Thick Skin Bulbous Tip Rhinoplasty

Thick skin bulbous tip rhinoplasty is one of the most common concerns among the patients considering rhinoplasty. At the same time it is one of the most challenging cases to be addressed as it requires a different approach and fine workmanship. To achieve the best possible results the quality of the skin should be improved before the surgery by the special treatments. Due to a wide alar base and low ability to shrink for thick skin alar plasty is performed to remove the excessive skin and fat tissues on the wings of the nose.

Additionally to the internal interventions it is performed to bring inside the nose from the front, reduce the nostrils’ size and fix asymmetries between them, thus this way catch a harmony between the tip and bridge of the nose. It shouldn’t be confused with the open surgery since all interventions are performed through the nostrils without opening the nose. When it comes to reduction rhinoplasty essential to keep in mind that there is always a limit on how much a nose can be reduced safely without compromising the functionality. Therefore, thick-skinned patients need to set realistic expectations.

In this blog you will find before and after pictures of Thick Skin Bulbous Tip Rhinoplasty with the Closed Atraumatic Technique by Assoc. Prof. Dr. Suleyman TAS.

Case 1 (Before and right after the surgery):

The patient burst up in tears when she saw her new nose, changing it was her dream for a long time. Here long nose, droopy tip with smiling deformity, dorsal hump and deviation was treated in one nose surgery.

Case 2 (Before and right after the surgery):

Here, severe thick- skinned patient, with a deviated septum, alar flaring, droopy tip, and wide alar base was transformed into aesthetically pleasant and natural-looking beauty. The pictures are presented with a survey on instagram.

Case 3 (Before and right after the surgery & 7 days after):

In this case a bulbous and droopy tip, alar asymmetries, deviation of the septum and the nose and dorsal hump was treated by the Closed Atraumatic Rhinoplasty. For thick skinned patients when lifting the tip, it should be designed the way it will be able to carry the overlying structures and avoid a droopy tip appearance in the future.

Case 4 (Before and right after surgery):

Here the tip was reduced, refined and supported, dorsal hump shaved down, deviation of the nose and septum aligned in the middle for the thick and oily skin. Now it is a Celebrity Nose Job  which is cute and small nose with a nice nose forehead pass & feminine slope.

Case 5 (Before and right after the surgery):

A male rhinoplasty with thick skin; projected tip, high dorsum, dorsal hump, crooked nose and severe breathing issues treated by Assoc. Prof. Dr. Suleyman TAS. In male cases over reduction should be avoided as it may cause feminization. Male rhinoplasty is different than female rhinoplasty.

Case 6 (Before and right after the surgery):

In this revision rhinoplasty case, the nose has been aligned, dorsal hump eliminated, the tip reduced and refined, alar excision has been performed to harmonise the tip and the bridge, also to fix the asymmetries between the nostrils.

Case 7 (Before and right after the surgery):

In this case; open roof deformity, severe deviation, bulbous and overprojected tip, with old alar scars and extremely distorted anatomy treated by the Closed Atraumatic Technique and ended up with an aesthetically pleasant and natural results.

Case 8 (Before and right after the surgery):

In this case a dorsal hump was eliminated, bulbous and projected tip reduced and refined, the nose aligned to the midline, and breathing issues addressed in one surgery. Immediately we are able to see how much a nose job has altered the overall appearance of the face, beautified it and all facial features became harmonious with each other. That’s what happens in experienced hands of Assoc. Prof. Dr. Suleyman TAS.

Case 9 (Before and right after the surgery):

This is an exceptional revision case performed by Assoc. Prof. Dr. Suleyman TAS. Extremely thick and oily skin with a bulbous and droopy tip ended up with an aligned to the middle nose which was overall reduced and refined without rib cartilage grafting.

Case 10 (Before and 7 days after):

Another thick skin male rhinoplasty with a bulky tip, asymmetric nostrils, dorsal hump, and deviation has been treated by the Closed Atraumatic Technique. Alarplasty has been performed to address the wide base, alar flaring and asymetries between the nostrils.

Rhinoplasty surgery aims reshaping the aesthetical appearance of the nose while solving the problem of breathing. While reshaping the aesthetical appearance of the nose, structure of the skin should be evaluated well. We can categorize structure of the skin in 3 groups; Thick skin, moderate thick skin and thin skin. All of them needs different preparation phase before nose job and different healing phase after nose job. Most patients think it is not good to have rhinoplasty for thick skin. But it is not true. In our clinic, we do receive a lot of patients with thick skin and attain satisfying results. Now, we are going to talk about preparation for thick skin rhinoplasty. With the help of this preparation, best-in-class rhinoplasty for thick skinned patients can be achieved.

What are the Differences between Thick and Thin Skin Nose?

People with thick skin and thin skin have their advantages and disadvantages. Thick skin hides well small unevenness’s, while thin skin reflects everything. If you have enlarged pores, oily skin and wide alar base you probably have a thick skin which can be identified by a specialist. Thick skinned patients require a preoperative preparation in order to improve the quality of the skin and can achieve the best possible results during the nose surgery.

Thick Skin vs. Thin Skin

Cartilage and bone framework is reshaped during nose surgeries. One of the factors that determine the final shape of the nose is the thickness of the skin and subcutaneous tissues. We can think of this as follows: When you throw two types of sponge into the water, the thicker absorbs more water, the thinner sponge absorbs less water, and similarly, the thick skin will take longer to recover than the thin skin. Therefore, patients with thick skin need to adapt themselves to a longer period that requires more patience.

Preparation for Thick Skin Rhinoplasty;

There are 4 effective treatments for thick skinned patients before rhinoplasty. After medical examination, the most appropriate one is recommended to the thick skinned patient.

1. Dermaroller Treatment
2. Dermapen Treatment
3. Ablative Carbon Dioxide Fractional Laser
4. Vitamin A Treatment

1) Dermaroller Treatment

It is a cosmetic device consisting of hundreds of titanium micro needles placed in sequence around a cylindrical apparatus. These needles are 0.5 or 2 millimeters long and 0.1 millimeters in diameter. Since the needles are made of titanium, they are stainless. The dermaroller should be gently rolled on the nose with upwards, downwards and diagonal movements. The purpose of treatment is to generate new collagen and skin tissue for smoother, firmer, more toned skin. Thus, there is a noticeable change in our skin and when you touch your skin; it becomes tighter after 5-7 months of use.

2) Dermapen Treatment

Nowadays, Dermapen is one of the most effective skin rejuvenation treatment based on micro needling. Actually it is one of the procedures dermatologists have used to increase collagen production since the 1950s. The aim of Dermapen treatment is to increase the production of collagen, which provides the skin’s flexibility ability. With Dermapen treatment, a controlled destruction of the skin is created. This controlled destruction stimulates the cells (fibroblasts) responsible for collagen production in our skin, helping to improve the overall quality of the skin. In fact, it tries to heal itself due to the damage caused by dermapen application, thus successful recovery ensures rejuvenated skin appearance.

So you can see tightening of your nasal skin in 2-3 months.

3) Carbon Dioxide Functional Laser

Fractional lasers deliver laser light to the skin in small diameter columns and create heat damage to the skin through tiny columns. The skin areas around these damaged areas remain intact. The heat-damaged area is quickly repaired with cells from the surrounding undamaged skin. Due to the long wavelength of the carbon dioxide (CO2) laser, it can go deep into the skin.

Since it peels off the upper layer when applied on the nasal surface, we can see a thinner and tightened skin in each session. Carbon dioxide laser is suitable to be made in winter. Depending on the condition of the skin, 3-4 sessions can be done with an interval of 3 weeks.

4) Vitamin A Treatment

Vitamin A is widely used in many fields and purposes in medicine. One of them is thinning the skin and acne treatment. Vitamin A provides the tightening and thinning of the skin by shrinking the oil pores on the surface of our skin. The use of vitamin A should be with the advice of your doctor. The process should proceeded by deciding on the dose and how much your skin needs and followed up in certain periods. The completion of the treatment is 3-4 months.

All mentioned methods are different from each other and you should start required thick skin treatment before nose surgery with the advice of your doctor. If you have any questions regarding thick skin rhinoplasty, you may contact us via WhatsApp.

Author: Assoc.Prof.Dr. Suleyman TAS