Management of Thick Skin Envelope on Nose

Hi.  It is important to understand the terminology.  The skin itself cannot be thinned with surgery so when surgeons or patients talk about it they really mean thinning the soft tissue under the skin - ie fat, fascia and muscle.  The only way the skin itself can be thinned is with steroid injections and I don't use it in my practice as the results are unpredictable and if it is overdone it can be very difficult to fix.  Surgical thinning of the soft tissues is routinely done by experienced rhinoplasty surgeons and definitely improves the final result.  Hope this helps.  Regards.

Thank you for your question. In simple terms the answer is yes, the tissue over the tip of the nose can be thinned. In truth, the skin which is made up of epidermis and dermis is not thinned with a rhinoplasty procedure, however, the underlying subcutaneous tissue, nasal SMAS and intercartilagenous connective tissue can be thinned. If you have thick nasal skin prior to rhinoplasty you need to be aware that you have limitations on how much definition you can achieve to your rhinoplasty, although there are procedures that can help.RegardsDr Guy Watts

Hello. These types of decisions should really be made by your surgeon. Debulking the nose can be dangerous if done too aggressively by a novice surgeon. Once you find the right doctor, I would let them choose the technique they want to achieve your desired result.

Surgeons use their best judgement at operation.  To make a strong "never" for anything may not be best (I would allow an "almost never", however).  Thinning the nasal skin can be indicated, but overdoing it (which may not be evident at operation) can result in a hard to remedy deformity.  So, go to a surgeon who you believe based on reputation, photo examples, and consult has judgement you are comfortable with.

Hi Tycho,I agree that there are surgeons that routinely thin the skin and doctors who would never thin the skin and it can be confusing.  The concern with excessive skin thinning is that in can compromise the blood supply to the skin and put it at risk for necrosis. I personally do believe some conservative debulking can be done and a rhinoplasty surgeon with experience should be able to talk to you about this.  But more importantly than thinning the skin, I think the success of a rhinoplasty when dealing with thick skin lies in reshaping the underlying structure of the nose so that when the skin drapes over the structure again it makes the nose more attractive.  I truly believe changing the shape of nose is more important than trying to change the skin. Thick skin can also take longer after the surgery to have swelling resolve. Sometimes the surgeons will use steroid injections to help the skin heal faster after the surgery. There is one positive thing about thick skin, it is much less likely to have small asymmetries become visible from under the skin. Small imperfections are unlikely to be noticeable. I hope this helps!

 It is possible to undergo a rhinoplasty procedure with thick skin over the nasal tip. A conservative debulking of the subcutaneous tissues can occur during the procedure, but it is crucial to follow up with your surgeon to manage the postoperative healing process which includes steroid shots, a low salt diet and Blenderm tape application at night. In addition, cartilage grafts placed in the nasal tip can also be used to give more definition when there is thick skin present.

The thick skin envelope is something that needs to be addressed both during the surgery and postoperatively. Without addressing this intraoperatively either with a debulking procedure and/or grafts, it is unlikely you will see a major change to the nasal tip. I think debulking the fatty tissue to the tip can be helpful when done carefully with an experienced surgeon. For thick skin patients, I routinely perform this in the nasal tip. Additionally, the postoperative management frequently involves kenalog injections to help expedite the swelling that is associated with thick skinned individuals. Hope this helps.

Thick tip skin needs support from tip grafts. Thinning skin, by removal of subcutaneous tissue is not advised if one is using a tip graft. If no grafts are used in a thick skin nose, you get a round, shapeless blob for your tip or a poly tip deformity.