Question:
I am interested in rhinoplasty but one doctor told me that I have thick nasal skin. How does this affect my surgery?
Answer:
With our experience in ethnic rhinoplasty, I often deal with very thick nasal skin. The implication of thick nasal skin is the effect that it has on achieving definition of the nasal tip.
I describe thin versus thick nasal skin to patients very much like a very thin blanket covering a chair versus a very thick duvet cover covering a chair. Very thin skin, like the very thin blanket, allows all the contours of the underlying cartilage to be easily identified, much like the contours of the chair are easily identified when a thin blanket is covering the chair. With a thick duvet cover, it is very difficult to identify the contours of the chair when the duvet is covering the chair. Similarly, very thick skin camouflages the contours of the underlying cartilage of the nasal tip.
This is not problematic; however, it does require me to perform different techniques in the operating room to achieve more refinement to the nasal tip. In addition to using suture techniques to achieve tip definition, I may use tip grafts to achieve further refinement of the nasal tip in the thick skinned patient.
The other implication of thick nasal skin is the amount of swelling that occurs after the surgery. While refinement of the nasal tip will be appreciated within the first month after surgery, it takes approximately 6 to 12 months for the final refinement of the nasal tip to be fully realized.
Additionally, very thick nasal skin may require steroid injection in a specific region of the tip. This specific region is known as the supratip. I tend to perform these injections within the first two weeks after surgery and repeat them approximately every six weeks as needed until refinement of the supratip region is achieved.
Finally, very thick nasal skin tends to be oily. I place a dressing on the top of the skin of the nose. This dressing is also known as a dorsal splint. I remove it approximately one week after surgery. Following removal of this dorsal splint, the very thick nasal skin can be quite oily. Therefore, as a complimentary service to our patients, our aesthetician performs a glycolic facial to cleanse the skin of the nose and provide a fresher appearance to the nasal skin.
