Thick Skin - Best Technique to Narrow a Bulbous Tip?

The most common way we create defined nasal tips is by removing some of the tip cartilages. For patients with strong cartilages and thin skin, the tip skin shrinks around this smaller framework making the tip smaller. However, when the skin is thick and cartilage weak, removing cartilage has the opposite effect. The way we often create tip definition in thick skin noses is to add cartilage to increase strength. Grafts called shield grafts are also used to press into the thicker skin to provide more underlying structure and shape.

Hi asia1101 in asia,

Thick skin patients more likely develop scar tissue after rhinoplasty, as compared to thin skin patients. To improve bulbous tip, rhinoplasty surgeons typically reshape and reposition the tip cartilage. Some cartilage is removed and some may be added to create more tip definition. Thick skin may also require removal of some extra soft, fibrofatty tissue deep under the skin during surgery, effectively "thinning" the skin. Lastly, steroid injection after surgery help reduce swelling and scarring to further refine the nose.

There isn't one best method to correct bulbous tip, but rather many good potential options. Only after a comprehensive evaluation can a rhinoplasty surgeon help determine appropriate options for you. Best of luck.

Dr. Chaboki

See an experienced revision rhinoplasty surgeon who can examine your nose and tell you if anything further can be done. In some patients the skin is so thick that you can only thin it so much and no more.

When very thick skin is present on the tip, the patient is just not a good candidate for a rhinoplasty. Two previous rhinoplasties are not making this type of surgery any easier. It is important not to remove structural cartilage for fear of the nose collapsing. There is some defatting of the skin that can occur during the rhinoplasty procedure whereby the skin is thinned along with removal of some scar tissue. Frequent cortisone injections in the first six months after the surgery are also a technique that is employed as part of postoperative care. Blenderm tape applied at night is another technique that helps to prevent recurrence of fluid and scar tissue in the super tip area of the nose.  

Thanks for the question but you did not post a photo. So very hard to advise especially in your case with 2 failed rhinoplasties. Good luck but see more PS in person. From MIAMI Dr. Darryl j. Blinski

You have posed a very common question.  Thick skinned patients have a difficult time achieving fine tip definition.

You are now approaching dangerous territory with your nose.  You have had multiple procedures, and are proposing to remove the support to the tip.  Have you considered steroid injections?

At this point, you not only have thick skin, you have scar tissue.

 

I would consider leaving it alone, surgically.

 

sek

Removing all the lower laterl cartilage will not thin your tip - it will make the tip look worse. In fact, adding cartilage to the tip may improve definition. Get a second opinion from a surgeon who does a lot of revision rhinoplasty work. There is a limit on what can be achieved in a thick skinned nose.

Hi,

Treating bulbous tips is a real challenge. All the fibrofatty tissue should be removed in addition to replacing the tip with tip grafts and shield grafts. This thins out the tip and allows for the underlying architecture of the nose to be seen. You can check out my website on tip refining techniques.

Best,

Dr.S.