Why Does the Skin Thicken After Rhinoplasty Surgery?

Hi Ms Smith,
Sorry to hear about your unsatisfactory rhinoplasty results. It is difficult to answer your question without before and after pictures of your nose.
Thick, oily nasal skin is difficult to work with. With this type of skin, if too much cartilage and bone are removed, the nose may lose definition, and the skin may appear to thicken. In some patients there is scar tissue formation after nasal surgery that may take months to years to resolve.
Steroid (Kenalog) injections may help a little, but one must be careful to avoid atrophy of the skin (too much shrinkage). It is best to discuss your concerns with your surgeon, or see another revision rhinoplasty specialist. As you probably have been told, it does get more difficult to achieve excellent results with each additional nasal surgery. Good luck and be well.
Dr. P

It’s not unusual for the skin to appear thickened following multiple rhinoplasties.  In reality the skin usually becomes thinner following multiple procedures while the subcutaneous tissue actually thickens.  This phenomenon is usually related to scar formation and the swelling that accompanies these procedures.
            It’s important to realize that in the immediate post-operative period swelling, inflammation, scarring and the healing process itself can contribute to the changes that you describe.  Under these circumstances, it takes up to a year to see significant improvement in skin thickening.

            In the immediate post-operative period swelling can be minimized with taping techniques and massage.  Scarring of the subcutaneous tissue can sometimes be improved with steroid injections.  Unfortunately, in most cases improvement usually requires patience and the passage of time.

            In the interim it’s important to maintain good communication with your plastic surgeon.  Your surgeon should be able to reassure you and alleviate your concerns.

If one has had multiple rhinoplasty procedures, the skin may overall become thinner, but what may increase is the amount of dense scar tissue. That is why it is prudent to not do an operative procedure on the nose for at least 1-2 years if a revision is required. Certainly, one does not want to perform frequent repeat rhinoplasty procedures as this can be catastrophic because of the significant potential scarring. The key is to do the primary rhinoplasty without the need for a revision and if needed then wait at least a year before considering a revision.