Feb 21

Why does my skin thickness matter?

Skin quality and thickness is one of the most important factors in determining your final Rhinoplasty result. And it can also be one of the hardest to predict. When we perform Rhinoplasty, most of what we do involves altering the cartilage and bone that makes up the nasal skeleton. We shape the cartilage and bone in many ways to take on the new desired contour. During the healing period for many months after surgery, the skin and soft tissue that lays over this skeleton must contract inwards and ‘shrink wrap’ onto this altered framework for the desired changes to become noticeable. That’s why you don’t see real definition for weeks to months after surgery while the skin and soft tissue is swollen.

Most people have skin of moderate thickness. The thinner your skin, the faster and better it will contract. So, if you have very thin skin, you can expect over time that a lot of definition can be achieved. This has obvious advantages but may also have its disadvantages. Thin skin will allow for a high degree of refinement but any tiny irregularities or asymmetries may also show through. This can be especially true if you have thin skin and very strong prominent cartilage underneath. You can recognize this in someone whose entire tip cartilage outline can be seen easily through the skin. We may recommend in certain circumstances using a layer of material such as fascia or acellular dermis (Alloderm) during surgery as a thin cover and concealer to help smoothen out your final look.

At the other extreme is very thick skin. Thick skin readily conceals any tiny irregularities. However, it can be much more difficult to achieve the desired level of definition and refinement because sharp lines and angles can appear blunted under a thick cover. Sometimes it is just not possible in this scenario to achieve very sharply defined features. There are some things we can do to improve definition, though. If your skin is very thick and you want increased definition, we may use larger tip grafts or dorsal grafts (on the bridge) to compensate. We may also judiciously thin out the fatty tissue under the skin, especially at the tip, to achieve more refinement.

Another potential pitfall occurs when a thick-skinned nose must be reduced significantly in size. Thick skin tends not to contract as much or as quickly as we might like after surgery. If the nasal tip or bridge is reduced too much, the space in between the reduced nasal skeleton and the skin can fill in with scar tissue over time. The result can be a nose that may be somewhat smaller, but is amorphous in shape and poorly supported. It tends to look a little ‘blobby’ once healed and patients often end up unhappy because they wanted a small, refined nose instead of a small, unrefined one. To avoid this outcome, we will usually recommend reducing your nose a little more conservatively in this situation. Thick skin requires more support, so leaving a strong nasal framework is an especially good idea in this setting. A very nice and dramatic result can still be had and a moderately smaller, but refined, nose will tend to look much better for you. Sometimes we can push along the skin shrinkage with steroid injection and having you tape your skin at night for an extended period after surgery to achieve the optimal result. It’s important to keep in mind also that thicker-skinned patients will usually take longer to see the degree of refinement they want, sometimes up to 2 years or more after surgery.

The good news is that an experienced Rhinoplasty surgeon can get a good sense of your skin type, thickness, and quality during your assessment, and give you a very good idea of what results can be expected or achieved. Your skin thickness should also be taken into account during surgery when changes to your nasal framework are made. This will render post-operative healing more predictable.

If you have particular questions related to your skin thickness, feel free to post them and we’ll get back to you as soon as possible.

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59 comments

59 Comments so far

  1. Antonia June 12th, 2008 4:26 pm

    Dear Beverly Hill Rhinoplasty,

    I had a 2nd rhinoplasty done in Sept 07, I was happy with the width & height of the 1st outcome, but there was a bump & uneven tip. The 2nd surgeon took down the bump, but much to my horror increased the size of my nose with AlloDerm. I thought that it was swelling until I received the op. notes. And indeed she noted that the goal was to make a larger nose. I am very upset, is there anything that can be done to return my nose to the width & height I had when I went into this? Thank you

  2. Admin June 15th, 2008 5:28 pm

    Dear A,

    It is often possible to reduce the nose and make it
    smaller, even in revision. Considering the alloderm was placed about 8-9 months ago, you may be finding that with time the alloderm is slowly resorbing on its own.

    Our concern is that you said the operative note said the intent of surgery was to make your nose bigger. If that is the case, its less likely that the alloderm is the main reason your nose is bigger. Lastly, and perhaps most importantly, remember that this was your second
    surgery and often the swelling takes much longer to resolve in revision, so you may just need to be patient.

    Feel free to contact us via email or phone and send us pictures or come in for a visit, so we can better help determine how we can help you.

  3. Antonia June 21st, 2008 10:53 am

    Thank you very much. The op. notes states that the implant was placed along the bilateral dorsum, and that the irregularity at dorsum was reduced with a rasp. A pocket was created to insert the alloderm. I was hoping that the alloderm could be removed & my nose would go back. But I have noticed that my nose feels very bumpy, and still quite painful. I am making an effort to be patient, but I am very unhappy with the way it looks. Thank you again. Your help has been much appreciated.
    Antonia

  4. Admin June 21st, 2008 11:41 am

    Dear A,

    Operative notes can help, but they don’t always tell the full story. You mention feeling some bumps. Alloderm may have been used in your case to cover any grafts or small bumps, even after trying to smooth out the dorsum with a rasp.

    Alloderm works by providing some thicker cover over thin areas. Eventually, it is mostly absorbed and replaced by scar tissue. So, unfortunately it can’t just be removed as you had hoped.

    We know it’s hard to wait to be happy with your nose, especially the 2nd time around. But, 9 months is still a little early. You may find over the next 3 to 6 months that things start to settle down and smoothen out, and that your nose continues to get smaller. Sometimes, taping your nose at night can help this go faster.

    Feel free to send us some pics. They won’t be posted. If you’re close by, drop in so we can talk about your concerns in more detail. We hope you’ll be happy, but if things are moving in the wrong direction, rest assured that improvements can usually still be made.

  5. Antonia June 26th, 2008 4:24 am

    Thank you very much. I am in MA so I can not stop in. I really appreciate all of your help. This has been difficult for me. I really hope that it does get smaller, but I do not think it will be as small as when I went in. She did make a statement to me that it is not as large as it was, but closer to it(my God given nose). That was not the goal at all. She also stated in her op notes that the patient wanted to return to a larger nose. This is why I am so upset. I never wanted that, and even if this nose does get smaller, it was not designed to be as small as it was. I will need further surgery. Which is very emotionally taxing & expensive. But at least I have hope that I am not stuck w/this. All of your advice has been very helpful. Thank you so much for listening & trying to help!

  6. elise January 11th, 2009 8:58 pm

    I just had rhinoplasty and was informed I had “thick skin” and couldn’t achieve a huge difference, which upset me a lot because I’ve wanted to get this done since I was 12 and I’m 26 now. I always knew I;d be prettier with a little bit smaller less projected nose. Anyways my surgeon did osteotomy (to make it less wide) and other things, but I’m scared i’m going to be dissapointed because of this thick skin thing! I have minimal bruising under my eyes which makes me worry because shouldnt you bruise A LOT if your bones were broken in your nose? The computer imaging results he showed me were nice, not perfectly how i wanted my nose but i know that might not be possible. But I was still happy with those image resluts, but I;m afraid it might not even be close, he said I’d be happy to please, but if he could get to those results I will be happy. I know when he takes the splint off Its going to be swollen and I will be upset, I still think the tip looks too long or big but i know it’s stil very swollen. When can i compare my results to the computer and see how close they are?

  7. Admin January 20th, 2009 7:42 am

    Dear Elise,

    I’m sorry it has taken so long for us to get back to you. By now, I suspect you have gotten your cast off and hopefully you are happy with the results your surgeon was able to get you.

    In answer to your questions:
    1. The vast majority of our patients have minimal if any bruising, though we do osteotomies in the great majority of our patients. It is not necessary that you bruise and if the fractures are done correctly you can often be spared heavy swelling or bruising, so you not bruising may be a good thing.

    2.If the tip still looks too long/ projected after the cast goes off, it is a question of degree. Obviously, there is a bit of swelling that takes months to subside and in general by 3 months after surgery you are very close to your final result and should be pretty close to the imaged pictures. If it is not much different than before surgery, it is possible your surgeon did not de- project you, and this will likely not change with time.

    We sincerely hope this helps answer some of your questions. Feel free to email us or call if we can be of more help.

  8. Ron October 31st, 2009 10:11 pm

    Thank you very much for taking the time to post this valuable information!
    How do you define “thick” skin?
    What are the characteristics of an individual with thick skin?
    Is thick skin more prevalent in certain ethnic groups? If so, what groups?
    The thick vs. thin skin debate seems to be a nagging question among rhinoplasty patients, but I have yet to read a definition of “thick skin”. How can one determine if they have thick skin?
    I hope you can take the time to answer my question.
    Thanks again!

  9. admin November 1st, 2009 11:51 am

    Hi Ron, thanks for your insightful question. There is no textbook definition of thick versus thin skin. It is a ‘feel’ thing that surgeons learn with experience after evaluating and then operating on many noses. It should be noted that we are not just talking about the skin itself, but the thickness of the fibrous/fatty tissue pad beneath the skin that overlies the nasal cartilage. Thin skin contracts and heals faster after rhinoplasty and may show more detail of the cartilage underneath, whether good or bad. Thicker skin takes quite a bit longer to shrink and achieve final contour. We may encourage a more defined look by thinning the fatty tissues under the skin in some cases.

    Most people will be able to tell if they have oily, sebaceous skin. These skin types tend to fit into the ‘thicker-skinned’ category. So, some Caucasian noses may be more thick-skinned than others. Geography has a lot to do with it. Caucasians of more Northern ancestry for example, such as the British Isles, usually have thin skin. Those from more Southern regions, such as nearer the Mediterranean, will tend to have thicker nasal skin.

    In general, patients of other ethnic groups, including African, East and Central Asian, and Hispanic origins fall into the thick-skinned category. Of course, there is a huge amount of variation within groups. So, your best bet is to visit your prospective surgeon and find out where you fit in.

  10. Jessie April 14th, 2010 8:28 pm

    I had a revision open-rhinoplasty in Dec 2008. Post=op I was EXTREMELY (freakishly) swollen. I am now about 16 months post op and while I am for the most part happy, the lower 1/3 of my nose (tip) is still swollen (which does fluctuate – sometimes more swollen than other times – with temp, etc).
    I had a knobby tip that remained after the first surgery and the main goal of the revision was to refine the tip and get rid of the “knobs”. However, now I feel like my tip is bigger and less defined – esp in the supratip – than it was before (althougth the “knobs” are gone and the overall look is more streamlined). It also seems to be more swollen/puffy (the skin isn’t shrinking) on one side more than the other (apparently he did more work on this side).
    It can look (esp in photos with flash) very amorphous and bulbous. I was told that my skin isn’t necessaryily thick but is just having a very hard/slow time contracting around the structure. My Dr. said I looked great on the OR table and just thinks I am having a very slow (rare) healing process and it eventually will get better. I have had a few laser treatments to help tighten the skin and move the healing process along – they did help a bit.
    But I’m starting to lose hope and it’s a bit depressing…Any insight?

  11. admin April 15th, 2010 12:47 pm

    Hi Jessie,

    I’m sorry to hear you’re still having issues with healing after rhinoplasty. In people with thick skin or if the tip was deprojected a lot, it can take a long time for the skin to shrink and settle appropriately. Revision cases may take even longer. The fact that you are still noticing some fluctuation is a good thing. If you like the way your tip looks when it is least swollen on good days, then you should find that it continues to settle to that level with time.

    If not, I would suggest you take your concern up with your surgeon again. The key is to try to help the skin wrap quickly enough so that it does not encourage scar tissue to be layed down in the intervening space. It may be that steroid injection will still be helpful even over a year after surgery, although less so than in the first few months. If your surgeon does not seem to be addressing your concerns, another opinion may be helpful at this point.

  12. naomi April 16th, 2010 11:05 pm

    I had rhinoplasty surgery exactly 7 weeks ago. There has been no change in my nose at all. My main concern has always been the width of my nose(I am African American). Post surgery, my nose is exactly the same. I know there might be swelling but shouldn’t i be seeing a difference no matter how minor? Pre-surgery my surgeon said I had think skin.

  13. naomi April 16th, 2010 11:06 pm

    meant to say THIN skin

  14. admin April 19th, 2010 12:58 pm

    Hi Naomi,

    How much of a difference you are seeing now really depends on how much was done during your surgery. In most cases of rhinoplasty in African Americans, the nose was narrowed enough that you should be seeing some improvement at this point. It may still look puffy without as much definition as there will eventually be, but by 2 months you should be starting to appreciate the change. If the goal was a less dramatic change, it will take longer to see the intended result. Talk to your surgeon. We have found that early intervention works best to help thicker skin settle faster.

  15. samiera j June 19th, 2010 1:23 am

    hi. i had rhinoplasty surgery done 10 days ago. i used to have a large nose and my main issues were the width of my nose which was very wide and the tip, which was HUGE! after surgery i can see a difference in the width but im still concerned about the tip. my doctor says i have “thick skin” so he could only work with as much as was allowed. the tip and centre of my nose look very round. this bothers me. could this be due to swelling? my nose is still quite sore. when will i start to see a difference? i’m beginning to get depressed… thnak you.

  16. admin June 21st, 2010 8:43 am

    Hi Samiera,

    Thanks for your comment. The best thing to do is talk to your surgeon to get an idea of exactly what was done to your tip and what sort of change you can expect. At 10 days, you still have a lot of swelling that needs to settle. Check out our blog on swelling http://www.rhinoplastyinbeverlyhills.com/swelling-after-rhinoplasty and you’ll see that there is still noticeable swelling a few months after surgery with a lot more definition achieved after one year. With thick skin, this can take a little longer depending on what was done. So, have faith and talk to your doctor. All the best.

  17. Lynn June 25th, 2010 12:41 am

    I had an extensive open septo/rhinoplasty a year and a half ago. I had my nose deprojected, a dorsal bump removed and the tip narrowed/balanced a bit. The biggest dissapointment I am feeling is that my tip is bigger and less defined than before. Is there a possibility that it could improve on its own? What could be done if it doesn’t. I used to have what i would describe as a narrow, defined, pointy tip, now its big and round and less defined. Help!

  18. admin June 25th, 2010 7:50 am

    Hi Lynn,

    Sorry to hear your result is not what you had hoped it would be. An apparent loss of tip definition usually happens when the surgeon either did not support the tip adequately or tried to deproject the tip too much. As a result, the skin can’t drape appropriately on the tip cartilage and instead looks round and lacking in shape. After a year and a half, you may not see much more spontaneous improvement. Steroid injections may help but usually not dramatically. At this point, you might look into options for revision. The good news is that your nose can most likely be revised to achieve the definition you want. Feel free to send us some photos on our contact page http://www.beverlyhillsprofiles.com/contact-us and we can set up some time to talk.

  19. Annalee July 8th, 2010 4:34 pm

    I had my rhinoplasty 2.5 months ago. I found comfort in this article as my skin is very thick and the reduction was moderate. I also found substantial supportive evidence in the truth that the swelling changes by taking post operative pics with my cell. My tip is much more swollen today than it was a month and a half ago. Proof that there is a healing process happening.
    The best thing I have taken from this article is to continue to tape my nose. I find this greatly supports the framework and takes away the strange shifting sensations and discomfort. Also I had no idea that my scenario is a potential candidate to develop blobby scar tissue. We are always rushing things and want immediate results. We need to give our bodies a chance to heal. I was wondering if continuing to use an ice pack at night when my nose is peak swelling would be useful?

  20. admin July 8th, 2010 7:07 pm

    Hi Annalee,

    Thanks for your comment. I’m glad you found the article helpful. Icing your nose at this point is not really going to do much. It may temporarily shrink the tissues a bit so it might be helpful to use before an event. We recommend instead to tape for a night or two before an event where you are taking photos. We would completely agree that giving yourself time to heal is a great attitude and sometimes the hardest thing to do. All the best.

  21. Mike July 26th, 2010 8:24 pm

    Hello,

    Over the past twelve years, I have gone through a few nasal surgeries. In 1998, I had two rhinoplasty surgeries performed primarily to narrow the bridge as much as possible. At first, post surgery, my nose looked perfectly narrow and thin. I was told to massage the nose, but my doctor did not spend a great deal of time instructing me on how to perform the exercises. As a result, my nose began to widen (which is extremely frustrating because it looked perfect). In 2002, I had an implant placed on the bridge of my nose (I met with a doctor and he thought my skin would drape better if an implant was inserted). My nose looked narrower, but I still wasn’t 100 percent satisfied. Approximately 3.5 weeks ago, I underwent another rhinoplasty in which another doctor performed ostetomies on my bridge to narrow it more. My bones feel narrower at the breakage point, and in certain lights, my nose appears narrower, but in other atmospheres I don’t feel like my skin is draping the way I would like it to in order to achieve that narrow / refined look. My doctor injected a steroid two weeks ago and said the cortisone would manifest itself in my nose and the effect would come over time. I think this time around, I have been performing the “nasal exercises” correctly, but I’m still concerned that the skin is not draping around my nose the way it should be. Would taping the nose at night help? Any feedback would be greatly appreciated and perhaps we could set up a time to chat if you are available. I’m a little depressed that I don’t quite have the result I want.

  22. admin July 27th, 2010 9:30 am

    Hi,

    The fact that your bridge feels narrower and looks better in certain lighting is an encouraging sign. The steroid injection should help the swelling go down faster. We do find taping helpful for our patients, not in improving the overall result but in getting patients there and feeling socially comfortable a little bit faster. Talk to your surgeon about taping and other efforts to improve your healing. If you still feel that your result is not as expected after about 6 months, that would be an appropriate time to start talking about your options. All the best.

  23. Mike July 27th, 2010 11:10 pm

    Thanks – I saw my doctor today and he said that I have done a great job exercising my nose over the past three weeks, and that my bone is maximally narrowed (if he uses two fingers to slowly pinch the point of breakage, it takes him a couple of seconds to find the bone due to the space between the skin and the bone. His thoughts are that the skin is going to drape much more. In three weeks, he said he’d inject me with another steroid in higher volume (not stronger dosage) around the walls of my bridge, etc.

    He didn’t think taping would help me. As of Thursday I will be four weeks post op. How much can I really expect my nose to drape to give me that really narrow effect which I desire? Just curious to hear your thoughts

  24. Emily August 5th, 2010 2:51 am

    Hey, i just got my septo-rhinoplasty done on the 3rd of august and i was told i have thick skin and i wont be able to get a very defined tip. However, i can see the tip of my nose and it looks lifted up a bit too high and my nostrils look larger and wider.. Is this normal? I’m starting to worry my nose will look like a pigs nose :/ i just turned 18 and i hope i didnt make the worst decision of my life yet. Please help!! Thank you!!!!

  25. Uniska August 19th, 2010 11:42 pm

    First I enjoyed reading your article and going through your website.I had rhinoplasty/septoplasty 9 days ago. I used to have dorsal humps and my nose was overall crooked. Even though I see a drastic change in my nose shape, the thing that is bothering me is my nose tip. It is extremely round and bulbous. I know its swollen because its very stiff and hard. Im afraid its going to take way too long to go down and i also read some intimidating stories online where people had the same problem and it never changed. Is that possible? The swollen tip makes my nose tip look very fake and plastic-like. Is there any thing i can do to speed up the healing process such as taping it?
    Thank you so much!

    U

  26. admin August 22nd, 2010 4:51 pm

    Hi Uniska,

    We’re glad you enjoy the site. At 9 days after surgery, there is still a fair bit of swelling that needs to settle. If your tip is far more swollen than before surgery, I would suggest paying a visit to your surgeon to be sure all is healing as it should be. Taping can be helpful but talk to your surgeon first. All the best,

  27. Pam August 23rd, 2010 6:15 pm

    Hi!

    My daughter had a second rhinoplasty about 7 weeks ago. Her tip is still hard. My question is… will the length of her nose (profile) shorten as the swelling goes down? Does it take longer for swelling to go down the second time. Can the swelling in the tip cause it to look like it is drooping?

    Thank you so much!
    Pam

  28. admin August 24th, 2010 5:07 pm

    Hi Pam,

    I hope your daughter has a terrific result. It can take longer for swelling to settle after a second nasal surgery. While that is the general rule, it really depends on what was done during the procedure. Likewise, it is possible for the tip to rotate upwards or downwards slightly after the procedure depending on what was done. Your best bet is to speak to your daughter’s surgeon to determine exactly what was done and what you can expect in terms of tip changes. In the first few months after surgery, swelling in the tip and the infratip (the area just below the tip) can cause that area to look more full. It should flatten and settle with time. Hope it works out great for you.

  29. michelle November 23rd, 2010 7:57 am

    i had rhino plasty 8 days ago,my dr. took off the stint and nasal cast.it looked pretty good..but than a couple of hrs later..it looked as if i hadnt had anything done..im confused..i am of african american..with a really wide width and a big bubble in the middle..im feeling fustrated and depressed at this moment…my nose looks like it did before i went in..why the drastic change after a couple of hrs?

  30. admin November 23rd, 2010 9:01 am

    Hi Michelle,

    One of the reasons we wrote this blog is to make people aware of skin thickness issues. In many African American noses, there is typically a thick pad of fatty tissue beneath the skin that contributes to the sense of width and fullness. If this is not addressed during surgery then you would probably not achieve the level of definition you are seeking.

    That being said, you are immediately post-op and much of what you are seeing is just swelling of the tissues that was being reduced by the splint. If you liked what you saw right after the splint came off, you will likely get back to that place or hopefully better. The best person to talk to at this stage is your own surgeon as he or she can answer your concerns based on what was done during surgery and can give you an honest sense of what to expect as healing progresses.

  31. C December 30th, 2010 9:32 pm

    Hi – I have thin skin and am 7 months out from rhino and septo plasty. There seems to be scarring on the side of my nose and on the top of my nose on the bridge. It looks terrible when there is light shining down. Is this something that will go away with time? Or do you think it might be the underlying cartilage? Any thoughts would be greatly appreciated. Are there procedures that can eliminate such scarring?

  32. admin January 11th, 2011 9:40 am

    Hi C,

    Without photos, it is impossible to tell you what you are seeing. It is not likely to be scarring unless there was some skin breakdown during the healing process. It is more likely that you are seeing some irregularity in the underlying cartilage or bone. This is more of an issue with very thin skin, but it can be corrected if it does not improve with time.

  33. Will Ames March 19th, 2011 3:03 pm

    Hi,

    I had a Rhinoplasty on September 30, 2009. I’m African American, 22 and it’s been 15 months since then. The rhinoplasty involved a deviated septum with no support and removal of a nasal bump I got when I smacked my nose as a kid and shaving the sides of the bridge. The nose has changed quite a bit since then, the swelling has gone down but there seems to be some residual swelling. I understand 18 months is about the time when about 90+% of the swelling should be gone? The nose drapes over the bone well, and I’ve noticed the swelling going down over the months but in the middle of the bridge, it seems swollen. Especially when I scrunch my nose, It’s as if the skin folds and there are pores galore. My main question is should this swelling worry me? Or should I give it maybe 6 more months to a year, which would mke it 30 months post op.

  34. admin March 22nd, 2011 9:31 pm

    Hi Will,

    You may not see a whole lot of change after 18 months in terms of skin contraction. In African Americans, it is important to use techniques that ensure the skin will be able to shrink and drape as much as possible around the tip and bridge in order to gain as much definition as possible. At this point, it may be time to revisit with your surgeon for advice as to what you can expect and what can be done to address your concerns.

  35. katie deja March 22nd, 2011 9:46 pm

    Hi,
    I had a rhinoplasty two and a half years ago and it appears where my dorsal hump was rasped down there still is a fluctuation of swelling. I also had the tip reduced and i feel it is a bit droopy and was actually made to thin. Can i still have swelling going up and down at this point in the dorsal hump area? It was also interesting, I was put on prednisone and an antibiotic for skin problems and during the month I was on it I had no hump so did the steriod reduce the swelling by chance? Sometimes my nose looks like no hump and other times it seems it comes back. What should I do? My surgeon said he could rasp it more but Im not really happy with the way he did my tip and first dorsal rasping so Im not sure I want to let him do it again Im afraid he might make a mistake again.

  36. admin March 22nd, 2011 10:14 pm

    Hi Katie,

    Significant fluctuation in swelling should not really be seen at two and a half years after rhinoplasty. Depending on what was done during surgery (and only your surgeon can answer this), it is possible that the skin has not been able to contract fully and wrap tightly again onto the underlying cartilage and bony framework of your nose. In this case, the skin appears ‘loose’ and anything that causes you to retain fluid in your skin may contribute to some apparent swelling. Likewise, anything that causes skin tightening will temporarily make the fullness appear to go away. Definitive treatment involves making sure that there is enough structure and support to your nose to allow the skin to redrape appropriately. If you no longer trust your surgeon to answer your needs, it may be time to seek another opinion. All the best.

  37. Sarah April 6th, 2011 12:00 pm

    I had rhinoplasty 2 months ago to fix my humped nose. My nose was really big with a big curve towards the bottom (looked like a beak). Because my nose was so crooked, I didn’t want people to notice so I told him to make it slightly curved. We didn’t really talk about the size of the nose and there was no digital picturing to know exactly how it’s going to turn out (made me real nervous). So far in 2 months the shape is much better but I feel like the profile is too big from the side. Is it the swelling? Will it shrink a lot in the next few months?

  38. admin April 8th, 2011 1:46 pm

    Hey Sarah,

    Yes, at 2 months after surgery, there is still a good amount of swelling, often in the area just above the tip which can make it look like it is still full in that area. Best to talk to your surgeon to see if he deprojected the tip at all (i.e., brought the tip in closer to your face). If you hadn’t discussed it much, it may not be something he planned on doing for you.

  39. Natalie April 11th, 2011 5:23 am

    Hello, I hope you can help me. I had a revison Rhinoplasty nearly 1 year ago now. After just 1 week of having it done my face felt like it had dropped. It it possible that when my bump was removed and the nose brought closer to my face that it made my whole face go downwards too? It is making me very unhappy, I just don’t understand what could of happened??

  40. admin April 11th, 2011 1:53 pm

    Hi Natalie,

    Your facial skin should not droop after rhinoplasty. If the nasal bones were brought in a lot during rhinoplasty, it may sometimes make the slight hollows under your eyes appear to start closer to the nose, although they should not deepen. Also, if a large bump in a dominant nose was brought down a lot, it may sometimes change the way your new nose appears in relation to your other facial features now that your new nose no longer dominates your face. While it can take some people a short while to get used to this change, by about 2 months after surgery, most people are accustomed to it. If you are still finding that your nose looks somehow ‘off balance’ with your face, we would suggest talking to your surgeon or to another revision surgeon to see why it appears that way to you.

  41. Natalie April 21st, 2011 3:45 am

    Hello,

    Thank you for coming back to me. Is it not possible that if the surgeon was too agressive and damaged either blood vessels or nerves whilst doing my operation that it could have affected my facial muscles or fat causing it to sag?

    Natalie

  42. behrouz May 5th, 2011 10:04 am

    Hi there,

    I was told by two rhinoplasty surgens that I have thick skin and the size of my nose can’t be reduced much. I am really disappointed since I have a very large projected nose with skin bump at the end. The dr mention he can only remove the bump and reduce the tip by a little bit. This doesn’t reduce the projection.

    Are there any new procedures that can help people who have thick skin? I am suprised that there is not much that can be done with today’s technology.

    Also since thick skin doesn’t shrink, can the surgen reduce amount of skin?

    Thanks,
    Bruce

  43. admin May 5th, 2011 2:45 pm

    Hi Behrouz,

    We have found that even in thicker-skinned patients, it is possible to achieve a good amount of deprojection and definition. You should consult with surgeons who have a lot of experience with ethnic rhinoplasty. That being said, it is important to be realistic about what can be achieved with imaging and the compromise is sometimes not quite as small as you might like. But, you should be able to achieve a very meaningful result.

  44. Joe September 6th, 2011 3:54 pm

    Hi Drs,
    I had a primary rhinoplasty 1.5 yrs ago, which was mostly tip augmentation work; Tip Grafts were place and a columellar strut for projection. However after this time, I still find the tip over-rotated from the side profile, and the nose short from the front. I am interested now in a revision to bring the tip down and possibly a touch less projection. I believe my skin is on the thicker side. Do you think this is possible? Will more grafts be needed, or just adjustments of the current graft/struts? Any other information would be greatly appreciated

  45. admin September 7th, 2011 8:31 am

    Hi Joe,

    Yes, this can absolutely be done. It is possible to have a more detailed discussion with you after seeing photos and examining your nose. Sometimes, it is as simple as rearranging the current grafts. Other times, it can be more involved. An exam will be more informative.

  46. em September 14th, 2011 12:47 pm

    Hi,
    I had a closed rhinoplasty 7 months ago. I only had the tip reduced. When the cast was taken off after 7 days my nose looked amazing. About two hours after it became swollen. Now it’s been 7 months, and although the swelling has gone down slightly, It looks almost exactly the same as it did before the surgery. I can’t tell a difference. I’m freaking out. My PS said i have thin skin. I just don’t know what to do!

    Any advice would be greatly appreciated.

    thank you
    x

  47. admin September 16th, 2011 11:35 am

    Hi Em,

    It’s hard to say what is going on without examining your nose. We always recommend talking to your surgeon if you are unsatisfied to get an explanation of what was done during surgery and what you can expect going forward. Very often, your surgeon will best be able to answer your questions and take care of any problems. If you remain unhappy despite that, feel free to send us some photos through the Contact Us page on our main site.

  48. Evangelina November 2nd, 2011 5:08 pm

    Hi I have had two revisions done over the past 7 years but both times having been without good results.I under went an alar reduction. I experienced severe scarring on one side of the base due to oil being traped on the base line creating deep pores. My skin is very thick and oily and I believe this influenced the results. What can be done to prevent this from happening? What could have been done to prevent this?

  49. admin November 3rd, 2011 11:47 am

    Hi Evangelina,

    You’ve asked a great question. Patients with thick and oily/sebaceous skin can take longer to heal after nostril reduction. Depending on how it was done, they can also rarely experience less favorable healing with a visible scar though this should generally be preventable. In your case, the nostril scarring can sometimes be improved with a revision procedure or resurfacing with dermabrasion. Best to have an experienced surgeon take a look at your nostrils for a more detailed opinion. All the best,

  50. .Ann January 12th, 2012 10:00 pm

    I am a white female around 40 and had a reduction 1 yr ago. My Dr. narrowed my bridge and reduced my overall size. When the splint was first removed I loved how narrow my nose looked and figured the next morning change was swelling and would reside, however this is not the case. Why would my bridge become wider? I have thick skin and had a revision 6 months ago as I had developed a huge bump on top of my nose, I am figuring this is still swollen? My nose didn’t have the changes I had hoped because of the skin thickness but how does that effect the width change? Could I still have swelling?

  51. admin January 13th, 2012 2:42 pm

    Hi Ann,

    I’m sure you still have some swelling if you had a revision six months ago. You should talk to your surgeon about expected healing at this stage. There is a small possibility that the bones can widen as they are healing, but your surgeon can tell you for sure if this is the case.

  52. .Ann January 14th, 2012 3:52 pm

    Thank you for your advice, I will make an appointment and talk w/him. I wonder how small the chance of the bones widening are and you would think if your nose is broke and set unless hit it you would be good to go. Unfortunate and I hope that isn’t the case.

  53. PinkRose February 10th, 2012 5:58 am

    Hello,
    I am a 22 y.o. woman. I had a revision rhinoplasty 1 year and 3 months ago. My first surgery was quick- the doctor just put in a silicone L-shaped implant and was finished. Overtime I found all sorts of problems with it (including that it was too large & bulky for me) so I had the revision. The implant was replaced with my own ear cartilage and I also had an alarplasty.

    I am still unhappy with my nose. I am fine with the height (I am of part-Asian descent btw, just in case you haven’t figured it out), but I am having huge issues with the definition and width. It just looks like a blob to me. What I liked about the silicone was that it gave better definition.

    Now, my tip is still so big and wide. I have always disliked my nose and after 2 surgeries I still do. My nose does not fit my other delicate features at all.

    When I squeeze my nose, it feels like there is a layer of fluid or fat under my skin covering up the cartilage. I have also just found out that I have some scar tissue hanging from inside my nostrils, but I am unsure if what is inside my tip is indeed scar tissue. I heard that Kenalog should’ve helped with scar tissue/swelling in patients with very thick skin like myself. However, my doctor never offered it to me until at the 1 year mark. I heard from some doctors that steroids will no longer be effective past the 1 year mark. I want to get the shot now from another doctor since I have relocated and my surgeon and I are no longer in contact. Should I go for it or not? How can I tell if I have scar tissue or not? Will my nose ever narrow down?

    Thanks for your help!

  54. paul April 2nd, 2012 2:39 pm

    hello drs,
    Heres a question ive never seen asked anywhere online.Will a steroid shot reduce scar tissue that would never go down on its own ,or does it just accelerate a process that would occur naturally given enough time?Thing is ,ive had my 5th nose job and second open op 8 months ago and the swelling is terrible but hard,not fluid variety.Surgeon is extremely renowned nose man and wants to inject but says it will eventually reduce by itself anyway if I wait.Id rather wait to be honest.What does the clinical evidence say about this issue,ive never seen an answe anywhere.

  55. admin April 18th, 2012 1:06 pm

    Hi Paul,

    That’s a great question and one that I don’t think anyone will have a definitive answer for. It is very hard to study how steroids would alter the natural course of healing since swelling does tend to resolve on its own over time, even without the steroid. In my opinion though, steroid injections do speed the course of healing and do, in some cases, help the skin to contract down to a level that it otherwise might not have reached. I hope you have a great result.

  56. Rola November 20th, 2013 2:32 am

    Hello Drs,

    Hope you’re well.

    I had my open septorhinoplasty on 6th of August (16 weeks ago). No one can tell the difference as it is very subtle. I had a very small bump rasped, straightened my septum, slightly reduced a bulbous tip and had an osteotomy. When I look at my nose now I still feel like it is bigger than before maybe not bigger overall but theres something bulky about the lower 2/3rd area. Especially in pictures this is very prominent. I know there is still swelling but is swelling post 16 weeks significant enough to make my nose less bulky in due time? and how long does that take usually with medium skinned patients?

    Another question I have is regarding a scar on my nose. No doctor has been able to help me with this issue yet. I fell 2 years ago (before surgery) on my nose and ripped open the skin on my nose, on the bridge in the centre of my nose above my tip. Since that area is very tight (skin on bone) I developed a raised thick scar that was very lightly pink for a few months but is now exactly the same colour as the area surrounding it. This thicker skin changed the shape of my nose and is now more prominent since my bump has been gone after rhino because the lower bridge seems to have a hump but it is only skin thickness. My doctor suggested injecting Kenacort in the area but at 6 months post op. Will that help from 1 injection? or do I have to keep doing it. Also – I started using Cica-Care silicone sheets 4 days ago. Will this help reduce the bulk of thick skin?

    Sorry for the long explanation and I would really apprecite you response!

  57. developer November 20th, 2013 9:22 am

    Hello Rola,

    To answer your first question, it is common to have some swelling even at 4 months post rhinoplasty and, if your original goals were for a very subtle change, it may be that you are not seeing much of a difference yet. Swelling should continue to settle with time and hopefully you will have achieved the change you set out to accomplish.

    For the raised scar on your nose, there are a few options. Silicone sheeting works very well- there are some available over-the-counter and some available as gels (often combined with steroid or other medication) from your doctor. They can take several months to see a response but should help the scar to flatten over time. Steroid shots with Kenalog or other steroid can be effective but often require multiple treatments over several months to achieve the result you are looking for. Finally, some lasers, especially a pulsed dye laser in our opinions, have been shown to effectively reduce scar redness and thickness.

    That being said, all of these options are going to be less effective 2 years after the injury as opposed to sooner afterwards. If you are not getting enough response from these treatments, it may be advisable depending on the scar characteristics to consider scar revision or resurfacing. All the best.

  58. Yam June 15th, 2014 9:38 am

    Hi doctors,
    I had open rhino last april 21,2014. Ps harvested nasal septum to increase tip height and projection (columnella strut) and sutured ear cartilage graft above it perhaps for tip definition. Also place about 2.5mm gortex in my dorsum. Due to severe depression and psychological issues ( regretted having surgery and dying to have nose back pre op and too scared also for infection and gortex is hard to remove when if it stays a long time, PS agreed to remove it on july 4, 2014. So it will be just 2.5 months from primary. Ps only knows how to do open approach so my columnella will be opened twice. My ps said my nose will just go back to pre op state. My question are: 1. given the note above, is it likely that my nose will go back to pre op state? 2. As my columnella is still stiff at that time, will it give me a big risk for columnella? 3. Since all i want is removal of all these grafts, will it swell more than primary surgery? 4. These grafts made me feel sooo uncomfortable( very stiff and tight ), removal of these grafts may alleviate the tightness and stiffness i feel? Thank u so much doctors. I hope u can enlighten since my doctor does not really give me detailed answers when i ask. I am also trying to check if surgeon is just giving me false hopes. Thank u

  59. developer June 16th, 2014 7:50 am

    Hello Yam,

    It is hard to comment on your specific circumstances without examining your nose and getting a more detailed understanding. I would advise you to think carefully about your motivations for wanting your nose revised and the grafts removed. There is a healing period after rhinoplasty during which patients occasionally have a difficult time adjusting to the change. In truth, it is hard to know sometimes in the first month or two after surgery whether you will ultimately be happy with the outcome since there is always some swelling, stiffness, and numbness that can cloud the picture for you. The stiffness does settle with time. The swelling resolves. Remember there was something about your pre-op nose that you wanted to change. You might just find that you are happier with your new nose a few months from now. You can consider revision at any point without issue- it is not harder to remove gortex later rather than sooner. You can get back close to your pre-op appearance but, before you do that, I suggest having a more meaningful conversation with your surgeon so he or she can better explain to you exactly what you can expect as healing resolves. If you still have your mind set on revision, then you can proceed with a better understanding of expectations. We wish you all the best.

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