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Options for Fixing the Nose Tip That is Too Round?

Around 5 and a half years ago, I had Rhinoplasty to address my nose tip that was too round. All went well, and after two years, I had a revision to correct the tip even more, for there had been a lot of scar tissue there. The surgeon injected at the end some Kenalog on the bridge and it looked perfect. However, he didn't wanted to inject Kenalog on the tip where there still are a few lumps. Another revision would be too dangerous. We are now 1.5 years ahead since the last revision, and I wonder, is there anything can be done about this? Is Kenalog an option, or are there new techniques for scar tissue that might be an option? I have consulted two plastic surgeons, and they both gave me different answers.

Doctor Answers (21)

Revision Rhinoplasty to address tip abnormalities

+2

At one and a half years out from your last revision surgery, lumps and bumps in your nasal tip are not related to swelling but rather, irregularities of the underlying cartilage.  Your best bet would be to consult with a skilled revision rhinoplasty expert who would reshape your tip cartilages to give your nose a more normal appearance.  This may require using cartilage from your septum or harvesting a piece of cartilage from your ear.  When performed properly, this harvesting of ear cartilage shouldn't change the shape of your ears but may cause them to sit a few millimeters closer to your head.  

Kenalog (steroid) injections are unlikely to be effective and may make the problem worse.  Another helpful trick I've used in revision cases is to place fascia underneath the nasal skin, to help to camouflage any underlying cartilage grafts at the tip.  This fascia is harvested by making a small incision behind your hairline and taking a small, thin piece of the covering of the temporalis muscle, the muscle that bulges in your temple while chewing.

Hope this answers your question. Best of luck!

Dr. Mehta

Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 22 reviews

Kenalog for Nasal Scar

+2

O.K. - Lumps on the tip. 1.5 years after the last surgery. My first thought is cartilage irregularities which would require looking at the tip and correcting whatever deformity is causing the problem. However, after two surgeries and steroid injections into the nose it's really hard to give an accurate assessment without seeing your nose and knowing what your surgeon did. I have actually had good luck with steroid injections into the supratip area of the nose when there is prolonged swelling. I think some folks just build too much scar. If I've left the nose in proper proportion at the end of the surgery then any fullness in this area is going to be due to excessive scar formation. You can't use steroid to predictably reduce bone or cartilage - that's a potentially big problem. Best of Luck

Miami Plastic Surgeon
5.0 out of 5 stars 30 reviews

Revising the nasal tip

+2

Revision of the nasal tip is one of the most challenging aspects of revision surgery. This is not only because of the technical issues, but rather the creation of a suitable surgical plan based on analysis of nasal form.

Obviously, we cannot determine this for you in this forum. But, evaluation by an experienced revison rhinoplasty specialist should help determine what is possible for you.

Hope this helps,

Dr. Sam Most

Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

Revision Rhinoplasty

+2

Jette,

Injecting the nasal tip with Kenalog can cause thinning of the skin and remaining soft tissue, thus making those lumps more visible. I have found that in revision rhinoplasty cases with visible contour irregularity, certain fillers can be an excellent choice to smooth out these irregularities and sometimes improve the tip shape!

It is important to choose a Board Certified Plastic Surgeon when seeking out a rhinoplasty surgeon for these complex secondary nasal shaping procedures.

Newport Beach Plastic Surgeon
4.5 out of 5 stars 8 reviews

You can have nasal surgery without looking abnormal

+2

The goal of surgery is to have a natural nose. In revision surgery you must make sure the surgeon has vast experience since the revision rhinoplasty is one of the most difficult surgeries to learn. Your doctor should tell you his approach to your problem and why he is choosing it. Make sure you see actual photos or patients with your problem and how he corrected them.

Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Kenelog in the tip is generally not good idea, especially if problem is tip bossae.

+2

Jett,

The answer to your question partially depends on what the lumps are. For most patients, when they come in and complain of "bumps" at the tip from some other previous surgery, they are talking about tip bossae. Tip bossae occur when surgeons aggressively cut or remove the tip cartilage to make the nasal tip look smaller and more refined. Over time, whatever cartilage is left starts to bend and twist under the weight of the skin. As the cartilage twists on itself, the weak points at the ‘joints’ of this cartilage can start to form bumps or knuckles, called bossae, that are very noticeable through the skin. This amy be why the tip looked good to you originally but over time formed "scar tissue."

Many surgeons treat these bossae by going back and trimming them, weakening the cartilage even more. Unfortunately, in the long run this is not a good idea. If this is your problem and you really want a long term solution the tip cartilages must be reconstructed in order to restore their natural strength and resiliency while improving on the cosmetic appearance of the tip. This will usually allow for the surgeon to also remove any scar tissue that is preventing you from having the refinement you want.

Kenelog injected into the tip really does not help because it can cause the overlying skin to thin out. If the lumps are over the bridge anywhere up to the tip, we occasionally use kenelog to help settle scar tissue that may be filling the area.

Others may still do well with injection rhinoplasty if it is simply an issue of one side having a small depression which can then make areas next to it look lumpy. The depression can be injected with fillers to help soften the appearance.

I hope this helps answer your question.

Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Correction of Nasal Tip Deformity Five Years After Rhinoplasty

+2

Hi Jette,

Your question is most difficult to answer without seeing your nose. The most common "lumps" in the tip are bossa caused by the lower lateral nasal cartilage buckling. It is correctable with surgery, but is an advanced technique that should be performed by an experienced and skilled rhinoplastic surgeon.

Kenalog injections this far out from your surgery will cause atrophy of nasal tissue, and most likely should be avoided.

In the past few years injectable fillers such as Restylane, Juvederm, and Radiesse have been injected into the nose, the so called non-surgical rhinoplasty to smooth out post-surgical deformities. These injections are only a temporary fix, and require repeat treatments.

E-mail photos for a more precise answer. Good luck and be well.

Dr. P

Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Revision Tip Rhinolpasty

+1

Lumps in the tip of the nose at 1.5 years after a rhinoplasty is most likely due to irregularities in the underlying cartilage framework and/or grafts that were placed in the tip of the nose.  A Tip Revision rhinoplasty can be performed in order to determine the location and amount of cartilage causing the problem. This cartilage can then be reshaped and/or re-arranged in order to reshape and refine your nasal tip.

Web reference: http://rhinoplastyofbeverlyhills.com/

Los Angeles Plastic Surgeon
4.5 out of 5 stars 25 reviews

Have two different opinions about Revision Rhinoplasty, now what?

+1

 I have performed plastic and cosmetic surgery, including Rhinoplasty, for over 20 years and this is the single most difficult thing for patients to understand.  Medicine, including plastic and cosmetic surgery in general and Rhinoplasty specifically is not performed the same by all Rhinoplasty surgeons.  if it were, there'd be no need for consultations, you could just call and/or e-mail an office and schedule the surgery.  You will have to have 1 or 2 more consultations and follow your gut as to who you should entrust with your Rhinoplasty.  I have written an article here that may be of some help as it outlines a 4 step process that i think patients should follow in their selection process.  Hope this helps and good luck.

Web reference: http://www.drfpalmer.com

Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Tip lumps after 1.5 years ... what to do

+1

You say you have seen several different doctors and they gave you different answers; welcome to the world of plastic surgery. As you read the comments from the internet  you can begin to get  a meta-analyses if you will.

Seems as if we all agree the tip of your nose is most likely cartilage called bossaes. It should not be treated with more kenalog. You need to determine you  risk benefit ratio of doing more procedures including injections. And you need to consider the possibility of doing nothing.

You will want to make an appointment to speak with a Board Certified Plastic Surgeon to get further information. I hope this information has been useful to you.
Jon I Sattler, MD, Board Certified Plastic Surgeon, Glendora, California
 

Glendora Plastic Surgeon
3.0 out of 5 stars 14 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.

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