title: An Effective Algorithm for Management of Noses with Thick Skin.
abstract: BACKGROUND
  Thicker nasal skin blunts the definition of the underlying osseocartilaginous frame and the delicate topography of the nose posing additional challenges in producing desirable tip definition. Despite the recognized challenge in this patient population, there is a paucity of literature on how to overcome this problem.
  
  
  OBJECTIVE
  The goal of this article is to provide a systematic algorithm to manage patients with thick nasal skin.
  
  
  METHODS
  Approach to the thick nasal skin patient begins with an evaluation of the etiology of their skin thickness. Skin thickness secondary to sebaceous overactivity is diminished with the use of retinoic acid derivatives, lasers or isotretinoin (Accutane), commonly under the advice of the dermatologist. Rhinoplasty maneuvers include open technique, raising a healthy and reasonably thick skin flap overlying the tip, removing the remaining fat overlying and between the domes, creating a firm cartilaginous frame and eliminating dead space using the supratip suture reported by the senior author, and trimming redundant nasal skin envelope when indicated.
  
  
  CONCLUSIONS
  This systematic approach has been greatly effective in achieving often predictable and aesthetically pleasing rhinoplasty results.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Case School of Medicine, 29017 Cedar Road, Cleveland, OH, USA. bahman.guyuron@gmail.com.
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
authors.affiliation: Dupage Medical Group, Warrenville, IL, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lee
mesh_terms: D000465:Algorithms; D005260:Female; D006801:Humans; D007641:Keratolytic Agents / Q000627:therapeutic use; D055171:Nasal Cartilages / Q000601:surgery; D009666:Nose / Q000601:surgery*; D012225:Rhinoplasty / Q000379:methods*; D012867:Skin / Q000187:drug effects; D012871:Skin Diseases / Q000178:diet therapy / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D014212:Tretinoin / Q000627:therapeutic use
chemical_list: D007641:Keratolytic Agents; D014212:Tretinoin
keywords: Algorithm; Rhinoplasty; Thick skin