Big Nose, Thick Skin, Bulbous Tip...any Hope?

I've already made my consulation appointments, which has inspired my father to do the same. He was once told, years ago, that he has the most "meaty" nose the surgeon had ever seen. That comment left him discouraged and down. Is there anything that can be done with his nose? He has a very bulbous tip with what appears to be thick skin (with a large nose in general.) Is there anything that can be done for him?

Doctor Answers 8

Bulbous tip

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The reason the tip looks bulbous is because the cartilage under the skin is very bulky. This is one of the easiest bulbous tips to fix with a rhinoplasty. It only requires reshaping of the tip cartilages. The skin is not that thick and will conform to the new cartilage shape.



New York Facial Plastic Surgeon
4.8 out of 5 stars 285 reviews

Thick nose

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This is a very challenging nose as it's shape is effected by thick soft tissue and not prominent cartilage. It can be improved however. Contemporary rhinoplasty techniques would lower the profile, raise the tip and add structure to develop more shape. Realistic expectations are a must though.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Not an easy nose

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But it can be improved. He would need to have reasonable expectations and not expect a miracle. The skin is not as pliable as a younger individual.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

The position of the tip cartilags deterines tip shape

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Your father has an anatomical variation of his tip cartilages--they do not parallel the nostril rims but run up toward the inner corner of the eye.  This normal variation is present in 50% of the population, according to my research.  Sheen described the variation in 1978 and I have also written about it.

These cartilages need to be repositioned and the tip restructured. The skin, which is heavy, is the other half of the problem.  His nose cannot be reduced because the skin will just not shrink--this is definite.  But its shape and proportion can be improved, and the nose be made to look more attractive.

You must find a surgeon who is very familiar with this cartilage variation and used to fixing it.  Be sure that you see postoperative results that you like.

Good luck to you and your father.

Mark B. Constantian, MD, FACS
Nashua Plastic Surgeon

Droopy nose

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Honestly? I think he's got a tough nose to get a great result. The main reasons are because of his age and thick skin it is going to be very hard get the tip up and get it to stay there. The problem is the thick skin above the tip. The tip shape itself is due to the cartilage which can be improved without too much difficulty. It may actually take "thinking outside the box" from an experienced rhinoplasty surgeon to be able to help him in one operation. One thought I have would be to actually remove some of the thick skin from the bridge of his nose. This is similar to what we need to do with patients who have skin cancers on there nose. The result would be to be able to lift the tip. This would leave him with a scar over the bridge of his nose but with his thick skin it should heal well. At the same time some work could be done directly to the tip and I'm sure he will need a columellar strut. Without examining him these are my thoughts. Good luck.

Improving a big bulbous nose with thick skin

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It is important to note that while indeed the nose is very wide, beefy and bulbous, there are some improvements that can be made to the nose if the patient has realistic expectations.  The tip cartilages can be appropriately narrowed, adjusted, and trimmed; sometimes the tip cartilage is sewn together as part of a tip plasty operation.  Further refinement of the midthird of the nose can be performed to narrow and refine it to further balance the nose.  The nose can also be lifted and tilted upwards slightly to improve airflow and shorten the nose.  The thick skin will be a difficult problem to deal with and will most likely require postoperative injections of cortisone in the tip and super tip areas of the nose over the few months after the procedure has been performed.  Close follow up with your rhinoplasty surgeon is important.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Big Nose, Thick Skin, Bulbous Tip...any Hope?

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I have performed Rhinoplasty for over 20 years and IMHO, minimal change would occur even after a very aggressive open Rhinoplasty.  The tip can be thinned, excess subcutaneous tissue taken but the excess skin and over-active sebaceous glands will still hide the smaleer nasal structures below.  This would require a resurfacing laser to thin the skin externally at 1 year after the open Rhinoplasty.  Bottom line, if your Dad hates the nose, go for it but with reasonable and limited expectations after all of the above was done.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Bulbous nose can be improved.

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There are 2 issues- the thick skin on hte tip and the bulbous nose.  The thick skin can be improved slightly with a properly used fractionated CO2 laser.  The nasal tip cartilage can be treated with an open rhinoplasty.  Therein, the tip will need to be elevated with a carefully sewn-in graft (your dad's nasal tip is heavy) and carefully sculpted lower lateral cartilages that also need to be properly suspended.  This is not an easy nose for the novice and please have your dad go to a Board-Certified Facial Plastic Surgeon to do this. I spend a lot of time doing revision rhinoplasties done by other surgeons on "easy" noses.  

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 18 reviews

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.