Q: Dr. Eppley, I am interested in having a rhinoplasty done but am uncertain as to whether the result would be worth it. I have a very big nose with very thick skin. It is way out of proportion to the rest of my face. No one else in my family looks like this so I don’t know where I got it. In looking online at a lot of rhinoplasty results, a lot of times I don’t see that much of a difference in many of them. I am worried that I might end up as one of those type of results. And when you have a nose like mine, you need a big change. I have attached some pictures for you to see. Tell me what you think, is a rhinoplasty worth it for me?
A: Rhinoplasty in noses that have a very large and thick skin sleeve are very challenging. Not so much because of the technical execution of the surgery but in how the skin will respond and how much shrinkage of it will occur. One can make a significant change in the shape of the underlying cartilaginous strutcures but if this skin does not adapt to it well, then much of those changes will not be seen. In looking at your nose, you are correct in pointing out that the size of the tip in particular is way out of proportion to the upper nose and the rest of your face. At least half of the size of your nasal tip is skin which can not be removed but can only shrink to some degree.
The key to rhinoplasty in the thick-skinned male nose is the recognition and realistic expectation that you can never have a small or well-defined nose. That is not anatomically possible. Most likely, you can never have the type of nose change that you would ideally want. But some improvements can be made anmd could be very worthwhile. In your rhinoplasty, I would tnarrow and lift the tip cartilages, defat the nasal tip carefully, augment the dorsum with cartilage grafts, and do a significant nostril narrowing. I have done some computer imging for you to see what may be possible. I would also consider a chin augmentation which would help balance your facial profile and is a classic manuever to help make the nose appear a little ‘smaller’ by changing other facial proportions.
Dr. Barry Eppley