Rhinoplasty: external shaving is invaluable in treating thick, sebaceous skin.

In more than 35 years of practice, one of my most difficult rhinoplasty problems has been the management of patients with thick, heavy, sebaceous skin. Many of these patients have had previous rhinoplasties and are unhappy with their results and sometimes with their surgeon. These dissatisfied patients may roam the globe in search of the magic consultation that will give them hope for a thinner nasal tip with nice definition. The main problem is that the thick sebaceous skin causes poor nasal tip definition, inadequate nasal tip projection, and a high supratip deformity. Sculpturing the lower lateral cartilage, removing the cephalad portion of lower lateral cartilage with all fibrofatty tissue, and lowering the high supratip septum is certainly necessary …