Crooked and Thick-Skinned Nose Aesthetics: Challenges and Solutions

Thick Skinned and Asymetrical Nose Aesthetic

Sometimes, in rhinoplasty operations, several factors that make the operation difficult can be added up. Two of these, a crooked nose, when combined with thick skin, presents a unique set of aesthetic challenges. During surgery, in addition to the difficulty of making the nose symmetrical, thick skin characteristics and related points to be considered can make the operation even more difficult. The patient I shared here applied due to crooked nose deformity and serious nasal congestion that occurred in his nose after an accident he experienced in childhood. In addition to serious septum deviation, the patient had caudal septum dislocation and weakness in the nasal tip cartilage support tissue.

Aesthetic Concerns of a Crooked and Thick-Skinned Nose

Crooked nose aesthetics refers to a nose shape that appears far from or deviated from the vertical midline of the face. It can cause both nasal breathing problems and an asymmetrical appearance in the face in patients. This asymmetry can affect facial balance and draw unwanted attention to the nose. When combined with thick nasal skin, the aesthetic challenge becomes even more significant. Thick skin, like “wearing a very thick winter coat and the resulting appearance of the person wearing it always looks thicker,” tends to create a softer, more voluminous appearance, limiting the visibility of refined nasal contours.

Patients often report feeling self-conscious due to:

• Lack of nasal symmetry
• Bulky or undefined nasal tip
• Unequal nostril or dorsal irregularities
• Less refined overall nasal profile
• Nasal congestion
• Dropping of the nasal tip when smiling, creating a more asymmetrical nasal appearance

What Causes a Crooked and Thick-Skinned Nose?

There are several factors that contribute to this type of nose:

• Genetic predisposition to a deviated septum or misaligned nasal bones
• Nasal trauma that may cause nasal fractures that lead to displacement
• Thick sebaceous skin or excessive subcutaneous tissue (genetic skin traits)
• Poor surgical results from a previous rhinoplasty (secondary rhinoplasty cases)

Most of the patients who applied to our clinic had a history of severe nasal trauma during childhood. Generally, in cases of childhood trauma, when the growth points in the nose are damaged, it can be seen that as the development of the nose continues, various problems such as becoming asymmetrical, crooked or collapsed can occur. When some of the patients apply to us, they show their childhood photos and state that their nose was quite smooth and symmetrical, but as they grew, my nose became crooked and more asymmetrical. Especially after frontal blows to the tip of the nose, many problems such as crookedness, bending and asymmetrical can occur over time. It can be understood that the nasal septum, which is the structure that separates the nasal cavity in the middle of the nose into two, is distorted and asymmetrical due to the damage to the growth points of the nasal septum, which is a structure that separates the nasal cavity in the middle of the nose. In patients with frontal trauma to the tip of the nose, there may be very different nasal septum deviations simultaneously. For example, many different problems can occur such as caudal septum dislocation, severe septum fracture inside the nose and spur formation after healing. In childhood nasal traumas, even if the nasal bone is not broken, the structure inside the nose may become crooked and asymmetrical over time as a result of crushing.

Aesthetic Approach to Correction of Crooked Nose

Structural Realignment

The foundation of correction begins with correcting the underlying structures. Surgeons often use osteotomies to realign the nasal bones and septoplasty to correct septal deviations. Various cartilage grafts and cartilage shaping procedures can also be performed. The goal is to center the nose and improve symmetry. Some patients' septum may have ossified due to trauma and there may not be enough cartilage graft for nasal reconstruction. Even if it is a primary rhinoplasty, some patients, especially in cases of corneal cartilage, may require rib cartilage. You can discuss this situation in detail with your doctor during your examination.

Improving Definition Despite Thick Skin

Patients with thick skin often require strategic techniques to create definition:

• Tip support grafts (such as shield, cup, or columellar support grafts) to highlight and shape the tip of the nose
• Two-level skin dissection and underskin tissue removal
• Spreader grafts to widen the internal nasal valves and correct dorsal irregularities
• Careful contouring to prevent over-resection that may be masked by thick skin
• Avoiding a third space under the skin

Balancing Function and Aesthetics

More than aesthetics, crooked noses often cause functional problems such as nasal congestion. A comprehensive rhinoplasty plan should address both form and function to achieve long-term, balanced results. As an otolaryngologist, I am dedicated to addressing issues related to septal deviation and nasal valve stenosis in my patients. In patients with thick skin, preserving the cartilage support of the nasal wings and preventing nasal valve collapse are critical. It is also important to provide nasal tip support and prevent drooping of the tip.

The patient shared in this article underwent an open technique rhinoplasty operation. During the operation, two-level skin dissection and underskin tissue removal were performed on the skin in the supratip area. A graft consisting of cartilage and this skin tissue was placed on the patient's nasal root. Various cartilage graft applications were made to the tip of the nose to increase nasal tip support. No procedure was performed on the patient's nevus on the nose upon the patient's request.

Post-Operative Aesthetic Considerations

Healing timelines tend to be longer for thick-skinned noses. Patients may find that swelling, especially around the tip, takes months to subside. It is important to have realistic expectations – although perfect healing is limited by skin thickness, significant aesthetic improvements and facial harmony can be achieved with expert technique.

Additional Post-Operative Care Suggestions

The following additional care suggestions may be helpful for patients with thick skin:

• Extension of salt restriction for up to 6 months
• Pressure on the nasal skin with a nose pinch
• Use of bromelain, green tea, arnica gel for a longer period of time
• Steroid injections if necessary after 6 months
• Use of roaccutane tb (consult your physician)

Correcting the aesthetic concerns of a crooked, thick-skinned nose is a delicate process that requires an experienced rhinoplasty surgeon. In individually planned rhinoplasty operations, ultrasonic device and micromotor assisted procedures, minimally traumatic tissue shaping techniques ensure that our patients have a more comfortable postoperative time after the operation.

Search result link where you can find articles prepared by Dr. Murat Enöz about "crooked thick skinned nose" and published on this website (you can also reach previous articles by clicking "more posts" at the end of the page) >> https://www.ent-istanbul.com/search?q=crooked+thick+skinned+nose

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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