Introduction Oneof the greatest challenges in cosmetic rhinoplasty is the overly thicknasal skin envelope. In addition toexacerbatingunwantednasalwidth, thicknasal skin is amajor impediment to aesthetic refinement of the nose. Owing to its bulk, noncompliance, and tendency to scar, overly thick skin frequently obscures topographic definition of the nasal framework, thereby limiting or negating cosmetic improvements. Maskingof the skeletal contour is usuallymostevident followingaggressive reduction rhinoplasty where overly thick and noncompliantnasal skin fails toshrinkandconformtothesmallerskeletal framework. The result is excessive subcutaneous dead space leading to further fibrotic thickening of the already bulky nasal covering. Despite the decrease in nasal size, the resulting nasal contour is typically amorphous, ill-defined and devoid of beauty and elegance. Tooptimizecosmetic results in thick-skinnednoses, contourenhancement is best achieved by elongating and projecting the skeletal framework whenever possible (Figure 1). Skeletal augmentation not only reduces dead space tominimize fibrotic thickening, it also stretches and thins the outer soft-tissue covering for improved surface definition. However, in noses in which the nasal framework is already too large, skeletal augmentation is not a viable option, and the overly thick skin envelope must be surgically thinned to achieve better skin contractility and improved cosmetic outcomes. Histologicexaminationofoverly thicknasal tip skin reveals comparatively little dermal thickening or increased adipose content but ratherasubstantial increaseinthicknessofthesubcutaneousfibromuscular tissues.1Dubbed the “nasal SMAS” layer,2 the fibromuscular tissue layer lies just beneath the subdermal fat andmay account for an additional2 to3mmofskin flapthickness.OwingtoadiscretedissectionplaneseparatingthenasalSMAS layer fromtheoverlyingsubdermal fat, surgical excisionof thehypertrophicnasal SMAS layer canbe performedsafely inhealthycandidatesusingtheexternal rhinoplasty approach.3However,theoverlyingsubdermalplexus(containedwithin the subdermal fat)must be carefully protected.3-5 Similarly, inadvertentdisruptionof thepaired lateralnasal arteries—major feedingvessels to the subdermal plexus—must alsobeavoided, and special care should be exercisedwhenworking near the alar crease.3-5 SMASdebulking is also contraindicated in skin less than 3-mm thick because overlyaggressivesurgicaldebulkingmayleadtounsightlyprominence oftheskeletal topography.However, intheappropriatepatient,SMAS debulkingcanreduceskinenvelopethicknessbyasmuchas3.0mm, with greater reductions common in revision rhinoplasty caseswhen vascularity permits.6