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.

     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!