Thank you Dr Naderi for your recent reply to me on RealSelf.com. There I asked about the possiblity of rhinoplasty for a severely sebaceous nose with a bulbous tip. You commented that it is hard to achieve a nice refined tip on thick oily skin, but depending on my skin type, during surgery the “undersurface” can be “thinned out” and “defatted”. Would you be so kind as to explain what you meant by these 3 terms? Also, at 50yrs old with no acne, would you suggest Accutane to be a better route over the above ideas? Thank you Dr Naderi. Rhonda alias “Bama Hayseed”
My comment was to be taken as “it is not possible to create a very defined tip in a very thick skinned nose as compared to a medium or thin skinned nose.” However, very nice definition and improvements and results are realistic with proper technique. With proper pre-op dialogue and discussion and computer imaging, you can show a patient what is possible post-op. Almost all patients like what they see and are very happy post-op. The rare patient who expected a very pointy or “tiny cutesy” nasal tip despite their VERY thick skin will see that it is not possible and will decide not to go through surgery.
Now, with proper structural techniques such as tip sutures and tip grafts using natural cartilage, very nice improvements and results can be achieved on a thick or sebaceous type skin.
In some patients, the subcutaneous fat from the undersurface (below the skin) of the nasal tip can be removed carefully. Thats what those terms means. This results in modest thinning of the skin and better results. Care has to be taken not to remove too much or the blood flow to the tip can be affected.