Deproject the nose in thick skin?

Thank you for your question. Reducing the projection of the nasal tip in the presence of thicker nasal skin poses considerable challenges. One solution is to reduce the thickness of the tissues in the tip and supratip areas. For some people, this is sufficient to change the compliance of the skin and allow it to drape nicely around the reshaped nasal tip cartilages.

In some instances, the thickness of the skin is due to significant blood flow to the tissues and may not be controlled well with the reduction of the subcutaneous layer. There is a technique to control the contour of the supratip and tip in thicker skin, which works with deprojection techniques and involves removing an ellipse of skin in the supratip region. Unfortunately, this technique is associated with a vertical midline scar, which is very faint but a scar nonetheless.

When somebody has thick skin and if they require nasal tip de projection, we can often achieve significant narrowing with the use of an extended shield tip graft, and a columella shoring strut graft. Thank you for your question. Sincerely, Dr Joseph

Hello and thank you for your question. Nasal tip deprojection is a very complex move in Rhinoplasty and can have outstanding results in the right patient with the right technique. You should make sure that you can view hundreds of nasal tip deprojections on your surgeon’s before and after gallery of their website. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon