Rhinoplasty for Thick Nasal Skin

Anatomically, nasal tip skin is thicker than dorsal skin and contains much more sweat and sebaceous glands. The thickness of the nasal skin directly and the distribution and density of the sebaceous glands directly affect the result of the operation. Therefore, it should be paid attention to the structure of nasal skin and its possible effects on operation results during rhinoplasty planning and giving information to the patient.

Is the rhinoplasty of thick and fatty nasal skin more complicated and challenging?

The final and clear answer to this question is yes. Based on my experience, I can say that after the reduction of the nasal tip cartilages of the nasal tip of the patients with thick skin, the skin does not stretch as before the operation and looks like a tent. In that case, the only thing to do is to attach the nasal tip skin to the lower cartilage-bone structure with sutures, tapes, and plaster. Because there is not any surgical method to correct this situation.

Why is thick nasal tip skin resistant to change?

In rhinoplasty, while it is possible to remove excess bone and cartilage structures, it is not possible to remove excess nasal skin (even though millimetric skin pieces are removed from the outer lower part of the wings of the nose and the skin separating the nares to reduce the nares, it is not sufficient). In rhinoplasty, the long-term recovery ability of the skin is very important and directly affects the result. 

In thick skins, the recovery is harder. Also, due to overactive sebaceous glands, nasal tip skin may swell abnormally. In patients having thick nasal skin, the swelling in the nasal tip may be permanent after a long recovery period. Even though it is possible to decrease this swelling with a cortisone injection, the intended result is not always obtained

Is it possible to get a good result in the patients having thick nasal skin?

The answer to this question is ‘yes’, but not always. Generally, all patients having thick nasal tip skin have had a better nasal structure compared to the pre-operative period, however, in some patients, the intended result cannot be obtained due to over-developed scar tissue and the inability of the nasal tissue to recover. Therefore, expectations of the patient having thick nasal tip skin should be reasonable and they should now that there is a risk of an unintended result. The operation of the patients with thick nasal tip skin is relatively risky in terms of the physician and patient. 

Some Points to Know about the Operation

In some patients, it may be necessary to renew the nasal plaster after 1 week. In other words, in patients having thick nasal skin, nasal splint, however, if the patient has pustulation at the nasal tip, this is not applied. It is similar to classical rhinoplasty except for the duration of the splint.

Doç. Dr. Burhan Özalp
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