Nose surgery: Thick or thin skin?

The essential role of the skin

The skin plays a very important and often underestimated role in rhinoplasty as its condition has a decisive influence on the surgical result. Our outer nose shape has often little in common with the underlying cartilaginous bony structure, which is covered with a layer of fat, muscle and skin. This is a very important anatomical component that is essential to discuss with the surgeon prior to the procedure. A medium skin thickness often allows for a much better aesthetic result than very thin or very thick skin.

Very thin skin: advantages and disadvantages

Very thin skin on the nasal bridge has the advantage that swelling only lasts for a relatively short time after the operation and scars in the area of the columella heal better with the so-called open approach procedure. 


The disadvantage of thin skin is that any minimal irregularities on the nasal bridge are immediately visible, which would otherwise not be noticeable with a medium or thicker skin mantle. These irregularities can best be avoided by a very careful surgical procedure with additional build-up of a new, thin lipid layer by using the body's own fat.


This new lipid layer is between 0.5-1mm thick and at the same time prevents the visibility of the smallest irregularities as well as a change in shape due to severe scarring and a tendency to contraction on the nasal bridge in patients with thin skin.

Disadvantages of very thick skin

The advantage of thick skin is that minor imperfections are almost completely masked, however, the positive sides of thick skin finish here. In a patient with thick, seborrhoeic skin, there is no possibility to promise a petite nose of the photo models, since the surgical possibilities are very limited, especially in the nasal tip area. The cartilaginous-bony structure can be reduced to a maximum and frequently the nose tip still remains unformed afterwards.


To make it easier, just imagine a thick down duvet with three or four magazines underneath. Removing one or more magazines does not change the outer shape of the feather blanket; however, the same "experiment" with a bed sheet would lead to a different result. 


A detailed consultation is necessary and a computer simulation should not end up with a small nose of fine contours in this case. The only alternative is to shape a slightly larger but well formed nose, as it looks more aesthetically attractive than a smaller but poorly defined nose.

The photo shows a patient where an attempt was undertaken to thin out very thick skin at the tip of the nose.  Obviously, medicine has its limitations, therefore many attempts to provide a delicate nose to patients with thick skin by means of surgery are accompanied by unattractive consequences.