How common is skin necrosis?

After 25 years as a rhinoplasty specialist, we are happy to report that we have not seen any cases of skin necrosis on either primary or revision rhinoplasty surgery cases. We liberally use cartilage tip graft on patients with thick nasal tip skin to achieve refinement. I hope this helps! Sincerely, Dr. Joseph

Hi, It is better for you to consult with your facial plastic surgeon who can examine you and give you opinion based on examination.

It is rare, I've seen it a couple of times in my career. It is not reversible. If you have thick skin, defatting the skin is a fundamental technique to get decent refinement of the tip. I'm not sure that the defatting adds to the risk of skin necrosis...smoking and infection definitely do.
There are worse risks than skin necrosis...death, brain injury, csf leak, cartilage necrosis/collapse etc. The reality is that there are *many* patients who are unable to accept the very significant risks of rhinoplasty surgery. If that is how you feel, having given the decision due adult consideration, accept that is the fact in your case and make a conscious decision to move on and live your best life with the nose you've got. Nobody has to have a nose job.

Thank you for posting your question here !I will base my answer on the limited information provided, for a more detailed and customized plan please consult with your plastic surgeon.
During a rhinoplasty the underlying structures (bone and cartilage ) are altered to achieve certain goals (in your case refining the tip). Having thick skin makes it more challenging for those changes to be reflected on the surface. That being said , it does not mean that you won't see a change but the changes might be more subtle.
Thinning the skin during surgery is feasible though it carries the risk of compromising the bleed supply and potentially causing skin necrosis , but if done right the chance of that happening is minimal . Other options include placing the patient on a skin care routine (including products with retinol) pre op to improve the skin quality sometimes in addition to laser or other treatments . This might take some time but it does help improve the skin quality pre-op. Some surgeons might also use additional grafts in the operation such as a shield graft to make the architectural changes more pronounced on the surface.
In general skin necrosis in a healthy non smoking patient is pretty rare especially if the surgeon does not over do the skin thinning and is mindful of the blood supply though it is never zero.
I hope this helps, best of luck!

Hello and thank you for your question. When good technique is used, true skin necrosis is extremely unlikely. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

In primary, uncomplicated rhinoplasty this would be exceedingly rare if the operation is being performed by a well-trained surgeon who understands the anatomy and complexity of the nose. Skin necrosis becomes more of a concern in patients who have undergone prior surgeries with an alteration of the native vasculature of the nose. I would recommend finding a well trained plastic surgeon or facial plastic surgeon with expertise in rhinoplasty surgery to ensure a safe result and a result that you are happy about.
Sean Fisher, MD Aesthetic Plastic Surgeon Seattle, WA

It’s completely normal to have concerns before surgery. Complications like necrosis (tissue death) are rare and typically associated with certain risk factors. However, these risks are always carefully assessed beforehand, and preventive measures are taken during the procedure

If you're trying to reduce your risk of skin necrosis, you should undergo closed rhinoplasty, not open rhinoplasty which interrupts the blood supply and the lymphatics to the nasal tip. It's extremely rare to have any type of necrosis with closed rhinoplasty. All incisions are placed on the inside of the nose, and no external incisions are required. No painful packing is required either.

Skin necrosis after rhinoplasty is quite rare, but it can happen, especially if there is significant thinning of the skin or disruption of blood flow during surgery. Early signs, like skin discoloration, should be addressed immediately, and treatment can help prevent further damage.
To reduce skin thickness on the tip of the nose, especially in cases where the skin is too thick for ideal rhinoplasty results, several non-surgical treatments can help:
1. Before Surgery: Topical Retinoids (like Retinol): Retinoids promote skin cell turnover and can gradually thin the outer layer of the skin (epidermis) while boosting collagen production in the deeper layers. This can help in softening and thinning the nasal skin over time, making it easier for surgical procedures to achieve refined results. 2. After surgery: Steroid Injections: In some cases, corticosteroid injections may be used to reduce inflammation and skin thickness. This is more common post-rhinoplasty when thick scar tissue (fibrosis) develops.

Skin necrosis after rhinoplasty is pretty uncommon.
The risk factors include open rhinoplasty, defending the skin and operating on people who have underlying risk factors in particular long history of smoking.
An open rhinoplasty with moderate defatting of the dermis should have a fairly low risk of skin necrosis.
It may sound like a dramatic complication, but I think patients should be more worried about other complications that are far more likely like an aesthetically poor outcome.
In the end provider selection is the most important in regards to getting a quality outcome and to minimizing complications.
to find the best provider I suggest have multiple consultations with an active attempt at vetting each provider during that consultation.
During each consultation, ask each provider to open up their portfolio and show you their entire collection before and after pictures of previous patients who had similar facial characteristics who had the same procedure, your surgeon is recommending.
Sufficiently experienced surgeon should have more before and after pictures than you have time to look at During the consultation.
Mats Hagström MD