Can I achieve refinement with medium thick skin? (Photo)

You are very suitable for having rhinoplasty with Piezzo technology. I recommend narrowing the nose base, reducing the projection of your nose,correcting the bulbous tip,fixing the hanging columella and giving your nose some more definition which will result in more feminine look.
Thin skinned patients heal considerably quicker tham medium or thick skinned patients so I advise you to be patient during your healing period. Best of luck to you

Simply put, based on these photos, YES you can get refinement of your tip, even with medium/thicker skin and even if you are not going for an overdone look. It is very obvious to me that your LLC are too wide and possibly with the lateral crura even being too long, so there is definitely room to get improvement! You will just need to have realistic expectations about your swelling and healing recovery (truly takes at least 1 year) because of the thicker skin.

Based on your photos, you appear to have a wide and droopy nasal tip appearance. You also have a small profile bump and if these issues are causing dissatisfaction, rhinoplasty surgery may be considered for achieving a more feminine and less distracting nasal appearance. I hope this is helpful! Sincerely, Dr Joseph

Thank you for your question. You are an excellent candidate for rhinoplasty. I agree with your assessment and think it is one of the most beautifying surgeries that we do as plastic surgeons. 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.

The nose naturally tends to get longer with age, as gravity pulls on it over the decades, so it's not unusual that you would think it's longer than it was. Also, for many people, the skin tends to get thinner, showing the underlying tip cartilages better, a very subtle change, but we interpret it as the tip getting wider. From these photos, you don't seem to have skin that particularly thick. It's probably more that the cartilages are strong, and that bodes well for the results of a rhinoplasty. The goal might be to elevate the tip a bit, narrow the tip, and lower the little bump along the bridge of the nose. That would also serve as a facial rejuvenation operation, because elevating the tip of a nose back to where it was 20 years ago makes the face look younger.



How *much* to elevate the tip, or narrow the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

Since your nose is drooping and you have a bulbous tip, you would benefit from rhinoplasty, which will give better definition and increase the nasal labial angles to approximately 110 degrees. The nose appears to be leaning towards one side and this can be corrected as well.

Best Wishes,

Gary Horndeski, M.D.

Hello. Great question. There is a lot to be said to answer this properly, but will try to give you the high points. As we age the support structures of the nose weaken and the skin thins out, revealing more of the underlying structure and accentuating certain features, so it’s normal to feel this way. Medium- thick skin is fine, and from the picture I would guess more medium thickness as I can see a glimmer of shape of the underlying cartilages through the skin. You tip fullness is not from thick skin but more from the shape, convex curvature, and orientation of the lower lateral cartilages. The first part of a successful rhinoplasty is a good thorough consultation, where you collaborate with the surgeon on your ideal outcome. I find this takes at least 30 minutes and computer morphed imaging is extreme helpful. This allows you and the surgeon to communicate efficiently and for you to see what is possible with your specific nose, as well as how it looks on your face.So although it would not be adequate for me to simply answer what I would do for your nose and how, hopefully I can give you some good information to set you down the right path. As mentioned, consultation with morphing is very important (in person or virtual). Go to at least 2 -3 different consultations with true rhinoplasty surgeons, this will allow you not only to compare notes but also to learn about the surgery. Some things I hear from revision patients are “I rushed into it”, “I didn’t do my research”, “I just did it along with my body work” etc ….Don’t get lured by gimmicks. Rhinoplasty and cosmetic surgery has become marketed much like everything else in our lives, but the consequences are bigger than simply choosing a trendy brand that is not “as advertised”. The thing I have seen highly marketed is the “different techniques”…. Scarless, incision-less, closed, preservation, ultrasonic, etc …. They’re all general approaches to the nose, they are all surgery, they all have risks … plus the first three are the same thing and the last one is not a technique but a tool that is used to cut the bones. It’s the surgeon that is giving you the results and safety, not the approach / technique. What matters is that there is clear communication btwn you and surgeon, that the surgeon understands your anatomy and how it has to be changed to achieve your desired results, and that the surgeon has a wide array of maneuvers / techniques (diff from overall “techniques”) to be able to address your specific anatomy. Also that the surgeon will give you their best effort. Rhinoplasty is a difficult surgery because it’s like a puzzle that we solve every time we operate. We assess and go in with a plan, but we must also have the ability to change that plan if need be, and to even do the same maneuvers slightly differently in order to achieve happy results. I hope this information helps you find the right surgeon and achieve the desired results. Keep reading on rhinoplasty from reputable sites. Do several consultations, they are well worth the consultation fees as they will give you useful information. Don’t settle for a simple “yes, we can give you the nose of your dreams with fastest recovery because we use a “special technique”.Lastly, if I had to answer based on these pictures: dorsal reduction, spreader grafts or flaps, minor deprojection, small amount rotation, lateral crural grafting to correct convexity and crural repositioning to help orientation in order to reduce the bulbous tip while avoiding pinching of the side and supporting the nostrils, columellar support with a strut graft or septal extension, alar rim grafts, and possibly an alar reduction. Good luck!

Hello.
Based on your images, your skin looks more medium than thick. This does not add difficulty for your rhinoplasty. The amount of change you want can be simulated during your consultation, so you can have an idea of the surgical result.

When performing a rhinoplasty, it's impossible to thin down your thick skin. A conservative amount of cartilage can be removed from your bulbous nasal tip, shaving down the dorsal hump, and narrowing the bridge line with all of the incisions placed on the inside of the nose. This is called closed rhinoplasty. No painful packing is require either. You'll most likely require several follow ups for steroid shots to reduce the the excessive swelling that occurs with thick skin in the supratip part of the nose.

Rhinoplasty surgery is not an operation, but instead general term used for many different operations used to change various aspect of the nose. The nose is typically divided into subunits, and there are different procedures for each subunit of the nose.
Before recommending any procedures, the first step is to make an assessment. This should begin by the patient giving a clear explanation of what they don’t like and what changes they’d like to see in their nose.
Both the assessment and surgical execution of rhinoplasty surgery is considered complex, and these procedures are best done by plastic surgeons, who have extensive experience or preferably focus exclusively on rhinoplasty surgery.
Common rhinoplasty procedures may include dorsal reduction, infracturing to narrow the width of the nose, lifting the tip, creating tip definition and creating a supra tip break.
Some plastic surgeons do this without transecting the columella. This is referred to as a closed rhinoplasty. Those who recommend making an incision across the columella prefer an open rhinoplasty.
The following are some general guidelines, on finding the right provider.
To find the best provider, I suggest patient schedule multiple in person consultations with experienced plastic surgeons in their community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who have similar body or facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. An experienced provider should in fact have hundreds or preferably thousands of before and after pictures to choose from for commonly performed procedures.
Being shown a handful of preselected images, representing the best results of a provider’s career is insufficient to get a clear understanding of what average results will look like in the hands of each provider.
There is no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely you are to find the best provider for your needs.
Take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. It’s not a bad idea to bring pictures of your own body/face to use as reference when reviewing before and after pictures.
The biggest mistake patients make is scheduling only one consultation without properly vetting or comparing providers before scheduling surgery.
Best,
Mats Hagstrom, MD