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

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. 

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.

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.