Skin Excision During Rhinoplasty?

Hi, I had rhinoplasty 1.5 years ago - my nose looks rediculous from 45 degree view now. Literally once it gets half-way down the bridge it's a riot of 3/4mm thick skin attacking the cartilage underneath, no defined shape. I honestly don't see the point in going for another op unless he removes some skin from the tip or makes it thinner somehow, is this possible and what type of scar would be the result? Is the scar fadeable (lasers/peel)? Also, how was Michael Jackson's nose reduced so much?

Doctor Answers 5

Thick skin/shapeless nose post-rhinoplasty

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From your description, it's impossible to determine if the issue is all skin or if the underlying cartilage needs to be reshaped. I suspect an open rhinoplasty with significant skeletal reshaping and some skin modification can achieve a reasonable result.

Unhappy after Rhinoplasty

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It is nearly impossible to say without a picture what is going on. I always think it is a good idea to give your original surgeon a chance to make things right unless you have no confidence in them. Secondary Rhinoplasty cases are very difficult and you should seek a board certified surgeon to do it. Make sure it is someone who specializes in nasal surgery. Hard to say whether you need cartilage grafts or some kind of fascia graft beneath the skin to camouflage some kind of deformity or if the skin really needs to be thinned. This is a tough one without seeing you. Sorry.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 54 reviews

Thick skin and rhinoplasty

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Thicker skinned patients have less definition of the underlying structures of the tip. Sometimes some defatting can help.  I am assuming MJ had thinning due to repeated surgery and atrophy.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Thinning The Thick Nasal Tip

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Thick-skinned noses are challenging and tip changes in them after rhinoplasty can be unpredictable. No plastic surgeon is going to remove skin from the nasal tip area (admittedly that would be helpful in some patients) because of the terrible scar that would result. A scar down through the nasal tip has a near 100% likelihood that it would not be a better trade-off for the thicker tip nose. And there are not magical scar treatments that are going to make it fade to an acceptable level. Defatting of the nasal tip can be helpful but care must be done with that technique to prevent skin healing issues.

Unhappy after rhinoplasty

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I hear your frustration. It is impossible to give any opinion without photos, much less an examination. I would suggest returning to your surgeon so that you can discuss your concerns. Otherwise you will need to make consultations with other rhinoplasty surgeons. Good luck.

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