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Help lost Fullness in Tip After Rhinoplasty

I had primary rhinoplasty,where i wanted my nose to be made refined and the bump to be taken out.i told the surgeon that i like the fullness in my tip as i think it looked cute and loved its round shape,but he still narrowed it.friends are saying its a nice result,but i really am unhappy because that was the one thing i wanted to keep and its gone.i feel my nose is more pointy now and i hate it. is there anything that can be done to make the tip more round again ,but still look refined.

Doctor Answers (12)

Non-surgical rhinoplasty for tip refinement

+2


Dear rhinoplasty patient from London,
In order to avoid another surgery known as revision rhinoplasty, injectable materials known as non-surgical rhinoplasty are good option for you. Since you seem to be satisfied with other parts of your nose after rhinoplasty, your narrow tip can be easily refined with Radiesse or Restylane. Good luck and good healing
 


Orange County Facial Plastic Surgeon
5.0 out of 5 stars 94 reviews

Rounder tip

+1

In doing a rhinoplasty , sometimes if you have a very round tip and then narrow the nose because of taking down the bump, refining the tip a bit is usually in order.  But if you are unhappy talk to yoru doctor.

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

Narrow Tip after Rhinoplasty

+1

Cartilage or fascia graftts can be placed to increase tip fullness. Make sure you clearly describe your goals to your revision surgeon.

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

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Revision rhinoplasty for fuller tip, surgery or fillers?

+1

I am sorry to hear about your disappointment with your nasal tip after rhinoplasty.  This is not an uncommon problem, in efforts to make the tip less bulbous, sometimes the surgeon creates an overly narrowed appearance.  Other problems after tip work include:

  • asymmetry of tip, with one side higher than the other
  • new shadowing around the tip with a "parentheses" deformity
  • loss of tip support with an even rounder appearance
  • over-rotation with an unnatural appearance.

Unfortunately, all of these outcomes are possible and at times, difficult to repair.  Fortunately, they often times may be repaired however, surgically or non-surgically.  If you find a very experienced rhinoplasty surgeon, he or she may be able to give you an estimation on how difficult the repair would be and how likely he or she can accomplish it.  A really awesome development is the use of dermafillers around the nasal tip and this may save you another trip to the operating room and may restore some of your original appearance.

An injector who is experienced in non-surgical rhinoplasty techniques may use fillers to add contour and volume back to your nose.  This is an advanced filler technique and it's important to find someone who does a lot of this kind of work.

Again, I am sorry to hear your road to a great nose is a little more circuitous than we would have wished but hopefully it does end with a great nose.  Good luck!

 

I am proud and confident with the results my patients have received with a revision Rhinoplasty surgery. Please feel free to click on the link below to review their before and after photos.

David Mabrie, MD
Bay Area Facial Plastic Surgeon
4.5 out of 5 stars 56 reviews

Restoring tip fullness

+1

There are two dominant techniques for narrowing the tip of the nose.  One is called dome binding, in which a permanent stitch is used to pull the paired cartilage of the nasal tip closer together.  The second is a dome division technique, whereby the curved part of the cartilage is cut in half.  If your surgeon used the dome binding technique, then it may be possible to go in and cut the stitch. The cartilage will separate and the tip will widen.  If your surgeon used the division technique, then the correction is quite a bit more difficult and will almost surely require some type of grafting to repair.

Joseph Campanelli, MD
Minneapolis Facial Plastic Surgeon
4.5 out of 5 stars 7 reviews

Revision tip rhinoplasty should wait 12 months

+1

There are many techniques to modify the nasal tip. If you want to increase the volume of your nasal tip, which it sounds like you do, cartilage will need to be added. This can be obtained from the nasal septum or rib. Typically your surgeon will wait a minimum of 12 months for the nose to heal completely and all swelling to resolve before proceeding with revision.

Best,

Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 37 reviews

Revision rhinoplasty

+1

Revision rhinoplasty can be used to reverse or re-create the desired shape of the nasal tip. This may require cartilage from the nose, ear or rib.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

Revision rhinoplasty and tip recommend.

+1
The tip can be refined andmade less pointy with cartilage grafting. Make sure you see a revision rhinoplasty specialist.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Pinched Nasal Tip

+1

Mazza

Without good before and after photographs, it is difficult to give you specific advice related to your nose.  That being said, there  are different techniques to handle the pinched nasal tip after rhinoplasty.  Hyaluronic acid fillers can be used in some cases by a skilled plastic surgeon.  However, I would avoid the filler Radiesse (calcium hydroxyapatite) in the nasal tip because injections of this material into thin nasal tip skin can create new problems. Just to clarify an another point,  while Aquamid is available in Europe,  it is currently not FDA approved in the United States.

Tip pinching may be due to over resection of the tip cartilage, vertical dome division (à la Goldman) or suture collapse of the dome cartilage. This pinched appearance will be exacerbated by thin nasal tip skin.  I would recommend several techniques or combination of these techniques depending on the problem:

1. Temporal fascia tip grafts for thin skin

2. Crushed cartilage tip grafts for a collapsed or thin tip

3. Cartilage spacer grafts placed  between the domes or in the sub-domal space.

4. Cartilage rim grafts or batten graft to help support weak or collapsed lower lateral cartilage. 

I also recommend that you consult with several Board Certified Plastic Surgeons before considering a revision.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 9 reviews

Reversing Pinched Nose Tip Appearance

+1

Regarding: "Help lost Fullness in Tip After Rhinoplasty
I had primary rhinoplasty,where i wanted my nose to be made refined and the bump to be taken out.i told the surgeon that i like the fullness in my tip as i think it looked cute and loved its round shape,but he still narrowed it.friends are saying its a nice result,but i really am unhappy because that was the one thing i wanted to keep and its gone.i feel my nose is more pointy now and i hate it. is there anything that can be done to make the tip more round again ,but still look refined
."

Reversing an operated nose tip from "pointy" back to "round" would depend on what exactly was done and how it was done. Nose tip roundness (in Surgicalese "bulbosity") is imparted by the shape and width of the central portions of the Lower Lateral cartilages. These cartilages or often narrowed by removing a variable width strip from the upper edge of the cartilages for a more refined look BUT the pointy look can be produced by using stitches to shape the remaining cartilage arch (which if removed would allow much of the old tip to come back) or less commonly by either cutting the arches and then stitching them together or crushing the arches. The latter two procedures cannot be reversed.

I would find out EXACTLY what was done by obtaining the operative note. You can ask your surgeon to see if he can reverse the tip work. If he cannot / or it cannot be reversed, your only option is the use of camouflaging fillers.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 60 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.