One of the greatest challenges in cosmetic rhinoplasty is the overly thick nasal skin envelope. In addition to exacerbating unwanted nasal width, thick nasal skin is a major impediment to aesthetic refinement of the nose. Owing to its bulk, noncompliance, and tendency to scar, overly thick skin frequently obscures topographic definition of the nasal framework, thereby limiting or negating cosmetic improvements. Masking of the skeletal contour is usually most evident following aggressive reduction rhinoplasty where overly thick and noncompliant nasal skin fails to shrink and conform to the smaller skeletal framework. The result is excessive subcutaneous dead space leading to further fibrotic thickening of the already bulky nasal covering. Despite the decrease in nasal size, the resulting nasal contour is typically amorphous, ill-defined and devoid of beauty and elegance.
Chu E, Davis RE. SMAS Debulking for Management of the Thick-Skinned Nose. JAMA Facial Plast Surg. 2015;17(4):305-306. doi:10.1001/jamafacial.2015.0361