Tip refinement rhinoplasty with thick skin, is it possible?

Question

I am interested in getting rhinoplasty to help refine my nasal tip among other nasal improvements. The more research I do, the more it seems my thick skin may not yield any tip refinement after surgery. I read an article online written by a plastic surgeon that stayed: "Very thick skin in the nasal tip means you should never perform a rhinoplasty. No matter what you do to the cartilage, the tip will be bigger after surgery, not smaller! Try explaining that to the patient after surgery!" Advice?

Eric M. Joseph, MD · Answer

Thick nasal skin may be associated with those from Asian or African descent. Your nasal skin may be a bit oily on the tip, or thicker than other's skin, but it's not an issue insofar as rhinoplasty is concerned. I disagree with the person you quoted - we operate on ethnic thick nasal skin regularly and achieve tip narrowing...My biggest concern about your rhinoplasty is that you have an obtuse (cute), nose-lip angle, and if you have surgery, every attempt should be made not to over-rotate your tip. That could lead to excessive nostril show. Hope this helps. Dr Joseph

Thomas A. Mustoe, MD, FACS · Answer

The shape of the tip is defined by the underlying cartilage and the soft issue-skin draping over it.   Surgery inevitably leaves some scar tissue that forms as part of the healing process and can limit tip definition.  You already have a fairly well defined tip and your skin is not thick but it is not delicate.   An in person examination would be necessary but I would be cautious a bout proceeding.   The amount of scar tissue that forms is unpredictable and there is a real risk that surgery would not improve your tip definition.

Jonathan Kulbersh, MD · Answer

Based on your photo, it appears you might be a very good candidate for tip refinement. Typically, patients with the thickest skin are of African American or Asian descent, and in experienced hands, even these patients can see good results from rhinoplasty procedures. Keep in mind that rhinoplasty is one of the most complex of all plastic surgery procedures. An experienced, board-certified facial plastic surgeon is your best bet for achieving the best possible results.

Robert Singer, MD · Answer

While there are some limitations of what can be achieved in patients with thicker skin, the area that concerns you can be realistically improved with an artistically performed rhinoplasty. Patients with thicker skin can get a significant improvement in the appearance of the nose but need to be realistic about the result.

Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you what to do and how to do it based on limited two  photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of the operative procedure would not be in your best surgery. Natural appearing results need to be individualized and what is appropriate for one patient is not necessarily the best for someone else. I would suggest that you find a surgeon with extensive ethnic rhinoplasty experience certified by the American Board of Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) or a facial plastic surgeon (otolaryngologist) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.
 
 Robert Singer, M.D., FACS 
 
 La Jolla, California

Tip refinement rhinoplasty with thick skin, is it possible?

Answers (4)

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