as can be done with thinner skin noses. The type of thick skin nose that can be helped the most is one with a wide tip and decreased tip projection. By increasing the tip projection, tension is placed on the very tip causing it to get thinner and the flared side walls tend to straighten. Also, some of the bulk of the fat side walls (where the walls meet the cheeks) can be removed by taking out a wedge of tissue in that area and hiding the scar in the nose-cheek crease. This will make the nose look narrower and less bulky.

Jack P. Gunter, MD (retired)
Dallas Plastic Surgeon

Thinning Nasal Skin Is Dangerous

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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.


Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

"Thinning" nasal skin in rhinoplasty

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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.

Thinning thick skin during rhinoplasty

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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.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Thick Skin Rhinoplasty

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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
4.9 out of 5 stars 43 reviews

Thinning nasal skin

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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
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Rhinoplasty for thicker skinned people requires a different approach

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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

Ran Y. Rubinstein, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 158 reviews

Rhinoplasty on Thick Skinned Nose

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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.

Give my regards to Axel, and Slash, and the rest of the Guns and Roses gang.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Thinning the skin in rhinoplasty

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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
4.9 out of 5 stars 86 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.