Doctor says my nose skin is too thick. Should I get a second opinion? (Photo)

Hi, there! Unfortunately, if you have thick skin, you really can't get a very small and defined nasal tip with rhinoplasty. However, there are other ways to get very close to what you desired.
I would recommend starting with a consultation with a board-certified facial plastic surgeon that specializes in rhinoplasty surgery to discuss if rhinoplasty can address your concerns.

I would recommend writing down the following questions before scheduling your consultation:
1. Are you unhappy with the tip of your nose?
2. Do you feel that your nose is too wide?
3. Do you want to make your nostrils smaller in appearance?
4. Are you looking to decrease the general size of your nose?
I hope some of these questions will help you pinpoint what it is that you don't like about your nose. Cost will vary due to various factors like anesthesia fees, facilities fees, etc. I wish you the best as you research your options when scheduling a rhinoplasty consultation.

Sincerely,
Philip J. Miller, MD, FACS Double Board-Certified Facial Plastic Surgeon

Marcy-
Thanks for your question. I would definitely get a second opinion. While your skin does appear thicker than some based on your photos, it is certainly NOT the thickest skin encountered in rhinoplasty surgery. And while there are definite safety limits that prevent any significant thinning of the skin, there are other ways to achieve improved tip definition even in thinker skinned patients. In cases such as yours, strong cartilage grafting and the addition of nasal structure can counteract some of your skin thickness and help achieve the result you desire. Make sure to consult with a board certified and very experienced rhinoplasty surgeon that can also show you before and after photos of noses like yours. I would be happy to meet with you in consultation.

Indeed you should get another opinion. Try to find a surgeon experienced with thicker skin types, perhaps South American and Latino. In general, tip and nostril narrowing may be achieved. We may use an "extended shield tip graft" to gain definition, projection, and narrowing with skin like yours. Hope this helps. Dr Joseph PS - the video below is a young lady who had skin like yours.

Thank you for your question. You are an excellent candidate for rhinoplasty. I would also recommend a small chin implant. I think rhinoplasty is one of the most beautifying surgeries that we do as plastic surgeons. I often deal with thick nasal skin. Your skin is not near as thick as others that I have dealt with on a regular basis. A large portion of my practice is dedicated to rhinoplasty surgery. It is important to only see plastic surgeons with extensive experience in rhinoplasty, ie perform at least 6 per month and have performed hundreds of cases. Also, critically evaluate on-line galleries to see if their art form resonates with yours. Rhinoplasty is definitely a grey haired plastic surgeon's sport. Best wishes to you.

Dear marcyisland,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Getting more than one opinion is always a good idea. Especially if the surgeon doesn’t really sound crazy about doing your procedure. Find someone else.

I would recommend to do both tip refinement and nostril width reduction together. One without the other may adversely affect the aesthetics of the nose. If you have thicker skin, the procedure can still be successful, but the cartilage maneuvers may need to be slightly more aggressive.

Hi there! Thick nasal skin is not a contraindication to performing a rhinoplasty. Your nostrils can be reduced in size and your tip refined. An open rhinoplasty would allow this to occur. For thick skin, the nose needs to be stretched with strong, cartilage grafts. By doing so, the nasal skin becomes more refined. You have to be careful about trying to thin the skin by cutting the underside away. That can lead to compromise of the blood supply. In short, there are options and I would seek another opinion with a facial plastic surgeon. Hope this helps!

Could your nasal tip be done? If a patient has thick nasal tip skin they will not get a pointy tip as a result of rhinoplasty. However in the vast majority of cases the tip could be made thinner than it was to start. In addition to what is achieved by trimming the Cartlidge below the tip skin, follow up injection of Cortizone to the tip could further reduce the width and thickness of the tip skin.

While skin thickness may make it very difficulty to get a very defined appearance, (especially in the tip area), it is not a contraindication to rhinoplasty surgery. It is very difficult to evaluate your nose and make specific recommendations for surgery without a complete examination and discussion in person. I would recommend a second opinion, preferably by a member of the American Society of Aesthetic Surgeons, (ASAPS).