Rhinoplasty for Patient with Thick Skin?

Question

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.

Ran Y. Rubinstein, MD · Answer

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

Richard J. Bruneteau, MD · Answer

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.

Tanveer Janjua, MD · Answer

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

Sam Jejurikar, MD · Answer

Hi,
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.

Michael A. Persky, MD · Answer

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

Otto Joseph Placik, MD · Answer

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.

Scott Trimas, MD · Answer

Thick skin rhinoplasty is more difficult and should be approached with some caution. For a person with thicker skin who desires a more narrow profile or tip, some defatting of the skin may be necessary. However, there are limitations as to agressive a thinning can result in skin necrosis or loss of tissue and a very poor result. Other ways to also narrow the tip or profile include the use of cartilage grafting to "tent pole" the skin or sewing the cartilages together to create a more narrowed tip often in conjunction with cartilage grafts. The other aspect requires frequent follow-up with your physician to make sure you do not build up scar tissue under the skin which can hamper the cosmetic improvement and make an initially narrowed profile widen with time. I hope this information helps.

David C. Pearson, MD · Answer

Thick skin imposes certain limits on how "sculpted" the nose can be made to appear after rhinoplasty. When we talk about thinning such tissues, it's really a combination of removing some of the transverse nasalis muscle over the bridge of the nose and some of the fibro-fatty tissue over the nasal tip.
In point of fact, we don't want to try to truly thin the skin, for fear of damaging too much of the subdermal plexus--part of the skin's blood supply between the subcutaneous tissues and the dermis.
All the best,
--DCP

Eric M. Joseph, MD · Answer

If you have thick skin, and weak cartilage, you may not be able to achieve the refinements you'd like to see in your tip.
Thick skin can be "thinned" under direct vision utilizing the open approach. It's not nasal SMAS that's thinned; rather, it's the fat and glandular tissue that's attached to the undersurface of the tip-skin that's thinned.
I hope this is helpful for you, and best regards.

Jon F. Harrell, DO, FACS · Answer

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 Patient with Thick Skin?

Answers (16)