The short answer is:      YES

But there are things the surgeon can do to account for thick skin and achieve great results for the patient.

 

BEFORE | 18 year old patient before surgery

AFTER | 18 year old patient 6 months after surgery, followed by monthly Kenalog and 5-Fluorouracil injections

Background: Rhinoplasty surgery primarily changes the shape of the cartilages and bones of the nose.  Once the desired changes are made to this framework, the nasal skin has to reshape around the new structure.  This is often referred to as skin “shrink wrapping” around the cartilage and bone so the nose can take on its new shape.  Thicker skin generally takes longer to shrink wrap, and so it can take longer to see final results.  In addition, there are particular areas of the nose (especially the supratip, just above the tip of the nose) where fluid, swelling and scar tissue can build up.  Meticulous preoperative planning, intraoperative techniques, and postoperative care, as detailed below, can lead to excellent results in patients with thick skin.

 

Preoperative Considerations:

  • Realistic Goals: It is important to use realistic computer simulations. Thicker skin means it is harder to get a very pointy or sharp nasal tip.   The nasal tip becomes more rounded as it heals in all patients, and especially in patients with thick skin.
  • Hyperbaric oxygen: Hyperbaric oxygen delivers additional oxygen to the nasal skin both before and after surgery. Because the blood vessels and tissue are getting extra oxygen from the treatments, the blood vessels do not need to widen as much, and this both reduces swelling and accelerates healing.

Intraoperative:

  • During surgery, areas of swelling, such as in the supratip area just above the tip, are anticipated, and the shape on the operating room table is formed to account for the known risk of swelling.
  • 5-Fluoruracil is a topical medication that can be applied during surgery by placing it under the skin envelope. This helps prevent excess scar tissue from forming.
  • A structural rhinoplasty approach, using cartilage grafts from the ear or rib when necessary, helps to support the tip of the nose and anticipate the weight of the skin.

Postoperative:

  • Hyperbaric oxygen after surgery can significantly expedite healing.
  • Monthly postoperative injections of a steroid and 5-Fluorouracil in targeted areas of the nose can help treat and prevent swelling, leading to a smooth refined profile.
  • In some cases of severe swelling, a low dose of isotretinoin (Accutane) can be administered for several months after surgery to help the skin quickly and appropriately heal around the nasal structure.

 

Bottom Line:       Patients with thick skin can have beautiful rhinoplasty outcomes.

The keys are proper planning, technical skill, and postoperative follow up.