Narrowing a Thick-Skinned Nose?

My surgeon said my skin is thick and proposed an alar base reduction so that it would fit within the width of both eyes, but the wide tip would become more apparent. He said no work could be done to the tip. However, my nose has a wide section of skin that separates the ala from the tip, which makes the nose look wider in a frontal view. In fact the angle is 90 degrees on each side. Can this section of skin be taken off so that the angle decreases, thus making it more triangular?

Doctor Answers 11

Thick skin is a challenge for cosmetic rhinoplasty

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The photo you submitted does indeed show your ala to be quite wide and alar base reductions would be beneficial. What it sounds like you are asking is if this would make your tip look more bulbous, and what could be done for that. It is certainly possible to narrow your tip, but not excellively so. Septal cartilage can be used as tip grafts and the lower structural cartilages could be narrowed. It will help give you some increased definition of your nose and a more triangilar shape that you would like. However, don't expect a fine, sculpted tip, since it's not really possible with your thick skin.

Thin skin rhinoplasty

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Noses with thick skin can be challenging, however, they can be improved. The shape of the nasal tip cartilages must be changed with suture techniques and tip grafts are almost always used to "push" through the thick skin in order to obtain a tip definition. Many times the thick skin is thinned from the inside. By doing these, the tip is defined.

Narrowing Thick-Skinned Nose

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Your alar base should be reduced. Tip skin cannot be removed and the thickness the skin cannot be significantly reduced. However, if necessary, the tip can be narrowed by changing the underlying cartilage.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Rhinoplasty to narrow nose with thick skin

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Thick skin is problematic when operating as it blunts the work being done on the nose. There is really not much that can be done about thick skin. Alarplasty is performed through an incision at the nostril sill along the floor of the nose. A small pie wedge of skin usually 2-4 mm is removed depending upon the patient’s needs, wants, and desires. Once removed dissolvable stitches are placed, which narrows the width of the nostril. The incision usually heals very inconspicuously.  

Thick skinned nose

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Thick skin poses a challange in rhinoplasty because the surgical sculpture addresses primarily the underlying bones and cartilages. The thick skin will sometimes partially negate the results of the surgical effort. But, with care, one can do things. In your case very careful (!) resection of the underlying fatty subcutaneous layer of the tip can result in some thinning and most importanly permanent sutures placed into the alar cartilage tips can achieve noticable narrowing. So all is not lost. Good luck.

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon

Rhinoplasty for Thick Skin or Wide Nostrils

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Hi Adrian2173,

Rhinoplasty patients with thick or oily skin have different factors that affect rhinoplasty surgery. As plastic surgeons have already stated, patients with thicker skin tend to have swelling for a longer period of time. The tip of the nose may also not be as well-defined or sculpted, as compared to thinner skin rhinoplasty patients. To improve rhinoplasty results in thick skin patients, plastic surgeons may remove extra tissue deep in the skin, inject steroids, and/or add cartilage grafts to the tip area.

In addition, generally for narrowing wide nostrils, rhinoplasty surgeons can alter the flare or width of the nostrils. Alar base reduction may be performed at the initial rhinoplasty surgery, or delayed several months later. Small external incisions are placed at the bottom of the nostrils to narrow & refine the nostril shape. Only after a comprehensive evaluation can a rhinoplasty surgeon help determine appropriate options for you. Best of luck.

Thick skin rhinoplasty.

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From the view you sent it appears that you need alar bare reduction and slight thinning of the tip and tip skin. Very often the tissue under the skin can be dramatically thinned. See an experienced rhinoplasty surgeon for the best results.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Thick skinned nose and tip

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Without the benefit of an exam, it does appear that your nose would benefit from narrowing the nostril base.  It is also possible to re-shape the nasal tip cartilage and in some cases the skin can be thinned as well to improve the appearance of your tip.  You need to have a consultation for a thorough evaluation before proceeding.

Rhinoplasty in Patients with Thick Skin

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Rhinoplasty in individuals who have thicker skin is a challenge, but one that can have rewarding outcomes.  Reshaping the internal cartilage and removing excess fatty tissue from underneath the skin can be successfully performed to provide more definition in a nose with thick skin.  Your nose will never show the definition as those patients who genetically have thin skin, but you also will not show small irregularities of the underlying cartilage.

Best of luck

Vincent Marin, MD, FACS

La Jolla Plastic Surgeon

Narrowing a thick skin nose

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Hello Adrian,

Thick skin noses can be a bit more challenging to operate on and obtain the results desired by the patient, but it is not impossible to narrow the nasal tip. Looking at the basal view you posted it does look like you may benefit from an alar base reduction, but it is important to analyze the entire nose and face in order to make those decisions along with a surgical plan. I find that when operating in patients with thick skin I often have to use cartilage grafts to refine the tip area successfully. In general, we never excise skin when doing a rhinoplasty  other than in the alar base or the incision site if needed during an external approach. The area of the lobule that you are describing is never amenable for skin excision. Best of luck to you.

Dr. A. Gantous

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.