In patients with thick skin it is important to keep the nose slightly larger (higher bridge and increased tip projection) to avoid problems with skin redraping or formation of a polly-beak deformity (when the tip droops below the bridge). In patients with thick skin Dr. Toriumi will recommend keeping the nose larger on lateral view to allow expanding the thick skin and form a better look on the frontal view. This is one of the more difficult concepts for patients to understand. Noses will always look narrower and more defined when they are more projected.
In patients with thin skin, the nose can be made smaller with a lower dorsum as the thin skin is more likely to contract and accommodate the underlying nasal framework.
This patient suffered from nasal obstruction and nasal deformity. She had a crooked nose and over-projected nasal tip. Special care was taken to straighten her septal deviation to correct her airway obstruction. Her nasal tip was de-projected (brought closer to her face) and her dorsum was reduced. She also had a small radix graft placed to raise her radix (the root of the nose, between her eyes). Her thin skin redraped well leaving her with a good improvement in nasal contour. The photographs demonstrate a one year postoperative outcome.