We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
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.
Text Size: A A A
Published online


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.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
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.

Graphic Jump Location
Place holder to copy figure label and caption
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.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
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.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.



SMAS Debulking in Thick Nasal Skin

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

Some tools below are only available to our subscribers or users with an online account.

2 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Multimedia
Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis