I had rhinoplasty 8 months ago and a month after the cast came off i noticed a boney bump slighlty beneath the bridge which emphasised a dip in the nose just above the tip. My surgeon used juvederm to fill it, and it looked perfect. The juvederm seems to be wearing off and i am more aware of the bump. Its tiny but you can see it slightly as the filler wears off and it upsets me. Is it worth having a revision as i will just worry every year when the bump/dip show again?
Boney Bump Just Under Bridge of Nose Followed with a Dip After Surgery
Doctor Answers (11)
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If it bothers you, treatment is reasonable. I would advise surgery.
In my opinion, it appears you have some contour irregularities on the bridge of the nose. Ideally, the surface of the bridge, on profile, should be relatively smooth - whether it’s a straight line, slightly turned inward (concave), or slightly turned outward (convex). Your results reveal a contour irregularity which could be viewed as either a low point at the dip or a high point just below and above it.
Whether or not you should make a decision to have a revision really depends on how much the problem bothers you. Based on what you’ve written, it sounds to me that it is fairly bothersome to you. Fortunately, a revision procedure is likely to be able to fix your problem either by augmenting the area that is sunken on the bridge or slightly lowering the areas which are very high. This is assuming that your skin envelope is thin enough to contract to fit the lowered structure of your bridge.
Yes, products like Juvederm and other fillers are another solution as you’ve pointed out. Although temporary, they don’t come without risk. In addition to the hassle of having the repeat treatment every six to twelve months there is also a risk that complications can occur with such fillers.
Web reference: http://dwkimmd.com/
The bump is you notice is from the depression below it which your surgeon filled with the injection - as stated by others a small cartilage graft can fill this contour deformity
Web reference: http://www.seattlerhinoplasty.com/html/index.php
Post Operative Rhinoplasty Irregularities: Surgery vs Filler
If you are satisfied with the results you achieve with the filler, which it sounds like you are then I would consider retreating the area with the Juvederm. I have had success using this filler as well as others in correcting small irregularities. I recognize that this is not a permanent filler but have found that it has lasted over two years without any intervening injections. Certainly surgical revision is an option. If you choose to proceed with surgery, it appears that the best option is to replace volume and I prefer to use a crushed cartilage graft harvested from the septum or ear. Recognize that at times the cartilage may resorb in which case you may be back where you started, or you may be left with a fullness which may be visible as well.
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Correcting bony bump after rhinoplasty
To correct this type of problem, either the bony bump has to be filed down or a small cartilage graft harvested from the internal portion of the nose has to be inserted into the depressed area to give a straight dorsal aesthetic profile. This will repair the problem on a more permanent basis.
Web reference: http://www.seattlefacial.com
Dip in Profile above Tip following Rhinoplasty
As you know, the improvement after Juvederm is temporary. You can achieve permanent correction with a cartilage or fascia graft. Remember, there is always a risk of complications with any invasive procedure. You have been informed re all alternatives, including doing nothing - the choice is yours.
Bony bump after rhinoplasty
Yes to surgery.
The filler is not a permanent solution and every time it is injected you risk creating problems to the skin, which may make a revision rhinoplasty more difficult.
Small revision rhinoplasty, surgery vs. dermafiller?
This is a great question, when you have a small imperfection of the nose, is it better to have surgery to repair it, use temporary dermafillers (like Juvederm), or use a permanent dermafiller like Artefill?
This is clearly something you'll have to decide with your surgeon, but I would strongly consider using fillers for a few reasons:
- For small imperfections, you have a lot more control with fillers. You can control the exact amount of filler placed as opposed to trying to secure a piece of cartilage and waiting to see what happens with scar tissue.
- Fillers may be done in the office in 5 minutes.
- The chances of a new unforeseen problem is probably less when done correctly.
Okay, you may be thinking, I don't want to do something every 6 months, I want something permanent! First, as experienced in this case, even initial surgical results aren't 100% permanent, as changes continue to occur years after rhinoplasty. Second, with small indentations, there may be continual stimulation of your own collagen with continued treatments. Third, a permanent filler like Artefill is an option with an experienced surgeon. Finally, many people do use temporary treatments like Botox, or fillers for nasolabial folds and it's something they work into their schedule for beauty.
Importantly, find someone very experienced and discuss all the risks and benefits carefully. Good luck with your nose!
For examples of Rhinoplasty Tip cases I have performed, please click the link below
Treatment of over-resected nasal dormsuf
A secondary rhinoplasty would require placement of a graft which is generally preferred over a synthetic material.
Web reference: http://www.bodysculptor.com/
Over resection of the dorsum of the nose can be permanently fixed with an implant or graft.
The dorsum of the nose was excessively filed and created a volume deficiency which was corrected by the temporary filler. A permanent graft of cartilage or a prosthetic graft (Medpore) can restablish the proper volume and make further injections unncessary.
Web reference: http://www.zubowicz.com/subpag,25-atlanta-rhinoplasty.htm
Is it worth having a revision rhinoplasty?
The decision to have a revision procedure is up to you. I would discuss your concern with your surgeon to see what options you have. An in person exam is needed to see what method(s) would best help your concern. You can then determine whether the risk/benefit ratio is such that it's worthwhile for you to proceed with surgery.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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