Cartilaginous Nose with Thick Skin

Reducing nose size and removing nasal humps are possible with rhinoplasty. Dr. Hosnani favors a natural style.

What are the characteristics of a cartilaginous nose with thick skin?

This type of nose possesses structural contrasts:

• Skin: The covering layer is thick, usually oily, and has visible pores (a characteristic of a fleshy nose).
• Skeleton: Unlike classic fleshy noses, the cartilage is not weak. The cartilaginous-bony skeleton is relatively strong and usually features a hump or significant bone width (a characteristic of a bony nose).
• Nasal Tip: Due to the thickness of the skin, the nasal tip usually appears wide or semi-wide, and the underlying cartilaginous details are hidden.

Reinforcing the nasal framework refers to a group of surgical techniques in which cartilage grafts, usually taken from the septum, ear, or rib, are used to strengthen weak or depressed areas of the nose. This is particularly important in fleshy noses, revision cases, Asian noses, or noses with weak tip cartilages. Structural reinforcement prevents the nasal tip from drooping, improves nostril symmetry, and helps the nasal framework remain stable over time and under external pressure.

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The main challenge in surgery for these noses

The greatest challenge in these noses is "displaying the changes."

When the skin is thick, it acts like a thick quilt covering a bed; no matter how elegantly you shape the skeleton (the bed), the thickness of the top layer prevents those details from being clearly visible.

If the surgeon makes the skeleton too small, the thick skin cannot contract to fit the smaller framework, creating a "dead space" that leads to scar tissue formation and nasal deformity over the long term.

Golden Technique: Structural Rhinoplasty

For these noses, old "reductive" methods (removing large amounts of cartilage) are no longer effective. The best approach is structural rhinoplasty:

In this approach, the nasal framework is reconstructed and strengthened using precise suturing techniques and sometimes cartilage grafts. This reinforcement helps prevent drooping of the nasal tip, recurrence of deformities, and future breathing problems.

• Strengthening rather than weakening: Instead of weakening the cartilages, the surgeon uses cartilage grafts (usually harvested from the nasal septum) to reinforce and solidify the skeleton.
• Creating a support base: The skeleton must be strong enough to withstand the pressure of the thick skin and push it outward, allowing the shape and angle of the nasal tip to be defined.
• Gentle thinning of the skin: In some cases, with extreme caution, the surgeon defats the subcutaneous layers in the tip area to slightly thin the skin (while strictly maintaining the skin's blood supply).

Fat removal from a fleshy nose means limited removal of excess fatty tissue and thickness beneath the nasal skin so that the cartilage shape becomes more visible. However, Dr. Hosnani recommends that this be done with great caution, because if the tissue is thinned excessively, the skin may be damaged or the result may look unnatural. Dr. Hosnani’s view is that in fleshy noses, surgical success depends more on strengthening the cartilage structure and shaping the nose properly than on aggressive fat removal.

Open or Closed surgery?

In cartilaginous noses with thick skin, the open technique is the preferred choice for most surgeons because:

• The surgeon has full visibility of the cartilages.
• It allows for the precise placement of delicate grafts and specialized sutures to shape the nasal tip.
• Controlling symmetry in thick skin is significantly easier with direct visualization.

In open rhinoplasty, after the columella incision and internal nasal incisions are made, the nasal skin is carefully elevated from the underlying cartilage and bone framework so that the surgeon has full and direct visibility of the internal nasal structure.

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Recovery period and swelling: Patience is the key to success

Patients with thick skin must understand that their recovery path differs from those with thin skin:

• Prolonged swelling: Thick skin has a high tendency to retain fluids and swell. While swelling in bony noses largely subsides within 6 months, it may take 1 to 2 years for the swelling to completely disappear in these noses.
• Longer taping: Your surgeon may recommend using nasal tape for a longer period (e.g., 2 to 3 months) to help the skin adhere to the underlying skeleton more quickly.

Taping the nose after surgery plays an important role in reducing swelling, helping the skin adapt better to the new nasal framework, and controlling fluid accumulation in the tissues.

• Cortisone injections: In many cases, to reduce persistent swelling in the supratip area (the area above the tip), the surgeon may prescribe very low doses of cortisone (anti-swelling injection) during the first few months post-surgery.

Corticosteroid injection after rhinoplasty is usually performed in areas with more resistant swelling, especially the nasal tip and the supratip area. Using a very fine needle, the surgeon injects a small amount of corticosteroid medication, such as triamcinolone, locally into the same area to help reduce inflammatory tissue and make the swelling settle faster.

Realistic expectations

In cartilaginous-bony noses with thick skin, the goal of surgery is "significant improvement," not necessarily creating a "very fantasy or miniature" nose.

• The nasal hump is corrected effectively.
• Drooping is corrected.
• The nose becomes more well-formed and proportionate.

However, one should not expect the tip of the nose to become as sharp and bony as in individuals with thin skin.

After the nasal splint is removed, you will be given a mirror to see your new nose and enjoy its beauty. Keep in mind that at this stage the nose is still swollen and is still far from its final shape.

Gallery of Cartilaginous Noses with Thick Skin