How does skin thickness of my nose affect the results of my rhinoplasty surgery?

Skin Thickness of the Nose

One common misconception regarding rhinoplasty surgery is that all the work happens under the skin. This is true regarding the actual surgical changes of your nose, but it is not true regarding the surgery results.  This is why a skin assessment is important to the rhinoplasty consultation. The skin of the nose plays a significant role in how your nose looks before and after surgery.

Image 1 - Skin Thickness at each 3rd of the nose

The Tent and Blanket Anaology for the Nasal Skin

The best way to conceptualize this is to consider the nose, particularly the tip, as a complex, tent-like structure with a blanket draped over the top. The cartilage and bone under your skin represent the tent and its supports, and the blanket draped over the tent represents the skin of your nose.

Imagine you have a detailed and well-defined modern tent. It has wonderful aesthetic angles and a defined peak. Now, think about three types of blankets: a thin, cool piece of fabric, a thicker but still flexible fabric, and a thick-down comforter. Which one will drape best and show the tent’s detailed features? The thin one, of course. You will choose the thick-down comforter if you want to hide all the details.

Image 2 - Structures of the nose underlying the skin

But how does this relate to the nose?

Skin Thickness Differences on the Nose

In Image 1, you can see three parts of the nose corresponding to the different areas of the skin. The skin of each of these parts is different in terms of thickness. Image 2 demonstrates the structures under the skin.

Upper 3rd of the Nose- The top or upper 3rd of the nose is the area with medium-thickness skin. This is the region of the nose that is bone. As you can see in image 2, bone lies under the skin of the upper 3rd of the nose. The medium thickness of this skin can help hide small irregularities of the bone both before and after rhinoplasty surgery.

Middle 3rd of the Nose - The middle aspect of the nose contains the thinnest skin. This skin overlies the cartilaginous dorsum (top) and other cartilage structures (Red/Orange color in Image 2). This region is very important for breathing and contains the upper lateral cartilages, which help keep the nose open. The thin skin creates a challenge in this area as any small defect can be noticeable after surgery.

Lower 3rd of the Nose - This represents the nasal tip and has the thickest skin of the nose. Under this skin is the lower lateral cartilages that make up your nasal tip. This skin area varies the most but is the thickest part of the nose. Some people have very thick skin at the nasal tip, while others can be much thinner.

Nasal Skin and Pore Size

In image 2, you can see a close-up of a patient’s nasal tip. You can see all the tiny pores, and as you move up the nose, the pores become less dense as the skin transitions to thinner skin. The primary reason the tip of the nose has thick skin is the density and large number of pores. This is also why getting pimples on the tip of the nose is more common. 

All patients have different levels of nasal tip skin thickness. Some patients have thinner nasal tip skin, which has benefits and drawbacks.

The benefit of thin skin is that it shows more tip details and definition. Once you alter the underlying tissue of the nose and reshape the tip, the thinner skin allows the fine details to show through. The drawback, however, is that it doesn’t hide small lumps and bumps or subtle asymmetries, as all the details of the underlying tissue are visible.

Image 3 - The pores of the nose are most visible in the thick skin

Thick skin has the opposite problem. It doesn’t show the details of the nose and, in some situations, can result in nearly no noticeable change in the tip after surgery. Even if we make the underlying cartilage small and very detailed, the thick skin will drape over this like a down comforter and will still look big and thick. However, it works better to camouflage some subtle defects like lumps and bumps.

When I assess patients at my rhinoplasty surgery clinic in Ottawa, pointing out skin thickness is critical. The thickness of your skin is a major determinant of how much smaller tip you can achieve. Patients with thick nasal tip skin need to ensure their expectations are appropriate as creating a very small tip is sometimes impossible. No matter how small we make the underlying structure of the nose, the tip will still look round due to the thick skin.

Another challenge with thick skin is that it tends to swell more and longer after surgery.

The good news is that there are things we can do both before and after surgery to improve the chances of better results in thick-skinned patients.

When patients book a consultation at my clinic in Ottawa, we include a no-cost skin assessment with a skin care specialist. We can review any concerns you have with your skin and try to plan to get your skin in the healthiest shape possible before surgery.  Part of the Rhinoplasty plan is also to ensure you keep your skin healthy.

How Can We Reduce Skin Thickness Before and After Rhinoplasty?

General Skin Care

Skin care before and after surgery is critical for healing and maintaining healthy skin. For any patient with Acne, deep pores, large pores, or thick nasal skin, I recommend using a skin wash that contains either salicylic acid or benzoyl peroxide. This is similar to treating the nose for Acne. It helps keep the pores clean and looking their best.

Retinol-based skincare

Retinol is a medication related to Vitamin A that can help reduce the pores on your face and nose. It can improve acne and reduce the thickness of your nasal skin. Patients can use retinol both before and after surgery. Using retinol can help reduce the pores, improve the skin tone and reduce the thickness. Retinol can also reduce acne on the nose.

Laser Skin Resurfacing

Laser treatments, such as CO2 laser treatments, erbium lasers, and others, can also help thin the skin of your nose. Laser resurfacing is typically used for more severe skin problems. Patients with very thick skin can benefit from laser treatments. However, there are risks with laser treatments, which can include scarring and redness. At my clinic at The Ottawa Derm Center, I have access to many other lasers, radiofrequency and similar devices that can help improve the skin quality of your nose and all aspects of your face.

Steroid Injections

Some patients can benefit from an injection of a steroid under the skin. Using a steroid can reduce the scarring and tissue under the skin and in some people, can thin the skin. This may be desirable however steroid injections also carry significant risk if done improperly. Steroid injections, when performed too frequently or too high a dose can cause blood vessels to appear on the skin, over-thinning of the skin causing depressions and can reduce the strength of the nose. I always urge people to go slow with steroid injections.

Summary of Nasal Skin Thickness

Even though skin thickness plays a significant role in your rhinoplasty results, managing your skin before and after surgery will help you achieve the desired results. My rhinoplasty practice at The Ottawa Derm Center provides all interested patients with a skin assessment by experts before and after surgery. As I mentioned, all patients can meet with a skincare specialist at the Ottawa Derm Center at no cost at the end of our rhinoplasty consultation. Please let us know when you book if you would like this.