Rhinoplasty and Thick Skin

Hello! My nose is quite big especially at the tip. I have thick skin and although I accepted that I'll never have a small nose, I want to have a narrow tip and smaller ala. But I've heard that when the ala is cut off, stretched and sewn back after the excess taken away, skin tends to pile up above the tip after a few months resulting in a humpy look. Is that true and is there anything to prevent it? Should I settle for a conservative surgery that won't reduce the length of my nose to avoid this?

Doctor Answers 16

Rhinoplasty in thick skinned patients

You are correct in stating that tip rhinoplasty in thick skinned individuals tends to be limited in its effect. The nasal skin won't shrink effectively when the cartilage is shaved or narrowed. having said that, I believe you will get some benefit from surgery as long as you are not expecting a profound change.

Your results may take more than one year to show, and you will most likely need some steroid injections during the post operative period. 

Consult with a surgeon and review computer models of what can be achieved.

New York Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

Rhinoplasty and Thick Skin

You understand the limitations of rhinoplasty in patients with thick skin. With proper techique, the tip can be reduced and contour improved without decreasing the length of your nose. I encourage you to consult with an experienced surgeon who will clarify what can be achieved, describe the operation, and explain recovery. It sounds like your expectations are very realistic.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Rhinoplasty and thick skin concerns

You're correct that drastic decreases in nasal size are difficult to achieve in patients with thick skin. I do believe that improvements can be made to the areas you are concerned about, though.

Visit with an experienced rhinoplasty surgeon so your options can be more fully explained. Also, preoperative computer morphing can be done to simulate what type of changes are realistic.

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

Can I have a Rhinoplasty if my skin is thick

You shouldn't reduce the length of your nose as this equates to tip rotation and your photos show the nasal tip to be rotated at the aesthetically ideal 115 degrees.  Shortening the nose would make the nasal tip rotate to 120 degrees or higher and look unnatural.

The nasal tip should be reduced and shaped but the alae themselves are quite thick and are typically not reduced externally as this can cause excessive (and visible) scars and deformed alar shape.  IMHO, you should consider augmenting your cheeks to create a soft, naturally feminine look to your face because your nose will never be really slim and sleek due to the thick alae.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Rhinoplasty and thick skin.

You need to see an experienced rhinoplasty expert. You can have the tip narrowed but with a method that prevents tip rotation and the bridge slightly trimmed. The skin can be defatted as well. So you can have a good , better-looking nose.

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

Rhinoplasty and Thick Skin

Thick nasal tip skin is a challenge which need aggresive thinning in order to achieve adequate redraping over the refined tip cartilages. This is the only way you can get a refine tip. Will need to get post operative steroid injections to avoid excessive scar tissue formation. Look at the before and after photos to see what can be achieved with this technique.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon
4.6 out of 5 stars 12 reviews

Rhinoplasty and thicker skin

What you say about rhinoplasty and thick skin can be true. There is a limit as to how much the skin envelop can shrink and conform the the smaller framework after rhinoplasty, and it does take more patience and time for full results to appear. However rhinoplasty at its best is conservative, and computer imaging may guide you to how small changes can really add up to a great result.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 43 reviews

Good result possible

You should be able to get the results you need.  The key is to find a surgeon that is experienced in making the correct diagnosis (and explaining to you what you need and why) as well as performing the surgery.  Thick skin does limit the overall "refined" look achievable but you should be able to get a nice improvement.  You may not need alar base excisions, but even if you do, it should not lead to the problem you describe when done properly. It will take months for your skin to contract and the swelling to decrease, so be prepared...good luck

Colin Pero, MD
Dallas Facial Plastic Surgeon
4.6 out of 5 stars 14 reviews

Thick skin

From the pictures you submitted, it appears that the tip is bolbous, this can be adressed with cartilage grafts in your case to compensate for the thick skin. This should give you a less round nasal tip from the front view, but the thickness of the skin will not change, so your expectations must be appropriate.

As for the alae width, it does not partcularly look too wide. Some patients think that by naroowing this area the alar base will appear thinner from the side view. This will not happen.

I would leave the alar base as is, and concentrated on the rest of the tip.


Best of luck,

Michel Siegel, MD

Michel Siegel, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 113 reviews

Rhinoplasty and thick skin

Thick skin is problematic to deal with in the field of rhinoplastic surgery.  Thick skin obscures the end cosmetic result.  There are some additive techniques that can be performed after the rhinoplasty to help with this.  Cortisone injections can be placed into the tip and lateral sidewalls of the tip to further refine it.  Blenderm tape can be placed across the bridge of the nose to help keep local pressure on the super tip area of the nose.  During the surgical procedure there are techniques that work better than others to narrow and refine the tip to create a pleasing tip profile.  These include suturing techniques in the tip that will narrow the existing cartilaginous framework.  Occasionally steroid injections are placed on the day of the surgery to minimize any scar tissue buildup in thick-skinned noses.  

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