What makes skin thin versus thick in the nose?
The thickness of the skin of the nose in rhinoplasty is important in determining the techniques needed to be employed in surgery. The thickness of the skin is due to many factors but mostly it is a characteristic that is inherited. To understand the difference between thin versus thicker skin there are different characteristics that one can notice. In general people who have thinner nasal skin can make out the shape of the underlying cartilages and structure of the nose while people with thicker skin generally have a more porous quality to the skin of the nose making the underlying structure less evident.
Techniques in rhinoplasty for thin-skinned patient
The techniques employed in surgery need to be different for patients who have thin skin versus those with thicker nasal skin. The thin skinned patient, although they will have less swelling after surgery, need to have a lot of camouflaging of the underlying framework in order to try and prevent irregularities from appearing after surgery. Thin skinned patients are at a greater risk for their nose to appear too pinched or their tip too pointy and unnatural. Whether thin-skinned or thick-skinned, the skin of the nose contracts to conform to the underlying shape after rhinoplasty. That is the swelling dissipates and while this makes the nose smaller after surgery it can also lead to the appearance of undesired deformities. Measures need to be employed in surgery to help prevent the unwanted pinched appearance or the pointy tip, giving the nose an ‘operated on’ or unnatural appearance.
Techniques in rhinoplasty for the thick-skinned patient
In the thicker skinned patient, while the concerns may not be those found in the thin-skinned patient, the challenge lies in creating refinements and narrowing of the nose while obtaining natural-appearing outcomes. Most commonly the thicker-skinned patient needs projection in order to create refinements in three-dimensions. Thicker-skinned patients need to have the illusion of having thinner skin and this can be accomplished by having the proper support of the underlying framework of the nose. An analogy would be covering a structure with a thick sheet—in order for you to see the shape of the structure underneath the sheet, that structure would need to be elevated into the sheet, that is projected in to the sheet. If, on the other hand, that structure were not elevated into the sheet, the thickness of the sheet would easily cover the shape of the underlying structure. As in the nose, if the underlying cartilage were soft and not projecting in to the overlying thick skin, the definition of the cartilage would be difficult to make out.
An astute rhinoplasty surgeon, needs to tailor and individualize their surgical technique for each and every nose. They need to take into consideration the anatomy of the underlying cartilage and bone framework of the nose, but equally as important is adjusting to the thickness of the skin of the nose to provide for the best and most natural results in rhinoplasty.
For more information on Dr. Anthony Bared, MD, FACS or if you would like to call for a consultation visit www.facialplasticsurgerymiami.com or call (305) 666-1774.