When making a large nose smaller how exactly is that accomplished?

Those are some well thought out questions. In general, the skin does in fact act like a shrink wrap over time to tighten down around the new cartilage structure. The refined cartilage structure should be made sturdy enough to support the skin over time. The key is not remove too much cartilage because there is a limit to how much the skin will actually shrink. That's why it's improtant to see a rhinoplasty specialist for consultation

You have asked several excellent questions that many of my patients ask in one way or another.  During my consultations, especially when reducing the size of the nose, I tell my patients that I spend a great deal of time reconstructing the framework of their nose.  Essentially, I create the tent pole design you were referring to so that I can determine the shape of the tent.  Other than some conservative fat reduction, what I do not have a great deal of control over is the canvas that this tent I have created is covered with.  In extremely large noses,  the surgeon and patient should understand that if the nose is reduced to a very significant degree, and the skin is already a little thick, the nose will look amorphous and without the delicate anatomy we like to see in our rhinoplasty patients.  The skin has a remarkable ability to contract and conform to the new shape and size of most noses, but there is a limit.  If a very large nose is reduced too much and the skin is thick to start with then the result is going to be less than ideal but you will still likely be pleased.

Hello and thank you for the question. No skin will be removed. Rhinoplasty is done by manipulating the underlying osteo-cartilaginous framework and the skin is simply re-draped over the new framework. My best advice is that you discuss your concerns and aesthetic goals with a board-certified plastic surgeon with extensive experience in performing rhinoplasty. I would ask to see before and after pictures of their real patients. It's important that you trust your surgeon's skills and ability to achieve the results you are looking for. In particular, pay attention to your surgeon's experience with rhinoplasty. Best,
Pejman Aflaki, M.D.

Johns Hopkins-trained double board-certified plastic surgeon

 

These are very good questions.  The skin does retract over the reduction in the underlying cartilage/bone framework - to a point.  At some point, the skin cannot retract and then the changes under the skin don't matter.  This is why over-reduction of the cartilage/bone is probably the biggest mistake surgeons make in rhinoplasty.  In fact, with thick skin, usually, the framework has to be INCREASED to stretch the skin to be able to increase highlights and definition.  It's counterintuitive for sure.  The best way to help patients understand this is with digital morphing software.  Hope this helps.  

With rhinoplasty the nasal skin has a remarkable ability to shrink to fit the underlying reduced structure of the nose. I have never seen excess skin after reducing the nose.