Any new rhinoplasty techniques to thin skin that is too thick for reduction?

Question

Hello, I was told by a plastic surgeon that my skin is too thick for rhinoplasty. The tip that is. Any new techniques? A dermatologist recently told me that RF microneedling can make it possible. Isn't laser a better option to attempt to thin the skin? Any info greatly appreciated, such a steriod options also. Thank you

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can understand from your question, in thick skin the healing time may take longer than normal skin. If you can send your photos at 95 degree angles from the front and side profile, we can make a more accurate evaluation.
It would be better face to face consultation.
Best regards!

Anya Costeloe, DO · Answer

Thick skin presents a challenge in rhinoplasty as it can limit the degree of refinement possible and can contribute to postoperative edema (swelling). However, I frequently perform rhinoplasties on patients who have thick skin and I use several techniques to manage thick skin during rhinoplasty. 
One technique is subcutaneous tissue debulking. This involves thinning the skin from the inside, removing the fatty layer under the skin to make it thinner. This has to be done carefully to avoid damaging the skin or causing irregularities. Another technique I use is defatting. This technique is similar to debulking but focuses specifically on removing excess fat that can contribute to the thickness of the skin. Sometimes, to provide structure and support to the nose in patients with thick skin I use rib grafts. 
It's important to note that not all techniques are suitable for all patients. Always consult with a qualified and experienced facial plastic surgeon to discuss the best options for your specific case. Best of luck!

Eric M. Joseph, MD · Answer

Please consider re-asking your question with a photograph of your nose. Not all people with thick skin are created equal. If you have firm nasal septal cartilage, rhinoplasty surgery may be considered for achieving a narrower nasal tip appearance, even with thick skin. I hope this helps! Sincerely, Dr Joseph

Gianfranco Frojo, MD · Answer

There are well established ways to optimize the soft tissue skin envelope. Preconditioning and treating thick skin can improve postsurgical results and reduce postsurgical unwanted results. Best of luck.

Jeffrey H. Spiegel, MD · Answer

We deal with this in several ways. (1) RF microneedling may help, (2) steroids can help, (3) thinning the skin during surgery can help, (4) prescription medication taken in advance of surgery can also thin the skin.

Photos are quite helpful.

Photos are quite helpful.

Ruslan Zhuravsky, DO · Answer

Hello,Thick skin rhinoplasty is performed all the time by surgeons that truly specialize in rhinoplasty, not just any plastic surgeon. I've operated on many patients that have been told by others that their skin is too thick, with great results. It's more about using the proper techniques during surgery and proper care after surgery. I would avoid any skin thinning attempt before surgery. Blood flow to the skin is very important for healing, so anything that can affect it should be avoided. After surgery, if needed, and depending on the healing process, you can inject steroids or use Accutane to thin skin. The difference btwn lasers and RF microneedling is a long one, but no, one is not better than the other. There are many different types of lasers, each is very very different. The word "laser" sounds very fancy and makes it seem like they can do magic, but they don't work the way they do in movies. They are wonderful tools but need to be used properly. Bottom line answer is make sure your surgeon does high quality rhinoplasty on a frequent basis. Do several consultations and you should get a feel for the difference. Good luck!

Steve Laverson, MD, FACS · Answer

My opinion respectfully disagrees with any doctor who believes that any person's skin is "too thick for rhinoplasty."  Many many rhinoplasties are performed in areas of the world peopled by populations with the thickest skin.  YES, your skin can be easily thinned during rhinoplasty, and this is commonly (always) part of the procedure for improved definition of features and nasal contours are requested or recommended.

Robert Ciardullo, MD · Answer

Ways to thin the skin after rhinoplasty: The most effective way to thin the skin and give more definition to the tip and supratip area after rhinoplasty is with steroid injection. This is commonly done in people whose skin in these areas is rather thick, yet undergo rhinoplasty, but would want a thinner tip and supratip
 with more definition.

Mats Hagstrom, MD (license on probation) · Answer

I would avoid the temptation of making definitive conclusions based on the input from one provider.
I suggest all patients considering having rhinoplasty surgery always have multiple in person consultations before contemplating selecting a provider.
The back of the dermis can be thinned out using surgical scissors removing subcutaneous fat to thin the surface layer substantially.
Whether this is indicated or appropriate is another story.
Rhinoplasty surgery is complex and finding the right provider for this procedure is not easy or straightforward.
Look for plastic surgeons who specialize exclusively rhinoplasty surgery, or at least those who have a high percentage of rhinoplasty as their regular procedures.
Look for providers who have wanted two decades of experience at a minimum in this type of surgery.
There’s no correct number of consultations needed to find the right provider.
The more consultations you scheduled the more likely you are to find the right provider.
I highly recommend people always avoid virtual consultations and instead reliant in person consultations whenever possible.
Without including pictures, we can’t begin to make an assessment or give you any quality recommendations regarding your own candidacy for surgery.
Micro needling or radio frequency treatments are not the treatments of choice.
This is an entirely surgical procedure, and both candidacy and outcome will be dependent on your fit for surgery and what can be done during the procedure
The secondary procedures you are contemplating are unlikely to predictively Deliver the outcome you are hoping for.
They seem like an uncomfortable waste of money in my opinion.
Consult with a few more plastic surgeons. If everyone consistently tells you the same thing, then you should listen to what they have to say.
Maybe the surgeon you spoke with just didn’t feel comfortable doing your procedure.
Best,
Mats Hagstrom, empty.

Any new rhinoplasty techniques to thin skin that is too thick for reduction?

Answers (9)

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