When you are considering a rhinoplasty, one of the things that your plastic surgeon will discuss with you is skin thickness. Nasal skin thickness is a key factor to consider when planning your surgery, as it can affect the final results. In this article, we will explain what skin thickness is, patients with thin skin vs. thicker skin, and how it can impact your surgery.
The importance of assessing the nasal skin type in a physical patient examination is often a key component overlooked before rhinoplasty. Skin type assessment is critical in all forms of nose surgery.
Essentially, skin thickness in the nose varies from very thin to very thick. Most patients fall into the “medium thickness” category, as Dr. Bared describes it. Skin thickness, and other features of the nose, are determined by our genetic makeup.
During your consultation with Dr. Bared, he will perform a thorough physical examination of your nose which includes the assessment of skin thickness. With this assessment, he will set a proper surgical plan and the kind of results to expect.
Why is Skin Thickness Important to Determine?
The type of nasal skin a patient has is one factor that influences the rhinoplasty outcome. In a nutshell, the nasal skin thickness may or may not limit what the doctor can achieve surgically.
How thick or thin the skin on the nose is will also shape the surgical plan for the rhinoplasty. Patients with thin skin are at a higher risk for subtle asymmetries to be more evident as the skin only provides a thin coating over the underlying structure. A nose with thin skin does allow for a detailed refinement to be made.
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 risk for subtle irregularities as it’s more difficult for refinements to become evident.
What Makes Nasal Skin Thin or Thick?
The skin on the nose is very different from the skin elsewhere on your face. It is thicker and has more collagen, making it better equipped to deal with the invasiveness of surgery. Some factors affect (either positively or negatively) its thickness, however.
Genetics is the main factor in how thick or thin the skin on your nose is. Some people are born with thicker skin on their noses than others. This is due to the natural composition of their collagen and elastin fibers. If you have a family history of thick skin on the nose, then there is a good chance you will inherit it too.
Sun damage can cause the skin on your nose to be thin. The UV rays can break down collagen and elastin in the skin, leading to a loss of firmness and elasticity. This can cause the skin on your nose to become thinner and more susceptible to wrinkling and other signs of aging.
Scarring from acne or other injuries can also cause the skin on your nose to thin. When injuries occur, the body produces collagen as part of the healing process. If this collagen production is excessive, it can lead to scarring. The scars will then replace the healthy tissue on your nose, causing it to become thin.
Aging is another factor. As you age, your skin naturally begins to lose firmness and elasticity due to factors like sun damage, scarring, and loss of collagen. This will cause
some parts of your face, including your nose, to begin sagging or appearing wrinkled. It’s important to note though that it’s normal for the skin on the area surrounding your nose (including your forehead) to sag as well.
Rhinoplasty Techniques for Thin Skin Vs. Thick Skin
The techniques employed in surgery need to be different for patients with thin skin versus those with thick nasal skin.
The thin-skinned patient will have lesser swelling after surgery but will need to camouflage a lot of the underlying framework to try and prevent irregularities from appearing afterward. Thin-skinned patients are at a greater risk for their nose to appear too pinched or their tip too pointy and unnatural.
Whether thin or thick, the skin of the nose contracts to conform to the underlying shape after rhinoplasty. That is, the swelling dissipates. While this makes the nose smaller post-surgery, it can also lead to the appearance of undesired deformities. We need to employ measures in surgery to help prevent the unwanted pinched or pointy tip, giving the nose an ‘operated on’ or unnatural look.
In thicker-skinned patients, the challenge lies in refining and narrowing the nose while maintaining a natural appearance. Most commonly, the thicker-skinned patient needs projection to create refinements in three dimensions.
Thicker-skinned patients need to have the illusion of having thinner skin. Having proper support of the underlying framework of the nose can accomplish this.
An analogy would be covering a structure with a thick sheet. To be able to see the shape of the covered structure, it would need to elevate. On the other hand, if that structure weren’t elevated, the thickness of the sheet would easily cover the shape. Regarding the nose, if the underlying cartilage were soft and not projecting into the overlying thick skin, the definition of the cartilage would be hard to make out.
How Rhinoplasty Varies For Both Skin Types
The thickness of your skin can affect not only the outcome of rhinoplasty but the type of approach as well. A skilled plastic surgeon can create a natural result on patients with thin or average thickness nasal skin, but this takes great attention and care during surgery. Taking into account the thickness of your skin will help him determine how much he can change it without increasing the risk of complications.
For Patients with Thin Skin
The rhinoplasty surgeon needs to consider that the patient with thin skin is at risk for these irregularities. Dr. Bared takes particular time and pays close attention when performing rhinoplasty on thin-skinned patients.
Dr. Bared will take the time during rhinoplasty to prevent the appearance of irregularities and asymmetries in these patients by using certain camouflaging grafts and soft tissue. He will avoid using specific grafts to avoid any indication the patient had work done.
In some cases, Dr. Bared may also use a thin layer of tissue from the temporalis muscle to help prevent irregularities and asymmetries after surgery. If performed successfully, these patients can enjoy the results sooner post-surgery. These refinements can be preserved in time as the nose continues to heal and the swelling resolves.
For Patients with Thick Skin
In contrast, thick-skinned patients can camouflage any possible refinements made in the nose. Hence, the rhinoplasty surgeon must consider the best method for thick-skinned individuals.
Dr. Bared tries to enhance the nose in thicker-skinned individuals by stretching the skin and thinning it. He 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 or more refined. But is it?
Try to imagine a thick sheet covering a marble statue. The more that statue reduces in size, the less evident the statue shape becomes. However, if that statue stood taller and were projected, its shape would be even more evident.
Can My Skin Be Too Thin for Rhinoplasty?
In general, most people’s skin is thick enough for rhinoplasty. However, there are some instances where the skin may be too thin. This is more likely to occur in patients who have very light skin or who have had a lot of sun exposure.
In such cases, the skin may not be thick enough to support a nose reshaping procedure. In these instances, it might be necessary to use tissue grafts to provide additional thickness and structure.
Talk to an Expert Today
An astute rhinoplasty surgeon needs to tailor and individualize their surgical technique for each nose. They need to consider the anatomy of the underlying cartilage and the bone framework of the nose. But equally as important is adjusting to the thickness of the skin of the nose to provide the best and most natural results in rhinoplasty.
Dr. Anthony Bared, MD, FACS, is one of the leading facial plastic surgeons in South Florida. He specializes in nose surgery like rhinoplasty, and even hair restoration techniques. If you or a loved one wish to know if your nasal skin thickness may affect your surgical outcome, get in touch with us now! Please, feel free to fill out the contact form below or simply call us to talk with an expert!