Why Does the Skin Thicken After Rhinoplasty Surgery?

Question

I have had 3 rhinoplastys due to a couple of errors, and now the middle part (the skin) of my nose has thickened. It doesn't look natural because my tip is thin and the above part of my nose is thick.
My last operation I had the skin thinned, but it didn't really help. Why has this happened? And what are my options? Is cortisone therapy an option? Thank you for reading this. Please help!

Michael A. Persky, MD · Answer

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

Richard J. Bruneteau, MD · Answer

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.

Rod J. Rohrich, MD · Answer

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.

Anil R. Shah, MD · Answer

Skin can seem thicker after a rhinoplasty procedure.  Typically, it is the result of scar formation in the subcutaneous tissue.   In some cases, skin can become noticeably thinner after a rhinoplasty, termed "shrink wrapping". 

	Post rhinoplasty, if patients exhibit excessive swelling- which can lead to scar tissue formation, taping and kenalog injections can help decrease the formation of scar tissue.  There are also skin care products which can help thin patients skin.  Seek a surgeon with experience in revision rhinoplasty and thick skinned patients.

Scott Trimas, MD · Answer

Thickened skin after rhinoplasty can occur from repeat operations; however, this is more common in the tip area of the nose. You may have developed some excess scar tissue in the middle third of the nose which can cause this problem. Alternatively, sometimes an underlying implant or cartilage graft may be the result of a thickend middle third of the nose. Kenalog injections in that area judiciously used can sometimes thin the underlying skin and soft tissues. Thick oily skin can also be the culprit and sometimes good skin care may soften or hasten the resolution of the process. However, it may be that you tend to form thicker scars than most people. I would recommend you follow-up with your surgeon and let him/her continue to treat you if you are otherwise happy with the results of your revision rhinoplasty.

Raffy Karamanoukian, MD, FACS · Answer

It is most likely that the thickening of the skin on the nasal bridge and dorsum is due to deposition of collagen, or scar, along the nasal dorsum and cartilage. This may affect skin aesthetics and texture. Speak to your surgeon as they may be able to use a special injection to soften the scar tissue.

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Why Does the Skin Thicken After Rhinoplasty Surgery?

Answers (10)

Answer: Skin Thickening After A Rhinoplasty

Answer: Skin Thickening After A Rhinoplasty

Answer: Thickened skin after rhinoplasty can occur from repeat operations

Answer: Thickened skin after rhinoplasty can occur from repeat operations

Answer: Revision Rhinoplasty and skin thickening

Answer: Revision Rhinoplasty and skin thickening

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