Bulbous Tip Hard to Refine if I Have Thick Skin? (photo)

I am looking to have rhinoplasty surgery but I have read that it is harder to refine a bulbous tip when the skin is thick. Will I be able to achieve the results I want of a refined nasal tip. How will surgeons go about this?

Doctor Answers 10

Bulbous Tip

Hi, There are several ways of tackling a bulbous tip. It depends what is causing the bulbosity. There are bulbous tips caused by overdeveloped lower lateral cartilages, fatty tissue under the tip and weak supporting cartlilages, as well as bulbous tips caused by scar tissue. See video links that show how these procedures are done. Best, Dr.S.

New York Facial Plastic Surgeon
4.8 out of 5 stars 272 reviews

Defining a nose with thick skin

There are several things that surgeons can do to define a nose with thick skin. First the tip needs strong support. Columellar strut grafts or a tongue and groove technique is used for this purpose. The tip cartilages are then defined and narrowed using dome sutures. Additionally, cap or tip grafts may be used to "push " the tip through the skin. The last and final step is the thinning of the nasal skin from the inside. 

Andres Bustillo, MD, FACS
Miami Facial Plastic Surgeon
4.9 out of 5 stars 115 reviews

Rhinoplasty tip surgery with thicker skin

Trimming the upper edge of the tip cartilages will give you most of what you want. If you want a more Romanesque tip with very defined light reflecting points the cartilage grafts placed to achieve that will be less effective because of the tissue thickness. The key question is how much refining you want or will settle for given the limits of thicker soft tissue.

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.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Rhinoplasty for Thick Skin

The key with these thick skin cases is strengthening the nose-  helping to project the tip and define it as well as possible.  In addition, I find post operative injections of steroids help the skin to reduce its thickness.  One advantage of thick skin-  it helps conceals any small imperfections.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
4.7 out of 5 stars 128 reviews

Bulbous Tip Hard to Refine if I Have Thick Skin?

     The level of refinement can be impaired to some extent with a thicker skin envelope, but the underlying lower lateral cartilages can be reduced in size and brought into a more favorable conformation.  In this way the tip can be refined.  The envelope can be manipulated as well, but the thickness of the skin will have an impact.  Nonetheless, you could have a very noticeable improvement with a closed rhinoplasty.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Thick skin and nasal tip rhinoplasty

Refining a bulbous tip involves reshaping the underlying cartilage and possibly bone to create the changes desired.  The issue with thick skin is that it will camouflage these changes and reduce how they impact the external appearance of your nose.  Techniques such as conservative skin thinning during surgery or post-operative steroid injections when needed can improve final results.  Also note that patients with thicker skin tend to experience more swelling after surgery which will take longer to resolve.  Discuss these issues with your rhinoplasty surgeon so they can advise you on what expected results can be achieved.  Hope this is helpful!

Michael Lipan, MD
Palm Beach Gardens Facial Plastic Surgeon

Bulbous Tip Hard to Refine if I Have Thick Skin?

The tip cartilages can be narrowed and refined regardless of skin thickness. The issue is that the delicate cartilage framework and surgical refinement can be less apparent in someone with thick skin as the soft tissue overlying the delicate tip structure obscures the underlying framework. This can typically be dealt with following surgery with steroid injections of the soft tissue envelope. I hope this information is helpful.

Stephen Weber MD, FACS

Weber Facial Plastic Surgery

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Bulbous tip rhinoplasty

 Thick skin and a bulbous tip can be a difficult problem to deal with in the healing process. The surgical technique involves narrowing the tip cartilages with sutures and removal of portion of the tip cartilages as well. Thick skin  patients will receive several cortisone shots in the supratip area of the nose in the first few months  during the postoperative period. It's best to have realistic expectations when performing the  rhinoplasty surgery. Please see  the link below for results of bulbous tip rhinoplasty in our practice.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Improving Bulbous Tip with Thick Skin

Your bulbous tip can be narrowed to achieve better definition. We can change the size, contour, and strength of the tip cartilages but we cannot change the overlying envelope of skin. Achieving the results you want depends on your expectations. Consult with a rhinoplasty specialist who will show you results in similar patients and establish reasonable goals.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Thick skin thick tip

In patients with thick nasal tip skin, I minimized the cartilaginous tip width during surgery and tell my patients at 6 weeks I may have to inject steroid subcutaneously into the scar to minimize the the scaring and maximizing the narrowness of the nasal tip.

David A. F. Ellis, MD
Toronto Facial Plastic Surgeon
3.5 out of 5 stars 8 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.