During a rhinoplasty surgery, the skin is raised off to reveal the nose’s bony-cartilaginous framework which is reshaped, filed, reduced, or altered to achieve the patient’s cosmetic desire. However, the procedure does not change the amount or quality of skin, which must be able to shrink-wrap onto the new contour to achieve good results.
Los Angeles plastic surgeon Dr. Tarick Smaili says that skin thickness largely determines the amount of changes the nose can handle, and the length of rhinoplasty recovery as well.
During the initial healing stage, which could take a few weeks or months, a patient will not see any “real definition” since it takes time for the skin to redrape to the newly altered framework. Postop swelling of the skin and soft tissue further conceals the surgery’s results.
A thick, oily nasal skin, which is commonly found among ethnic rhinoplasty patients, is less flexible than thinner skin, thus it contributes to longer recovery. According to studies, this feature can lead to residual postop swelling that can take up to two years to fully dissipate.
Thin skin, meanwhile, can redrape quicker and better than thicker skin and is less susceptible to postop swelling and bruising, which in turn leads to shorter recovery.
Because ethnic rhinoplasty patients are prone to persistent swelling, which could be replaced by scar tissue known to result in less than optimal results especially in the nasal tip, many surgeons use steroid (kenalog) injections after their surgery.
Steroid injections are particularly helpful in and around the supra-tip, or the upper nasal tip area, where most of the postop swelling persists. Aside from creating smooth results, the treatment can also accelerate rhinoplasty recovery, as suggested by Dr. Smaili.
These injections are also commonly used after a revision rhinoplasty, which involves more postop swelling than a primary nose surgery. However, some doctors recommend oral steroids as a precautionary measure especially in patients with a strong history of scar tissue formation.
Despite the challenges pose by thick nasal skin, the upside is that it is more efficient in “hiding” any residual asymmetry in the nose’s underlying framework. A thin skin, meanwhile, is less forgiving that even a mild irregularity could easily show.
Nevertheless, thick skin requires a strong [altered] framework to prevent amorphous appearance, nostril collapse, and other telltale signs of plastic surgery. And in doing so, the bulky skin in the nasal tip can also receive some tension, leading to a more refined, narrower look.