Rhinoplasty for bulbous nose with thick skin, large pores, and history of acne? (photo)

I'm a senior in high school, and I would like to get my nose done in the summer after I graduate before I go to college. I'm sure I want this procedure done, but my skin is the only thing that is holding me back. I have very large pores and a history of acne. I'm not only embarrassed, but worried about the results. What can I expect as far as results, and what can I expect of my skin? Is there anything I can do to improve my skin before surgery? I already use retin-a and take Spironolactone.

Doctor Answers 13

Rhinoplasty for bulbous tip

You are doing the appropriate thing for your skin by using Retin-A. A superficial TCA-based peel can also help regulate the pore size right before surgery but it should be done at least 3-4 weeks before your surgery. In terms of surgery, despite having acne-prone skin and large pores your end result will be more affected by the cartilage structure underneath your skin. Your bulbous nasal tip is due to the strong cartilages under your skin. This makes it ideal for shaping in rhinoplasty surgery and you can expect to have a good result. Make sure to have a good discussion with your surgeon about your concerns, your expectations and your goals.

Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 33 reviews

Bulbous tip rhinoplasty with thick skin

You're right that your thicker skin is a consideration when it comes to surgery, but it should still be possible to improve the overall appearance of your nose with rhinoplasty. There are several methods of improving a tip like yours, including cartilage trimming and suture placement. if you want it is also possible to address your bridge bump as well. You can read more about bulbous tip rhinoplasty at my web reference link below. It also includes some before and after photo examples of how a bulbous tip can be improved.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Rhinoplasty with Thick Skin

Thank you for the question and your photos, and congratulations on making the decision to move forward with nose surgery. Thick skin can make improvements in the contour of the nose a bit less obvious -- this is because the changes that are made in the bone and cartilage framework remain somewhat hidden by the skin "blanket." However, during the procedure, the skin thickness over the tip can be slightly reduced from the inside. In terms of the pore size and acne breakouts, the nose surgery will not address these issues. Other treatments can be used, however, including facial peels and laser. Best of luck moving forward!

#San Francisco Rhinoplasty

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 113 reviews

Rhinoplasty with thick skin

Good morning to you

You're doing everything right at the moment and your understanding of some of your limitations based on your skin I would say is accurate. That being said with the appearance of your tip and what I assume is strong prominent cartilage underneath it can make a very nice improvement and refinement to the tip as well as the position of the tip.

Just be sure to get more than a few consultations with board certified facial plastic surgeons. I think you could have great success with your rhinoplasty but with some limitations if you are looking for a very sharp refined look. I wouldn't necessarily suggest very aggressive changes to her nose based on these photos because he did have soft lines and contours of your face they give you a very warm kind appearance. Your eyes are beautiful by the way.

Hopefully that was helpful

Chase Lay, MD

Double board certified facial plastic surgeon

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 76 reviews

Rhinoplasty for bulbous nose

The rhinoplasty procedure won't not have any effect on the thick skin, large pores or acne breakouts on the skin. The rhinoplasty procedure will involve reducing the bulbous tip with a combination of tip suturing techniques and cartilage removal to affect the change in the tip. Also important to remove any dorsal hump at the same time to make sure the bridge and the tip are balanced with each other and your facial features. There is nothing that can be done preoperatively to make her skin better for the surgery itself, but anticipate needing a couple of cortisone shots in supra tip area of the nose in the first few months after the procedure. For many examples, please see our rhinoplasty photo gallery link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Bulbous nose tip and thick skin in rhinoplasty.

You seem to have done your research and have the understanding that thicker skin of the nose, especially the tip of the nose, can affect outcome the degree of tip refinement you can get with nose surgery. However, the other factor is the quality and firmness of your tip cartilages and how well they can be reshaped. Looking at your photos, you seem to be a good candidate for nose refinement surgery. The best starting point is to be evaluated by a board certified surgeon who does many nose surgeries a year. A rhinoplasty specialist. You will find that you will get answers to many of your questions and can have realistic expectations while planning your surgery. For now, it seems that you are doing everything that you can. The consultation should be your next step. You may have to drive a little ways from where you are to be able to be seen by an experienced nose surgeon.

Ramin Behmand, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 39 reviews


You look like a good candidate for rhinoplasty. I think the most important thing to do is go for a consultation and be properly evaluated.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Rhinoplasty for the bulbous tip,hump, etc. in patient with large pores and history of acne.

Rhinoplasty for the bulbous tip,hump, etc. in patient with large pores and history of acne. Removal of your home along with cartilage crafting of the mid nose and the edge of your nostrils is needed to prevent a pinch tip. The cartilage will come from your septum and be done in such a way as to create a natural looking nose without creating a pinch tip.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Rhinoplasty for bulbous nose with thick skin, large pores, and history of acne?

Your tip can be refined nicely and you can have a natural improvement in your nose. The skin may play a role in the level of refinement possible, but I think that the surgery would be worth pursuing.

Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

You look like an excellent rhinoplasty candidate

Judging from your photos, your skin does not look excessively thick. To me, more like a medium thickness skin type. The fact that you have active acne and large pores (and the fact that you are young) does mean that you have more sebaceous activity in your skin, which can result in greater swelling and some potential break-outs after surgery. But I do not think your skin issues will compromise your long-term results, as long as the surgery is done correctly. If your nose was reduced excessively, then you would have a relative excess in skin surface creating risk for poor draping of the skin and a lack of definition to the nose.

In general, I am a strong believer that rhinoplasty should aim towards making a nose as ideally proportioned as possible, not necessarily as small as possible . Your nose has a bulbous tip, a hump on the bridge, and a tip that angles down somewhat. I believe that if these are smoothed and the proportions improved, your nose would look significantly better without risking the skin excess problems. For more information on this, refer to my video presentation on this topic below (first of a seven part series).

David W. Kim, MD
Bay Area Facial Plastic Surgeon
4.8 out of 5 stars 37 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.