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

     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

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!