-anesthesia resident, s/p tertiary revision 5/2012-bridge and tip widened with septal cartilage I have a persistent issue plaguing me- ATROPHY ALONG ENTIRE RIGHT LATERAL NOSE WALL AND TIP. ALSO SLIGHT 2-3 mm DEVIATION OF TIP TO THE LEFT. I believe the atrophy is causing the deviation due to reduced firmness. Fat graft v silicone v ? Goals: to restore fullness to R side and symmetry, restore straightness and discrete line of light, nonsurgically preferably. Will be in SoCal in May for consults.
Nose contouring for atrophy - fat graft v silicone?
Doctor Answers (6)
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Definitely not silinone
First off, there is no reason to go to Southern California unless you live there or are from there. There are plenty of good and plenty of bad plastic surgeons everywhere regardless of zip code.
If you prefer a non-surgical route then try Restylane first and see if you like it. Do not go to fat right off the bat and stay as far as you can from Silicone or Artefill. Surgically, fullness can come from crushed cartilage, fascia or Alloderm. You have to evaluate the tip from the base view and see if in face it deviates or is it an illusion due to the lateral nasal wall depression.
Skin and soft tissue atrophy can be difficult to correct
Damage to the skin soft tissue envelope can be difficult to correct. There are a variety of tissue that can be used to improve this. Fat, fascia, cartilage and bone are optons. The best option should be natural and closely recreate the tissue that you are trying to replace. If structure is needed for support you may want to consider a more firm tissue.
Fat or filler can be used, but you would prefer something durable such as a cartilage graft. An examination would be necessary to determine anatomical constraints and concerns. Find the board certified plastic surgeon with ELITE credentials who performs hundreds a year.
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Why risk it?
Silicone injections in the nose? Very risky, I think. If it gets infected, you could have very major problem. Crushed cartilage, temporalis muscle or fascia would be worth considering.
Silicone to the nose
Do not consider using silicone in the nose, or any other fillers. After 3 rhinoplasties, the nose will never be perfect. Building up the sidewall can be accomplished with several options including cartilage and fascia. Best to look for a revision rhinoplasty specialist that has thousands of rhinoplasty surgery procedures under their belt. This will be a challenging procedure, so weigh the benefits/risks.
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