Can thick nasal skin be reduced?

Question

Are there limitations on what can be done during revision rhinoplasties? I am wondering if a nose can only be fixed to a certain extent. I have thick nasal skin and have had 3 revisions. The first 2 left me with too much nostril showing. The 3rd revision seemed to take care of that but now my nose is more bulbous and wider it was originally. I am 2 1/2 years post op and wonder if it's too soon for another revision. Thank you

Eric M. Joseph, MD · Answer

When we deal with thicker nasal skin types, sometimes the undersurface of the nasal tip skin may be defatted. When we're dealing with Revision rhinoplasty surgery, it's not clear whether or not this would be feasible in your situation. Please consider re-asking a question with before and after photos. Sincerely, Dr Joseph

Jeremy S. Nikfarjam, MD · Answer

Hi Mlps,
You touched on something I bring up very frequently with my patients! I see many patients who do have thicker than average skin on the nose, and they will point that out as an area of concern. We cannot reduce the skin's thickness. Sometimes if the skin is going to be stretched at all, it can give the appearance of being thinner. But I will make it a point to have that exact discussion with my patients. There are some medspa devices on the market that can help to resurface the skin thereby improving that appearance. 
There is no hard and fast timeline in terms of seeking another revision. If you are unhappy, you can seek a consult with a board certified plastic surgeon (who specializes in rhinoplasty revisions) to see if your goals are realistic and worth the surgical risk. 
I wish you luck in your search for treatment!
- Dr. Nik

Nima Shemirani, MD · Answer

Hi @mlps! There are limitations with thick skin. I recommend seeing an expert revision rhinoplasty specialist for an in person examination. There are options for you that can be determined after examination. Best of luck, Dr. Nima!

Jeffrey Lisiecki, MD · Answer

Yes, there are limitations to what can be done during revision rhinoplasties, depending on how you present and what was done in the prior rhinoplasty.  That being said, thick skin can be reduced in several ways.  Skin care and retinoids preoperatively can help control oiliness and inflammation.  Intraoperatively, the skin envelope can be thinned surgically.  After surgery, energy treatments like Morpheus8 can help reduce thickness, as well as getting back on retinoids and skin care.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.What determines the outcome of a rhinoplasty surgery is mostly the skin. If you have thick skin, the nose can be made smaller but there are limitations (on the other side there are also limitations for people with thin skin). If you originally had a big and bulbous nose with thick skin, your nose can be made smaller of course but not too much. Anyway, there are different techniques and even with thick skin it is possible to get rid of the bulbous tip and to make it smaller. For a revision surgery, 2 1/2 is enough time.Best regards!

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello! Thanks for your question. Thick skin can be treated in different ways. There is a thought that Accutane can be used to thin the skin safely. I do refer to Dermatologists in some cases to do this. During the operation, the skin can be thinned but you have to be very careful not to cause any vascular injury. After the rhinoplasty, steroid injections and taping are imperative to keep the inflammation and skin calm. At 2.5 years post op, you are not too soon for another revision. Hope this helps!

Can thick nasal skin be reduced?

Answers (6)

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