The importance of assessing a patient’s nasal skin type in a physical examination is often a key component that is overlooked prior to rhinoplasty. Skin type assessment is critical in rhinoplasty and needs to be taken into consideration before surgery. During your consultation with Dr. Bared, he will perform a thorough physical examination of your nose which includes the assessment of skin thickness. By assessing skin thickness, a proper surgical plan can be developed as well as the proper expectations. Essentially skin thickness in the nose varies from very thin skin individuals to very thick skin individuals with most patients falling somewhere in the middle. Most patients fall into the category of “medium” thickness as Dr. Bared describes it. Skin thickness as are the other features of the nose are determined by one’s genetic makeup.
Why is skin thickness important to determine?
A patients skin thickness will determine what can and cannot be realistically accomplished from a rhinoplasty. Accounting for a patients skin thick will also shape the surgical plan for the rhinoplasty. Patients with very thin skin are at a higher risk for subtle asymmetries to be more evident. As the skin only provides a very thin coating over the underlying structure, patients with very thin skin are at a higher risk for subtle irregularities. The thin skin does allow for very nice, detailed refinement to be made to the nose. On the other hand, patients who have thick skin have a thick coating over the underlying structure of the nose. In these cases the patients are not at great risk for subtle irregularities as much as it is more difficult for refinements to become evident.
Thin skin patients
The rhinoplasty surgeon needs to take into account that the patient with very thin skin is at risk for these irregularities. Dr. Bared takes particular time and pays very particular attention when performing a rhinoplasty on patients with very thin skin. Dr. Bared will take the time in the surgery to prevent the appearance of irregularities and asymmetries in these patients by using certain camouflaging grafts and soft tissue in the rhinoplasty. He will avoid the use of certain grafts as well to prevent their appearance after surgery. In some cases, Dr. Bared may also use a thin layer of tissue from the temporalis muscle as a means to help prevent irregularities and asymmetries from appearing after surgery. If properly performed, patients with thin nasal skin can enjoy the refinements and changes made to the structure of the nose relatively shortly after their surgery and these refinements can be preserved in time as the nose continues to heal and swelling resolve.
Thick skin patients
In contrast, patients who have thick nasal skin can camouflage any refinements attempting to be made in the nose. It is therefore imperative that the rhinoplasty surgeon accounts for the thicker nasal skin. Dr. Bared attempts to make the most refinements to the nose in thicker skin patients by “stretching” the skin and thereby “thinning” the skin. Dr. Bared will try to project into the skin to create these refinements. If possible, he will avoid a reductive procedure. This concept may seem counterintuitive in that he is not taking away cartilage to make the nose appear smaller of more refined. But if you imagine a thick sheet covering a marble statue. The more that statue is reduced in size the less the shape of that statue will be evident from the outside of the sheet. However, if that statue stood taller, more “projected,” the more of the shape of that statue would be evident from the outside of the sheet.