Surgical Approach to Thick-Skinned Rhinoplasty
When performing a rhinoplasty, a plastic surgeon has to consider the various anatomical features of the individual’s nose. Although we often associate rhinoplasty with the reconstruction of bone and cartilage, the quality and thickness of the skin has a significant impact on surgical technique and outcome.
A rhinoplasty involves lifting the nasal skin in order to access and resculpt the bone and cartilage. When the skin is redraped over the nose, it has to adjust to the newly altered shape. The anatomy of the skin influences how quickly it will contract and conform to the new structure. Thin to moderately thick skin tends to adjust more rapidly and predictably, revealing the framework of the nose earlier on. Very thick skin presents a unique surgical challenge for several reasons:
- Thick skin can obscure the underlying architecture and definition of the nose (the bone and hard tissue).
- Patients with thick skin are more likely to have prolonged swelling and inflammation after surgery.
- Thick skin does not adjust to the new contour as quickly as thinner skin does.
Thicker nasal skin tends to occur more frequently in certain populations, thus thick-skinned rhinoplasty is sometimes referred to as ethnic rhinoplasty.
To increase chances of improved definition in individuals with thick nasal skin, specific surgical techniques can be employed.
- Grafts on the tip and bridge. To achieve greater definition, Dr. Westreich may opt to use cartilage grafts on the tip and bridge.
- Reduction of fat in the soft tissue cover (envelope). The careful and conservative thinning of the fatty constituent of the soft tissue, particularly at the tip, can increase refinement.
- Appropriate reduction of the overall size of the nose. Because thick skin takes more time to conform to the nose, it is important to take a measured approach when making the nose smaller. If the surgery has produced a significant “gap” between the skin and the nose structure, there is a risk that scar tissue will form. This can result in an amorphous shape, an undesirable outcome.
- Preservation of adequate support. Thick skin requires greater structural support, so it is important to balance reshaping the nose with maintaining architectural integrity. A strong skeletal framework will also increase the chances of a more refined surface contour when the skin is stretched back into place.
There is no “simple” rhinoplasty procedure, however, a thick-skinned rhinoplasty requires a different level of expertise. The surgeon must have a sense of how much tissue should be removed to maximize results.
Your Thick Skin Rhinoplasty Consultation with Dr. Westreich, New York
As a rhinoplasty specialist, Dr. Richard Westreich understands the complexities of nasal anatomy and the intricate relationship between structural tissue and soft tissue envelope. Because of his extensive experience working with a range of patients and a diversity of nasal skin types, he is able to evaluate the skin accurately and get insight into how to best approach a surgery. If you are considering a rhinoplasty and are concerned about your thick skin, contact Dr. Westreich at his Manhattan office to schedule a consultation.