Rhinoplasty for Sebaceous Nose?

I am 50 with very oily skin since 13, worsening with time. I must wash my face approximately every 30 minutes; especially the nose and forehead. I've never seen a worse case.

I would like to have a Rhinoplasty to decrease the size of the bulb, but have heard that it is extremely difficult for a surgeon to obtain a thin refined tip on a sebaceous nose. Is this true? And if so, is there any way to safely eradicate the glands to decrease oil so I can have surgery? Like laser or that concentrated vitamin A oil on the net?

Doctor Answers 7

Combination laser and loop cautery can be used to sculpt the nose bulb

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Excessive sebaceous gland growth that produces a large bulbous nose (like Jimmy Durante or WC fields) is called Rhinophyma.

If you have this condition a traditional rhinoplasty will not improve the shape of your nasal tip. Removal of excessive sebaceous material from the tip and bulb requires external removal of the excessive sebaceous tissue.

The ala and tip (bulb) of the nose can be sculpted using a wire loop cautery and CO2 laser.

This procedure leaves the nose skin raw, new skin grows over the nose in 10 to 14 days.

This is the only method I have found which can reduce the size of the bulb in patients with Rhinophyma.

Attempts at Rhinoplasty which modifoes the structures under the nasal tip (bulb) are uniformly disappointing failures.

Accutane but wait.....

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}


I agree with the other surgeons. Thick, oily skin is not likely to result in a very refined tip. However, there are options and all hope is not lost.

Depending on your skin, during surgery the under surface can be thinnned out or "de-fatted."

Structural grafting and suture techniques also are often used in thicker skinned patients to give them very nice improvements in their tip.

Computer imaging to see what exactly is realistic as far as outcome is paramount. You have to see what is possible before you go through any surgery. If you like what you see then you can consider proceeding but if you think the imaged picture's tip is just not as narrow or refined as you had hoped, well then you don't have to go through surgery.

Now for the big one: Accutane, which is a very serious medicine used for severe cystic or nodular acne can usually thin out the skin and reduce the oil glands very nicely! The problem is that the medicine itself can have very serious side effects and no one in the U.S. will prescribe it for the purpose of getting a more refined nasal tip but it is used in other parts of the world for this purpose. I would not recommend you doing it but it is an option you should be aware of.

The important thing is to know that the old methods of cartilage excision to narrow the tip do not work on patients with thick oily skin and usually end up making the tip more amorphous and round in the long term.

Good luck.

Shervin Naderi, MD, FACS
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 119 reviews

You're correct-- this is a tougher problem

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Rhinoplasty on patients with thick, oily skin has one major unique challenge compared to rhinoplasty on patients with thin skin-- it's tougher to see the refinement and details of the underlying tip cartilage that has been reshaped. For this reason, it's important to examine you and lay out what some reasonable expectations should be. In addition, it will take longer to see the final results, up to a year or longer, and during that time, you will likely need some minor in-office procedures to help refine the results and calm the swelling.

The key here is that you can get improvement, but it is not as dramatic as in some patients with a different type of skin. If you check out the websites of surgeons who do rhinoplasties, you should see a range of results on a range of different patients with different skin types-- this will give you an idea at least of which patients get more dramatic results and which get more subtle ones. Ultimately, your best source of information with be a direct conversation with your surgeon. After he examines you, he'll give you his take on what you can expect.

Good luck!

Dr. Salemy

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Rhinoplasty for Sebaceous Skin Nose

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi Bama Hayseed,

Thick oily skin does present problems for rhinoplasty. It is difficult to obtain a thin, defined tip on a bulbous, sebaceous nose.

You may consider a course of Accutane if your physicians feel that you are a good candidate. There are down sides to taking Accutane which need to be carefully considered before committing to the treatment.

Patients who have taken Accutane must wait at least 6 months before having any type of surgery.

I prefer external/open approach structural augmentative rhinoplasty in patients with your type of nose.

I would not count on laser, and would certainly not spend $ on the concentrated Vit A oil on the internet.

Good luck , be well, and Roll Tide.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Thick and oily skin is tough, but improvements often possible

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You are correct - it can be difficult to create a very refined appearance to the nasal tip when the skin and soft tissue is very thick. In fact, our approach is very different for patients with thick skin, in comparison to our approach in patients with thin nasal skin. Rhinoplasty really is a very individualized operation. That said, we can often achieve very nice improvements in the appearance of the nose, even in patients such as yourself. The strategy may change somewhat - for example, a focus on optimizing the contour with less emphasis on literally making it smaller is sometimes the best recipe for a successful outcome. The skin care we will routinely manage in conjunction with a dermatologist. This approach can be very benefiical.

Patrick J. Byrne, MD, FACS
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 19 reviews


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If you are suffering from rhinophyma (sebaceous thickening of the nasal skin) there is a simple procedure using the CO2 laser to plane down the skin. The procedure doesn't hurt much. Takes about a week for the nose to resurface. Lasts a very long time, if not a lifetime.

Rhinoplasty not skin surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Rhinoplasty is not performed for sebaceous oily skin. A rhinoplasty operation is designed for sculpting the bone and the cartilage of the nose and is not skin surgery. The skin itself is lifted up, and the bone and cartilage are sculpted to the anatomical shape and the skin put back down. If you have a rhinophyma, the thickness of this can be reduced in size with dermabrasion.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 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.