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

Question

What happens to the excess skin? Does it just retract? If the goal is to make a man's nose smaller, can you describe in basic terms how that is accomplished? I was wondering where the excess skin goes. Do you actually remove the skin or does the skin "shrink?" If you think of a tent that is stretched out and you shorten the poles down, the tent will become deflated. How is that different for the structures inside the nose and the skin?

Andrew Miller, MD · Answer

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

Philip S. Schoenfeld, MD, FACS · Answer

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.

Pejman Aflaki, MD · Answer

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

Matthew Bridges, MD, FACS · Answer

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.

Ronald J. Edelson, MD · Answer

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.

Larry Weinstein, MD · Answer

Reduction rhinoplasty is an effective way to improve the profile of someone with a large nose. A large nose is usually caused by a dorsal hump of bone and cartilage. The excess bone and cartilage is removed and in some of my cases I carve it and trim it for insertion in the chin to improve the profile. Vector 3 dimensional imaging can help one see the possible results of skilled surgery. The skin does retract over time. Nasal skin is very thick and doesn't crease like a balloon deflated. Good luck...

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. It would be helpful to view pictures of your nose. Generally speaking, the skin will conform to the underlying cartilage foundation. The nasal tip can be refined by trimming, suturing, and reshaping the cartilage in your lower nose. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon. If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon. Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Robert W. Sheffield, MD · Answer

A rhinoplasty procedure can significantly make a large nose smaller. The inherent capability of skin to tighten up in-time around cartilage is beneficial in these cases. The manipulated cartilage structure is made robust enough to sustain the growth and restructuring of skin and connective tissue. A careful surgeon who pays attention to minor details will never remove extensive cartilage as there is a certain limit to the tightening capacity of skin tissue over a structure. In a bulky nose profile, the doctor and patient should bear in mind that reduction of nose to a very significant degree will make the nose look amorphous and disproportionate. I would recommend you to see a qualified facial plastic surgeon for detailed in person examination.I hope this helps. All the best.

Michael A. Carron, MD · Answer

Hi, your question is a good one.  It is very straightforward but the answer is not unfortunately.  The surgical term is "reduction rhinoplasty" i.e. reducing the overall size/bulk/projecton etc etc.  There are two approaches.  One is the endonasal "closed approach" or the external "open approach".  The operative steps depend on the individual nose. Skin is normally very elastic and will contract around the underlying structural skeleton i.e. the cartilage and bone of the nose.  It is almost unheard of to remove excessive skin.

It is very common in a reduction rhinoplasty to:

- Reduce a large dorsal hump
-De-project (shorten) an elongated nose
-Counter rotate an overly elevated nasal tip
-Shorten a caudal septum (in a tension nose deformity" to shorten a nose
-Improve tip elevation if it is an elongated, poorly projected droopy tip

The list can go on and on.  The surgical maneuvers are MANY and would exhaust the post.  The reduction rhinoplasty is indeed a rather common rhinoplasty operation.  I would see the opinion of someone who specializes in rhinoplasty.

Julian Rowe-Jones, MBBS, FRCS (Eng), FRCS (ORL) · Answer

The nose has a coat of skin on the outside and a lining of mucous membrane on the inside.  When the bone and cartilage framework of the nose are reduced we rely on the skin and mucous membranes "shrink wrapping". There is a limitation on how much shrink is possible.  Thick skin and skin in secondary rhinoplasty shrinks less.  There is no "tummy tuck" for nasal skin and only minimal capacity to trim nasal lining.  Generally if the whole size of the nose is decreased in the profile view the nose can look wider from the front, like your description of a tent with shorter poles.  Global nasal size reduction is complicated and is asking a lot of the skin and nasal lining.

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

Answers (12)

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