A large, bulbous, or boxy tip is a frequent problem that patients wish to have addressed with a rhinoplasty.

The shape of the nasal tip is determined by several factors. These include skin, subcutaneous tissue, and nasal cartilages.

During surgery, a rhinoplasty reshapes and re-orientates the nasal tip cartilages to improve the size of the nasal tip. In patients with thick skin, the amount of tip reduction and definition are not as dramatic because the skin thickness hides the changes that are made to the underlying framework.

During surgery, other manoeuvres can be performed to achieve better tip shape and definition. This includes surgically thinning the skin and by adding cartilage grafts to the tip. This adds another degree of complexity to the surgery.

Moreover, patients with thick skin swell more post-operatively, and the swelling takes longer to resolve. Sometimes, steroid injections into the tip are needed after the procedure to help reduce swelling.

In summary, patients with thick skin have to bear in mind that the amount of definition and reduction achievable is not as much as thin skinned patients. Also, it may take longer for the swelling to improve. Having realistic expectations of what surgery can achieve is really important in patients with thick skin. The aim of the surgery is to bring about an improvement and not completely eliminate the large tip.