Revision Rhinoplasty Q&A
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Options for Fixing the Nose Tip That is Too Round?
asked 3 years ago by Jette in Europe
Latest answer by Gary Motykie, MD
Question viewed 7,186 times
Tags: nose tip, kenalog, options, tip
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.
21 answers to Options for Fixing the Nose Tip That is Too Round?
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Have two different opinions about Revision Rhinoplasty, now what?
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...
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Nasal tip Deformity caused by cartilage
Hi Jette,
It appears that you have excess or deformed cartilage. You would be best served consulting with a revision rhinoplasty specialist. Revision rhinoplasty will most likely be your best option.
Injecting Kenalog will cause thinning of the tissues and will make the deformity more obvious. You should avoid this option.
Good Luck,
Dr. Sajjadian
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Revision Rhinoplasty to address tip abnormalities
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...
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Kenalog for Nasal Scar
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...
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Revising the nasal tip
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
Sam Most, MD
Bay Area Facial Plastic Surgeon
Bay Area Facial Plastic Surgeon
+2
Revision Rhinoplasty
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.
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Daniel Reichner, MD
Newport Beach Plastic Surgeon
Newport Beach Plastic Surgeon
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You can have nasal surgery without looking abnormal
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.
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Kenelog in the tip is generally not good idea, especially if problem is tip bossae.
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...
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Peyman Solieman, MD
Beverly Hills Facial Plastic Surgeon
Beverly Hills Facial Plastic Surgeon
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Correction of Nasal Tip Deformity Five Years After Rhinoplasty
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...
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Revision Tip Rhinolpasty
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.
Gary Motykie, MD
Los Angeles Plastic Surgeon
Los Angeles Plastic Surgeon
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Tip lumps after 1.5 years ... what to do
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...
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Jon Sattler, MD
Glendora Plastic Surgeon
Glendora Plastic Surgeon
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Revising the Tip Can be Tricky
There is no easy (Internet) answer: an examination is necessary to give any sort of reasonable answer.
This is an area about which experts disagree: be prepared for different answers, but don't be afraid to ask each consultant why their answer is different from what others may have suggested.
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Residual tip lumps after revision rhinoplasty
Residual lumps after rhinoplasty can be due to:
Buckled tip cartilage - this may not have been evident until more recently as the skin swelling may have obscured it.
Scar tissue - a steroid injection or 5-FU may help this issue if this is causing the problem.
It's impossible to give an assessment in your case without examining your nose. There are techniques available to address each concern. The thinner your nasal tip skin the easier it is for underlying...
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Depends on the cause
The lumps are likely deformed cartilage as opposed to scar tissue. Kenalog will not help this situation but a well executed revision rhinoplasty may help.
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Bumps in the tip are probably not scar, but cartilage
Most tip irregularities after rhinoplasty are due to contour imperfections in the tip cartilages, caused by some tip contouring surgical technique. Particularly if your nasal skin is relatively thin and your cartilages are relatively strong and stiff, these so-called "bossae" can form. Kenalog or steroid injection is unlikely to help in these cases. Revision surgery with re-contouring or camouflage grafing may help.
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Depends on what the lumps are.
There are hundreds of different rhinoplasty tip techniques that can be performed on the nose to make it look better. If diagnosed, scar removal is best performed with Kenalog injections into the tip. This melts scar tissue and removes the lymphatic edema that is trapped in the super tip area of the nose. Injecting Kenalog into the area of the tip where there are some lumps is actually a good idea if these are composed of scar tissue. If the lumps are cartilaginous or bony irregularities...
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Revision Rhinoplasty requires additional expertise
As a plastic surgeon, who performs many revisional rhinoplasties, I am often faced with people like yourself. The first thing to consider is the level of swelling and scar tissue. it is not unheard of to see swelling and hard scar tissue continue to resolve even three years after the surgery. Once the tissue is soft, better evaluation can be done and the chance of a succesful outcome is improved. Secondly, the more procedures you have, the lower the expectations must be. The reason you are...
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Robert M. Freund, MD
New York Plastic Surgeon
New York Plastic Surgeon
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Nasal tip deformity or lumps are most likely due to cartilage
The most likely cause of nasal tip deformities from underlying subcutaneous causes is rarely collagenous scar tissue, rather, a malpositioning of the nasal cartilage. The scar tissue may deform the cartilage, but the prominence of these cartilage pieces often cause the majority of the deformity.
In the case of nasal tip deformities, the gold standard remains an open rhinoplasty with repositioning and grafting of the nasal tip cartilage.
Raffy Karamanoukian, MD
Los Angeles Plastic Surgeon
Los Angeles Plastic Surgeon
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What are you goals?
My first question to you is what are you trying to accomplish since you said the first surgery went so well? Multiple attempts to over finesse the tip could cause you to lose your tip. Be very careful!
If those lumps are scar, they may benefit from Kenalog, but not typically after a year and a half. Does your surgeon feel the lumps are scar tissue or malpositioned cartilage remnants?
If they are cartilage, camouflage techniques might be in order. Speak to your surgeon about their thoughts on...
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Manish H. Shah, MD
Denver Plastic Surgeon
Denver Plastic Surgeon
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Tip of nose can be improved with filler if rhinoplasty is not an option
The only way to answer this question for you is to see your photos and review your operative report. Most irregularities at the tip are quite easy to fix and some are very difficult to correct. You can aways try a filler to the tip which is very effective most of the time but the results are temporary. Best of luck.
Jason B. Diamond, MD
Beverly Hills Facial Plastic Surgeon
Beverly Hills Facial Plastic Surgeon
+1
Rhinoplasty
If you are unhappy with the appearance of your nose specifically of your tip because of some tip irregularities, then I suggest a tip revision would be in order. Fillers like Radiesse to camouflage it may not do the trick. Often it is scar tissue/cartilage that causes the irregularities. Kenalog injections into the tip may thin the skin too much and cause telangiectasias to sprout.
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