Is there a better method to refine the nasal tip for someone with thicker skin other than removing tissue of the nasal tip?

I heard removing some underlying fat or tissue of the nasal tip to give a refined look for thicker skinned individuals can become a problem later, because when its first done it might look nice but then over a couple of months etc it may look overly done or cause other issues. Is there a better or safer method to refine the nasal tip for someone with thicker skin? Thanks

Doctor Answers 14

Reducing the thick skin of a nasal tip

I disagree with those who want to take out tissue from a thick skinned tip.

Firstly there is little tissue to be removed. Second just dissection of the alar cartilages will cause some reduction in the "fat" layer. Lastly, it is a dangerous maneuver because you will decrease the blood supply and risk necrosis especially if a tip graft is needed, which is often.


Great Neck Plastic Surgeon
5.0 out of 5 stars 6 reviews

Refining the nasal tip

Defatting the nasal tip is one way of refining the nose, especially when a patient has thicker skin.There are other techniques that can be used such as tip grafts and tip sutures.This should be discussed during your consultation with a Board Certified Plastic Surgeon.

Eugene Kim, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 52 reviews

Nasal tip refinement with thick skin

 When patients have  very thick skin, the majority of the width of the tip is composed of skin, not cartilage. An in person examination and consultation is required to determine the exact thickness of the nasal tip skin. To  narrow a bulbous tip usually requires suture techniques applied to the lower lateral cartilages of the nasal tip. A conservative cartilage removal can also be performed when necessary. Close followup with your surgeon using Blenderm tape and cortisone shots  to the tip of the nose can be performed during the first 6 months after the surgery to help manage  the shrink wrap affect of the nasal tip skin over the cartilaginous framework.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Your Options For A Rhinoplasty In Someone With Thick Skin Is Limited

The short answer to your question is no, there is not a better method to do this.  During a rhinoplasty, the skin is lifted up off of the underlying bone and cartilage, the bone and cartilage are reshaped, and the skin is laid back down on top.  If the skin is thick, it is not going to take the shape of the underlying cartilage very well.  We can thin the skin a very small amount in order to show off the changes we've made to the cartilage underneath, but if we thin the skin too much, we can disrupt the blood supply to the skin, causing significant problems.  When we do these kinds of rhinoplastys, we are walking a very fine line between wanting to thin the skin as much as possible so that we can see the changes we've made to the underlying cartilage but not wanting to thin it so much that the blood supply to the skin is damaged, which would cause scarring in the skin itself, ruining the results of the rhinoplasty.  Rhinoplasty surgery in thick skinned individuals is one of the most difficult rhinoplastys we do.  Consider only very experienced rhinoplasty surgeons for your procedure.  Good luck.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

Rhinoplasty and thick skin

Thick skin can be a factor in seeing refinement of the  nose. Tip suturing and possible grafting may help give definition.  Thinning the subcutaneous layer conservatively can also potentially help.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Refining a thick skin nasal tip

Improving definition of the thick skin nasal tip commonly involves a combination of tip cartilage grafting (which provides a strong foundation to redrape the skin over) and concervative thinning of the undersurface of the skin. These 2 maneuvers are pretty much the cornerstone of ethnic rhinoplasty surgery. Please consult a rhinoplasty specialist to go over your options. 

Alexander Ovchinsky, MD
New York Facial Plastic Surgeon
4.8 out of 5 stars 24 reviews

Refining a nasal tip with thick skin

There are a couple approaches to narrow a nasal tip with thicker skin. One is to debulk the fatty tissue that drapes over the cartilages. This should be done in experienced hands as it needs to be performed symmetrically and with caution to not violate the blood supply to the skin. The other approach is to use cartilage grafting which can create more definition. Sometimes both of these maneuvers are used simultaneously to maximize the result. Schedule a consultation with a rhinoplasty specialist to better understand the most appropriate treatment for you. 

Michael T. Somenek, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

Refining Nasal Tip in Thick Skin Patients with proper #Rhinoplasty

Hi.  The answer to your question is below:

1) Each nose is unique and different so we have to see and examine and feel your nose to tell you whats best for you.

2) If the skin is very thick then it must be thinned out a little.  The statement you mentioned and heard is incorrect.  

3) The results in a patient with thick skin will depend on your current tip position.  If you are under-projected then by adding projection you can bend the thick skin into a better shape.  If you are already over projected then there are more limitations

4) The strength and shape of your tip cartilages are key.  If you have strong cartilages and wide ones then bending and trimming them is the answer.  If you have weak ones as most patients with thick skin do then adding more cartilage from your septum or rib will again bend the skin into a better shape.

5) Removing weak cartilages in a thick skinned patient is the worse thing a plastic surgeon can do and I see it too often unfortunately.   

Shervin Naderi, MD, FACS
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 97 reviews

Is there a better method to refine the nasal tip for someone with thicker skin other than removing tissue of the nasal tip?

The concept to a refined tip is that there are cartilages in the tip that act as a scaffolding, and the skin/soft tissue is draped over the top of the scaffolding like a blanket. Definition can be achieved to some degree in the scaffolding, by shaping the cartilages, but if the skin that will overlie the shaped cartilage is very thick, it may not be harder to appreciate the defined cartilages. So one option is to thin out the 'blanket' of skin/soft tissue by conservatively removing soft tissue and then re-draping it. Conservative thinning is typically better based on the issues you mentioned, but it really depends on your skin. You will want a consultation with a board-certified plastic surgeon (or two) to assess your options. One last caveat is that fillers are becoming popular in rhinoplasty surgery and if you felt your definition was lacking months after surgery, filler can be used to add definition. Just something else to think about!

Hope that helps.

CDK 

Tip rhinoplasty in patients with thick skin

Refining the tip of the nose is to be done by two methods. One is to reshape and work on the cartilages of the tip of the nose. The other is to reduce the amount of fatty soft tissue under the skin on the tip of the nose. Obviously, no patient and no surgeon will like to have an incision on the tip that is visible, so skin is not ever removed from the tip.

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.