What really is achievable with thick skin rhinoplasties? How are celebrities getting much better results? (Photo)

Question

I have bulbous nose and have had surgery three times with no success. Doctors talk about how it is not possible to achieve a slender defined tip if you have thick skin and a bulbous tip. I do however keep seeing celebrities with thick skin getting perfect results with incredible definition. How is this possible? Is there a specific technique being performed on them? I have attached before/after photos of the celebrities I am referring to

Garrett Griffin, MD · Answer

Evrencap: I think the celebrity results you have shown...if real... are pretty good but not perfect. I would argue that in the afters, the skin looks a little too thin and a little bit TOO much definition is seen. Likely for these 2 examples, the skin was actually thinned by the surgeon. Surgically thinning the skin during rhinoplasty is possible and is a resonable idea in patients with really, really thick skin.  If it is moderately thick, it is better to ensure the nose is strong and use a strong tip graft for definition.  Sometimes the nose is not very defined but it is more due to tip cartilage shape and not actually due to thicker skin. In these patients, simply making the cartilage a little "sharper" with suture techniques is adequate.  Finally, these results look many probably 10 years out from surgery.  Most healing occurs in the first year but noses keep changing forever after rhinoplasty. Perhaps waiting longer will help you obtain the results you are looking for.

Suleyman Tas, MD, FEBOPRAS · Answer

Hello,Thank you for your question. Thick skinned patients may also have a rhinoplasty and achieve nice results after preparing and improving the quality of their skin. The determining factor here is about setting the realistic expectations as the amount of improvements is directly related to the initial size of the nose. Worldwide known celebrities often skillfully hide and photoshop the actual shapes of their noses. Need to consult an experienced plastic surgeon for a detailed examination of your case. To find out more revision before and after pictures please click on the attached link. Best Regards

Toby Mayer, MD · Answer

Thick skinned noses and rhinoplasty for celebrities? First of all, the examples you have posted are thin skinned noses with bulbous tips—an entirely different case. Surgeons use a variety of techniques for thick skinned noses. Look for a very experienced Rhinoplasty surgeon who does natural noses and choose several to see.

Stephen J. Pincus, MD · Answer

There are several techniques that are available to the patient with thick skin. Judicious wide undermining and soft tissue removal, steroid and 5-FU injections, post-operative taping and even occasionally, the use of Isotretinoin. You should seek an in-person consultation, so the doctor can evaluate your particular anatomy and show results that he operated who were similar.

Ronald J. Edelson, MD · Answer

One thing that can help tremendously is to have steroids injected into the tip. This will help thin out the skin. If this doesn’t help it is possible to thin out the deep portion of the skin with a revision rhinoplasty. Also bear in mind that many celebrity photos are photo shopped to give the person a slender nose.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. It would be helpful to view photographs of your nose. Based on your description, you may benefit from a tip refining revision rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. You may also benefit from soft tissue debulking of your nasal tip. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon. If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon. Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and photos but an examination and review of your surgical records is really needed to give an accurate answer.   So get those records and go on some complimentary consultations with experts and compare recommendations after a full examination and discussion of desired results aided with digital photography Dr Corbin

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