MoreYouthful.com

You are unhappy with the look of your nose and are visiting your facial cosmetic surgeon for consultation. You tell him how you want it to look. We can come close to what you are asking for, the surgeon says. Honestly, however, there is a limit to what we can do because of the nature of your skin.

Nasal skin that is either abnormally thick or abnormally thin presents extremely difficult problems for the cosmetic surgeon. The more up-front the doctor is in explaining this to you, the more likely you will feel satisfied with minor changes if you elect to pursue the surgery.

As with all surgeries, nasal cosmetic surgery (called rhinoplasty), presents the patient with risks and rewards, thick or thin skin simply offers fewer rewards. If you are one of these individuals, the risk of trying to have the exact type of rhinoplasty you desire is great, and can result in a worse problem than you had to start with.

Thick Skin

While every person’s nose has skin that is a bit thicker at the base (at the opening of the nostrils) than at the root (between the eyes), the person with thick skin looks as though the skin has piled up at the end of the nose. This person can be identified by a heavy nasal base, with a somewhat soft, rounded tip. People with this kind of skin might long for a refined, angular nasal contour, but as a rule must accept the probability of only minor change through surgery.

Here’s the unfortunate rule: Thick skin stays thick and cannot be made thin. It becomes even more shapeless if the underlying skeletal framework is surgically reduced. Taking away the framework from skin is like reducing the tension on a rubber band stretched between two fingers. There will be a point at which the band no longer stays on the fingers. That point comes a lot quicker if you have thick skin, which has very little ability to contract and conform to reduced tissues below it. In that situation, the bottom third of the nose remains shapeless, smooth and poorly defined, a circumstance called supratip deformity. So, if you ask the surgeon for a smaller, sharper-looking nose, you will be disappointed in the reply: Any attempt to make a thick nose smaller can only distort it.

The good news is that you can have a nose with a degree of greater definition, just not a smaller nose. Contour definition can be gained by building up the skeletal framework in key areas. The surgeon can create tension by using internal grafts and other techniques that provide some shape. Strategically placed grafts can create an illusion of refinement.

Thin Skin

Whereas thick skin reveals not enough, thin skin reveals too much. Every detail of every skeletal imperfection shows through thin skin. Even structures within the normal range of contour may be unattractive without the buffer of normal skin covering. Stretch a tight body suit on a less-than-model-perfect body, every unsightly bump and awkward angle becomes highlighted.

Your surgeon must be extremely careful to avoid what is called a surgical looking nasal tip, where everything under the skin becomes visible, every little bend or buckle creates potential for a crease or for asymmetry (where one side of the nose looks out-of-balance with the other side).

To correct visible irregularities and to prevent the creation of additional ones, your surgeon may use grafts to supplement your nasal framework. He or she may also use spreader grafts to prevent the visible caving-in of the sides of the middle third of the nose. Spreader grafts, specially formed strips of cartilage usually taken from the nasal interior, hold open the vestibules, the part of the nose located just above the nostrils. In cases of imperfect framework or extremely thin skin, it may be necessary to insulate with crushed cartilage placed over the bridge of the nose or into the nasal tip. This thinly crushed grafting tissue softens contours and prevents visible irregularities.

If you have thin skin, your nasal surgeon will try very hard to preserve as much as possible of the cartilages of the tip of your nose, also called alar cartilages. This is the solid framework of tissue that forms the column between your nostrils at their opening, and spreads out to form the wings of your nostrils. It is also important that the surgeon does not cut across the alar cartilages and disrupt their continuity. Such incisions may distort by producing sharp edges and asymmetrical deflections.

Realistic Expectations

When consulting with your doctor about any kind of cosmetic surgery, but especially if your skin is thick or thin - this is the question you should ask: Is my aesthetic goal possible to achieve given the particular anatomical characteristics of my nose? You should also ask for before-and-after images of previous patients with noses similar to yours. If your surgical expectations are more realistic after this consultation, you and your surgeon may be able to justify the operation.

Share This