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Cartilage Graft to Fix Dip in Nose?

I'm going in for my first (and hopefully last) rhinoplasty in 2 weeks. I want a very conservative change- make my dorsum and tip more narrow and slightly more defined (osteotomy and tip sutures), but my doctor thinks I need a cartilage graft to correct the slight dip (see picture). He says that the graft will slightly add height to the tip, too. Do I need to correct the dip, and will the graft change the shape of the tip and make it pointy? I don't want a pointy tip- just slightly more defined.

Doctor Answers (14)

Graft to fix nasal dip.

+2

The tip will not be pointy if done properly. The graft for the bridge dip can be cartilage or soft tissue depending on the depth and the skill of the surgeon with both materials. Make sure you make clear to the surgeon that you only want the dip done and nothing else if that is the case.


Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Fixing a dip in the nose

+1

The dip in the nose is created by a very high dorsal hump which when removed will give a nice aesthetic profile to the nose.  It appears that only minimal tip surgery needs to be performed, large dorsal reduction with hump removal, and osteotomies would probably be all that is needed.  

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

Primary Rhinoplasty and Cartilage Grafts: Building blocks for the nose

+1

Rhinoplasty is a very individual procedure which can be personalized to correct specific complaints. It sounds like you have very simple complaints that are reasonable based on your photo, however these simple complaints may require differing degrees of correction which may entail a combination of operative maneuvers, including cartilage grafts. It would not be unreasonable to place a graft in combination with tip suturing, and there are a multitude of cartilage grafts which have been described. A complete nasal analysis would be the only way to delineate what you need and then computerized imaging may give you an idea of what each maneuver can do. Typically, in a primary rhinoplasty the graft is harvested and fashioned from the septum which is expendable. For the "dip" you describe, it may require some internal support grafts which will not predispose you to the tip characteristics you mentioned. I hope this helps.

Dr. Trussler

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.5 out of 5 stars 11 reviews

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Why Gamble With Rhinoplasty? First, "Test Drive" a Filler.

+1

Hello, Almond Lotion.

Seems to me that you should consider a more predictable, less expensive answer to your problem. After all, cartilage grafting is fine when it works out perfectly, but........ there are never guarantees.

Have you considered have a filler injected, to fill the dip instead of rhinoplasty?

To " test drive" or " demo" the potential improvement, ask your surgeon to inject sterile salt water ( saline) and to show you how you would like the result obtained with a filler. The saline will disappear in a couple of hours. The other benefit from this " test" is that you get to determine how much and exactly where you want you want the improvement. You control the results. " Put a little bit more here and let's see how that looks, Doctor".

Hard to fault the logic of this. You can always have the surgery if you are not happy with the prospect of having a filler injected but if it were I, the decision to at least see the result of filling would be #1 on my list.

Robert Kotler, MD, FACS

Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

Cartilage Graft to Fix Dip in Your Nose

+1

Cartilage grafts and fascia can be used to fill "dips" or improve contour and definition without making the tip "pointy". Make sure you and your surgeon have the same goals and expectations. A second opinion might be helpful.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Differences in Rhinoplasty Technique Is Best Seen By Computer Imaging

+1

The decision to straighten or smooth the dorsal line of your nose can be done by hump reduction or middle vault and tip augmentation. Either approach could be correct if it achieves the look that you want. While you want and need to trust the experience and judgment of your plastic surgeon, you also want to have the final look that you think looks best. You should go back to your plastic surgeon and see computer imaging based on these two different approaches and see which one you like the best. Each approach will create a slightly different look to your nose. 

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 27 reviews

Nasal tip cartilage or not?

+1

The good outcome after rhinoplasty is  very directly related to the expertise and experience of the surgeon.

If  your surgeon feels that a graft is necessary ,probably he' s basing it on his own experience and prior results.If you trust him then let him  proceed , otherwise look for a second opinion by another surgeon who can examine your nose.

Erel Laufer, MD
Tampa Plastic Surgeon
4.5 out of 5 stars 14 reviews

Tip grafts

+1

Often I can achieve tip correction with sutures only. Tip grafts can sometimes be very noticeable through the skin.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Cartilage grafts in the nasal tip when really needed

+1

Your concerns are correct in that tip grafts will be visible after your procedure. If the grafts are done well the nose will not be pointy and can greatly enhance the projection and definition. It is true also that with open suture techniques that we use tip grafts much less often. We suggest working from computer simulations or photos so that you and your surgeon understand the goals and expectations. Once you set the understood plan into action you will have to rely on the instincts and experience of the surgeon you have placed your trust in.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 29 reviews

Consider filler trial before rhinoplasty

+1
From your picture and written description I would probably not do a graft in the area above the tip. I would reduce the prominent dorsum. If a conservative change is being considered, I might suggest a trial of an injectable filler such as Restylane to see how you might like the equivalent of a cartilage graft in the dip above the tip.

Sheldon S. Kabaker, MD
Oakland Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

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.