Rhinoplasty, or more commonly referred to as nose job, is not just about improving the outside appearance of the nose. “Goals” that are equally important include delivering results that look proportionate to the rest of the facial features, and preserving breathing functions by maintaining the underlying structural integrity.
The underlying anatomies of the nose, especially the skin thickness or lack thereof, affect the postop result and dictate the “ideal” surgical approach as well, as suggested by leading Beverly Hills plastic surgeon Dr. Karan Dhir.
Dr. Dhir says one of the advantages of thin skin, which is commonly found in Caucasian patients, is that it heals at a much faster rate than thick nasal skin, a common trait of ethnic patients—e.g., Hispanics, Africans, and Asians.
Simply put, rhinoplasty recovery for thin-skinned patients is shorter than those with thick nasal skin.
Thin skin also experiences less swelling at the nasal tip than thick skin. In fact, some ethnic rhinoplasty patients have to wait for up to two years to see the final result because of the persistent swelling, although most patients will already look presentable in public by the second week after their surgery, the celebrity plastic surgeon says.
Another advantage of thin skin is that it allows for a high degree of refinement due to its ability to redrape or shrink-wrap well to the new contour. Nevertheless, Dr. Dhir says the same trait could also pose some challenges since even the tiniest irregularities may be visible underneath the skin.
Asymmetries showing through thin skin are more common in patients whose nasal cartilage—which is the main framework of the lower two-thirds of the nose—is notably “strong.” This is manifested by a tip cartilage outline that is visible through the nasal skin.
For patients who have very thin skin and strong prominent cartilage underneath, Dr. Dhir may recommend soft tissue thickener such as acellular dermal matrix (Alloderm) or fascia to hide minute asymmetry and achieve smoother results from rhinoplasty.
Compared with thick skin, it is easier for thin skin to redrape to the new contour, thus more amount of alteration or refinement is generally possible. However, the renowned Beverly Hills plastic surgeon warns that over-resection must be still avoided because it leads to unnatural appearance, breathing problems, and collapsed nostrils or pinched tip.
Over-resection does provide little to no benefits, both long and short term, for rhinoplasty patients. This is particularly true for thick-skinned individuals who are prone to amorphous appearance after removing too much or incorrect manipulation of cartilage.