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Surgical Pearls | AAFPRS Advances in Rhinoplasty Featured Article

SMAS Debulking for Management of the Thick-Skinned Nose

Eugenia Chu, MD1; Richard E. Davis, MD1,2
[+] Author Affiliations
1Division of Facial Plastic Surgery, Department of Otolaryngology, The University of Miami Miller School of Medicine, Miami, Florida
2The Center for Facial Restoration, Memorial Miramar Hospital, Miramar, Florida
JAMA Facial Plast Surg. 2015;17(4):305-306. doi:10.1001/jamafacial.2015.0361.
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This surgical technique video illustrates debulking of the nasal superficial musculoaponeurotic system (SMAS) layer as a rhinoplasty technique in patients with thick-skinned noses.

Article InformationCorresponding Author: Richard E. Davis, MD, Center for Facial Restoration, 1951 SW 172nd Ave, Ste 205, Miramar, FL 33029 (DrD@DavisRhinoplasty.com).

Published Online: May 15, 2015. doi:10.1001/jamafacial.2015.0361.

Conflict of Interest Disclosures: None reported.

Additional Information: Dr Davis is responsible for gathering and interpreting all data presented in this manuscript and accompanying video.

Previous Presentation: This study was presented at the AAFPRS Advances in Rhinoplasty 2015 meeting; May 15, 2015; Chicago, Illinois.

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Figure 1.
Amorphous Nose With Ultrathick Skin

Amorphous nose with ultrathick skin. A, C, and E, Preoperative anterior, lateral, and basal views, respectively. B, D, and F, Corresponding 2-year postoperative views following (1) dorsal augmentation with diced cartilage–fascia graft, (2) increased nasal tip projection with septal extension graft, and (3) nasal tip refinement with tip sutures and nasal SMAS excision in the midline supratip and supratip sidewalls. Note improvement in nasal definition and contour obtained through combined skeletal expansion and SMAS debulking.

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Figure 2.
Nasal SMAS Debulking

A, Measuring nasal tip skin thickness using a sliding Boley caliper. B, Dissection of the nasal SMAS flap from the undersurface of the subdermal fat. Note the distinct color difference between tissue layers.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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SMAS Debulking in Thick Nasal Skin

Secondary rhinoplasty with excision of scarred fibromuscular tissue layer in a thick-skinned nose.

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