Rhinoplasty for thick skin poses some challenges. Nonetheless, achieving an aesthetically pleasing nose remains possible with meticulous reshaping of the bony and cartilaginous framework, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
During rhinoplasty, or nose job in layman’s term, the cartilage and bone are reshaped and a small piece is removed to eliminate the hump, correct the over-projection, or raise the drooping tip. Meanwhile, the skin must redrape well to the new framework to achieve a smooth and natural contour.
Because thick skin has less flexibility, it does not shrink-wrap as well or as tight as a thin skin. On the upside, it is good at hiding tiny contour irregularities, which could easily show through a markedly thin skin.
Dr. Smiley explains some possible maneuvers used in rhinoplasty involving patients with thick nasal skin.
- Go easy on reduction and narrowing.
The skin’s elasticity, which is closely linked to its thickness, will determine how much the nose can be reduced or narrowed without looking amorphous especially at the tip. Hence, the surgeon’s training, experience, and ability to predict the amount of skin shrinkage following surgery will play a critical role in the final result.
- Use meticulous dissection to limit scar.
Thick skin is susceptible to scars, which could conceal the details of the surgery or cause polly beak deformity in which the nose resembles a parrot’s beak.
Polly beak deformity happens when the supratip of the nose (right above the tip) pushes the tip downward.
Aside from meticulous dissection, another way to prevent or at least limit the risk of unnatural nose contour and other complications is to use closed rhinoplasty technique in which all the incisions are made inside the nostrils, while the wall of tissue between the nostrils remains intact during the entire surgery.
- Consider thinning of the subdermal fat.
When surgeons mention thinning of the skin, they actually mean thinning of the subdermal fat, a surgical maneuver that only suits a small number of patients. It should be done precisely lest the patient ends up with surface irregularities.
Thinning of skin may also translate to reducing the pre-existing scar tissue caused by a previous rhinoplasty. In this scenario, doctors should be extra careful and proactive (e.g., possible use of steroid injections postop) to prevent further scarring.
- Steroid injection to treat patients with persistent swelling or a strong history of aggressive scarring.
Steroid injections might be a good option in patients with persistent swelling (lasting more than three months) or a strong history of keloids. Occasionally, this is also used after a revision rhinoplasty.