Does having thick skin mean I can NEVER have a refined nose tip?

Question

Is there any way to reduce the skin thickness during surgery to cut it and make it thinner? Thanks

Philip S. Schoenfeld, MD, FACS · Answer

I have patients from many ethnic backgrounds who see me for rhinoplasty.  Thick skinned individuals is common in my practice.  You can certainly thin the skin by conservatively removing fat beneath the skin in the nasal tip.  You can also place grafts that will help define the nasal tip as thick skinned individuals frequently have weaker tip cartilage and the grafts help to define and support the tip. With all of that said, it is also important for your rhinoplasty surgeon to set realistic expectations with you.  Attempting to thin and define a tip more than nature will allow can result in significant complications and deformity of your nose.

Alejandro Nogueira, MD · Answer

It is a multifactorial approach:-defat to the fullest the domes of the alar cartilages, even denuding them from the perichondrium-total removal of the interdomal fibrofatty pad-very cautious and meticulous removal of the subcutanous subdermal fat of the tip-overcorrect the size, sharpness and prominence of the, clearly indicated, tip Sheen's grafting, using very strong and firm cartilage (likely from the septum insteand the commonly recommended ear one)-may the tip support be weak or not very firm then tip support maneuvers (strut or others) are required to make the overcorrected tip graft arise to the surface the define the tipAll this is due to the thick sking hiding partially or subtotally any tip definition maneuvers built underneath.In a very skinny tip the approach would be the opposite:-leave the domal cartilages with their cover, and in some exceptionally skinny transparent tips I have had to add temporal fascial or spared dorsal hump perichondrium graft to cover the domes as a camouflage blanket-make the minimal and essential fibrofatty pad removal-no touch to the skin, hadle with care-undercorrect and carefully size and shape any tip grafting or tip plasties, carrying out intraop testing of tip domes / grafting visibility or naturalness, using (if indicated) soft and pliable grafting, or even scoring it in a grid unicortically to weaken it-avoid adding unncessary or non-essential tip supportAnd any intermediate scenario between very thick and very thin skinned tips has to be finally assessed intraoperatively until naturalness is balanced with visibility of the tip definition maneuvers, taking any actions suitable to achieve such harmony; it is as bad a lack of as an excess of tip definition.

Lyle M. Back, MD · Answer

Naturally thick skin tissue covering the nasal framework can play a frustrating role in limiting the more subtle refinements possible. But some very nice changes can still be achieved, and there are some special techniques (eg. cartilage grafts) that are often used to help with this situation. Unfortunately, the skin cannot be thinned - a layer of scar tissue would result that could be as thick (or even thicker!) than was originally present.

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. I suggest that you move forward and consult with a board certified facial plastic surgeon. The in-person consultation is the only way to address your needs and concerns through the physical examination.
Best wishes,

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  There are two components to a thick nasal tip:  cartilage and skin.  If you have very thick nasal skin, this may make it more challenging to reduce the width of your nasal tip, but it can likely still be improved.  You may benefit from a tip refining rhinoplasty.
Your surgeon can accomplish this by trimming, suturing, and reshaping the
cartilage in your lower nose.  Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Reza Momeni, MD, FACS · Answer

The two, thick skin and refined nose tip, can co-exist, but it's certainly not as refined that you would expect form the nose surgery as if you had thin skin.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.

Steven Wallach, MD · Answer

Sometimes the undersurface is thinned a bit. But making it too thin can cause irregularities or healing issues.

Stuart H. Bentkover, MD (retired) · Answer

You can get some definition, but you need to be realistic about it and set realistic goals.  You will likely need cartilage grafts to our tip.The objective of a rhinoplasty is improvement.  Perfection is not possible.

Does having thick skin mean I can NEVER have a refined nose tip?

Answers (8)

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