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George C. Peck, Rhinoplasty: External Shaving is Invaluable in Treating Thick, Sebaceous Skin, Aesthetic Surgery Journal, Volume 17, Issue 6, November 1997, Page 414, https://doi.org/10.1016/S1090-820X(97)80061-1
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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 but will not solve the problem of the thick heavy nasal tip skin.
These patients require an umbrella graft to improve tip projection. An umbrella graft is composed of a cartilaginous strut placed in a vertical pocket between the medical crura and an onlay graft placed in a horizontal pocket overlying the alar domes. The onlay graft is the cap on the strut. The umbrella graft will definitely improve nasal tip projection, but it will not change the texture, tone, or color of the thick, sebaceous skin.
