Ask a doctor

My nose seems to be caving in at the tip... can this be fixed with a filler?

My nose seems to be caving in at the tip and each year seems to be getting worse. I have always had sinus problems and am wondering if I have a deviated septum? Can my nose be fixed with a filler? If I do have a deviated septum, does insurance cover rhinoplasty?

Doctor Answers (14)

How to best fix the groove along your nasal tip...

+2

Careful injection of filler can camoflouge the groove temporarily, but will not actually fix what is causing the problem, and it may not give you a look that you like any better (it will add volume to the center and can give the whole tip a rounder appearance). It appears from the photo that you have prominent lower lateral nasal cartilages, and the groove you see is the space between the two sides. This is best addressed surgically. Also, a deviated septum could be addressed during the same surgery. To determine if your septum is deviated, your surgeon just needs to take a look inside your nose. If you have difficulty breathing and have a deviated septum, then insurance will likely cover your septoplasty. Your surgeon can request a pre-authorization before surgery to make sure. Some insurance companies request a CT scan for additional documentation of a deviated septum before authorizing surgery.  Insurance will not cover cosmetic alteration of your tip. If you were to get your septum fixed at the same time as a cosmetic rhinoplasty, then your insurance would pay for the anesthesia fee, facility fee, and surgeons fee related to the time spent on the septoplasty, and you would be responsible for fees related to the time spent on the cosmetic portion of your procedure. Typically if you combine the two, your overall cost is less than if you were to do both separately. Good luck!


Beverly Hills Plastic Surgeon
4.5 out of 5 stars 11 reviews

Yes - "caving in" and deviated septum can be repaired with rhinoplasty

+1

“Caving in” could be due to a loss of cartilage, or secondary to weakening of the nasal ligaments resulting in drooping of the cartilages. These problems can usually be effectively repaired with various rhinoplasty techniques. As far as a deviated septum, this is usually a procedure covered by insurance, but this does not include the cosmetic rhinoplasty work.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
5.0 out of 5 stars 45 reviews

Nasal tip depression

+1

I can see from your photos what bothers you.  A long term permanent treatment would be to have a tip rhinoplasty.

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

You might also like...

Fixing depressed area in the middle of nasal tip

+1

As the others have mentioned, the depressed area you see is actually due to prominent nasal tip cartilages combined with thin nasal tip skin. This tip bifidity can create quite a bit of shadowing and draw attention to your nose.

I wouldn't recommend a filler injection to conceal the depressed area as this would mainly result in a fuller tip.

A rhinoplasty can be done to improve the appearance of your tip greatly. Your lower lateral cartilages are very convex. By giving them a flatter appearance your tip would have a much more natural appearance.

An examination would be needed to assess your septum. If this is deviated then insurance would typically cover the septoplasty part of the precedure only.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Be careful of fillers in the nose

+1

The area that you seem to be describing in your picture is that there is a small cleft at the tip of your nose between the cartilages that form the tip-the lower lateral cartilages.  The best correction for this would be rhinoplasty, or surgery to correct the shape of your nose.  While fillers have wonderful applications, the nose is one area where caution is advised.  There is likely a greater risk of skin injury with a filler at the tip of the nose in particular.  You also appear to have very thin skin that may be more susceptible to problems.  While often a filler may look very good for some time, it will eventually go away.  On the other hand you are an excellent candidate for rhinoplasty, and re-shaping of the tip could lead to some nice improvements.  

Regarding your sinus problems, you need a thorough physical exam to evaluate what the real problem is.  A deviated nasal septum is just one of many things that can cause 'sinus' problems.  Generally, insurance will not pay for cosmetic surgery.  On the other hand, if you need septum surgery, it is the right time to consider rhinoplasty as the septum is often used for much of the nose shaping surgery.  Find a surgeon who is experienced and really understands how to deal with theses complex issues.

Christopher Cote, MD
Denver Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Can a "Butt Nose" caving in at the tip be fixed?

+1

Regarding: "My nose seems to be caving in at the tip... can this be fixed with a filler?
My nose seems to be caving in at the tip and each year seems to be getting worse. I have always had sinus problems and am wondering if I have a deviated septum? Can my nose be fixed with a filler? If I do have a deviated septum, does insurance cover rhinoplasty
?"

You may have chronic sinus issues (?allergies).
You may have septal deviation which may or may not be associated with the sinusitis and therefore a Septoplasty MAY be partially covered by your insurer.

But - the "caving in at the tip" has NOTHING to do with any of these conditions. You have a common anatomic presentation where the separation of the "wings" of the Lower Lateral Cartilages of the nose making up the tip is visible owing to the extent of separation and the thin skin. This "Butt Nose" as some of my patients refer to it, does NOT impact on nose function in any way and correcting it will not be paid by any insurance company. Using Juvederm or Restylane will fill in "the crack" temporarily but a long term solution would require bringing the separated wings closer together with stitches using a TIP RHINOPLASTY.

Dr. Peter Aldea

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

My nose seems to be caving in at the tip... can this be fixed with a filler?

+1

The poor photo posted makes giving advise difficult. You appear to have a separating lower lateral alar cartilage medial crura. Yes filler can temporarily improve. Also there is a deviation of the septum I think. Insurance ONLY covers the septal correction the cosmetic rhinoplasty is your responsibility. Good luck from MIAMI Dr. Darryl j. Blinski

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

Nasal depression

+1

As some of the other surgeons have mentioned - the depression you see is the space between your lower nasal cartilages visible through your thin nasal skin. ( I don't know if you can find an image on line - if I saw you in person I could draw you a picture).  I would recommend rhinoplasty with tip work to bring the edges together.  Regardless, I'd recommend you find a trusted rhinoplasty surgeon.  He/she will be able to review your individual anatomy, discuss with you what you hope to change about your nose, and give you realistic expectations about your results.

Dr. Cat Begovic.

Catherine Huang-Begovic, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 5 reviews

What is the best option for a bifid nasal tip?

+1

In some people, the cartilage of the nasal tip is very prominent and combined with relatively thin skin leads to a groove.  Although filler could be used to conceal the groove, aesthetically it would just make the tip look larger.  The best solution for this is surgical correction.  It is a relatively difficult surgery but the results can be outstanding.

While it is certainly possible that you have a deviated septum and a functional anatomic problem that can be treated surgically, it is not related to the aesthetic problem you are asking about.  Your best bet is to see a facial plastic surgeon in your area.  They are trained in cosmetic and functional nasal surgery as well as sinus surgery.  You may end up needing all three.

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

Using filler for cleft in tip of nose

+1

The thinning of your skin is most likely visible fof the cleft you see in the tip of your nose. It is the normal separation between the two cartilages that support the nostril and tip. A filler could be used to give you an idea of what it might look like with a longer term correction which would best be cokmpleted with cartilage. Correcting a deviated septum does not mean that the external appearance of your nose will change.A filler could be used
 

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