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Facial Plast Surg 2018; 34(01): 022-028
DOI: 10.1055/s-0037-1617421
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Management of the Thick-Skinned Nose

Richard E. Davis
1   Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology, The University of Miami Miller School of Medicine, Miami, Florida
2   Department of Surgery, The Center for Facial Restoration, Inc., Miramar, Florida
,
Emily N. Hrisomalos
1   Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology, The University of Miami Miller School of Medicine, Miami, Florida
› Author Affiliations
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Publication History

Publication Date:
06 February 2018 (online)

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Abstract

When executed properly, open structure rhinoplasty can dramatically improve the consistency, durability, and quality of the cosmetic surgical outcome. Moreover, in expert hands, dramatic transformations in skeletal architecture can be accomplished with minimal risk and unparalleled control, all while preserving nasal airway function. While skeletal enhancements have become increasingly more controlled and precise, the outer skin-soft tissue envelope (SSTE) often presents a formidable obstacle to a satisfactory cosmetic result. In noses with unusually thick skin, excessive skin volume and characteristically hostile healing responses frequently combine to obscure or sometimes even negate cosmetic skeletal modifications and taint the surgical outcome. For this challenging patient subgroup, care must be taken to optimize the SSTE using a graduated treatment strategy directed at minimizing skin thickness and controlling unfavorable healing responses. When appropriate efforts are implemented to manage thick nasal skin, cosmetic outcomes are often substantially improved, sometimes even negating the ill-effects of thick skin altogether.

Keywords

thick nasal skin - nasal SMAS debulking - nasal skin stretching - skin closing tension - subdermal plexus
 

  • References

  • 1 Davis RE. Revision rhinoplasty. In: Johnson JT, Rosen CA. , eds. Bailey's Head and Neck Surgery–Otolaryngology. 5th ed. Philadelphia, PA: Wolters Kluwer/Lippincott, Williams, & Wilkins; 2014: 2989-3052 . Chap 184
    Google Scholar
  • 2 Chu E, Davis RE. SMAS debulking for management of the thick-skinned nose. JAMA Facial Plast Surg 2015; 17 (04) 305-306
    CrossrefPubMedGoogle Scholar
  • 3 Garramone Jr RR, Sullivan PK, Devaney K. Bulbous nasal tip: an anatomical and histological evaluation. Ann Plast Surg 1995; 34 (03) 288-290 , discussion 290–291
    CrossrefPubMedGoogle Scholar
  • 4 Letourneau A, Daniel RK. The superficial musculoaponeurotic system of the nose. Plast Reconstr Surg 1988; 82 (01) 48-57
    CrossrefPubMedGoogle Scholar
  • 5 Davis RE, Wayne I. Rhinoplasty and the nasal SMAS augmentation graft: advantages and indications. Arch Facial Plast Surg 2004; 6 (02) 124-132
    CrossrefPubMedGoogle Scholar
  • 6 Rohrich RJ, Gunter JP, Friedman RM. Nasal tip blood supply: an anatomic study validating the safety of the transcolumellar incision in rhinoplasty. Plast Reconstr Surg 1995; 95 (05) 795-799 , discussion 800–801
    CrossrefPubMedGoogle Scholar
  • 7 Davis RE. The thick-skinned rhinoplasty patient. In: Azizzadeh B, Murphy M, Johnson C, Numa W. , eds. Master Techniques in Rhinoplasty. Philadelphia, PA: Saunders, Elsevier Inc; 2011: 337-345 . Chap 27
    Google Scholar
  • 8 Nemati S, Golchay J, Iranfar K, Alizadeh A. Frequency of acne vulgaris and its exacerbation in facial and periorbital area after septorhinoplasty. Am J Otolaryngol 2013; 34 (05) 378-381
    CrossrefPubMedGoogle Scholar
  • 9 Cobo R, Vitery L. Isotretinoin Use in Thick-Skinned Rhinoplasty Patients. Facial Plast Surg 2016; 32 (06) 656-661
    Article in Thieme ConnectPubMedGoogle Scholar