This male patient presented desiring alteration of his nose and with problems with breathing secondary to heavy nasal skin causing nostril collapse and some septal deviation.
This was an extremely difficult problem due to the extremely thick skin which will always limit the degree of the achievable result.With careful thinning of the skin envelope during surgery a subtle shape of the nose is achieved and as new support is built into the nose the airway is maintained and improved.To reduce the width of the nostrils an alar base excision was performed.A radix graft slightly lifted the upper bridge of the nose which helps to alter a nose further. The result is subtle as only a moderate change is possible with very thick skin.