Non-surgical rhinoplasty is an excellent alternative.
Dear Ffcx in Germany;
recently returned from Berlin and found that some physicians are aware of our
current techniques in the United States for non-surgical rhinoplasty. Regarding the use of rib cartilage or
ear cartilage: you're correct in being concerned about warping and other
unforeseen consequences. I have been an advocate of using non-surgical injection techniques to
correct deformities such as yours. Using
a filler, particularly a permanent filler, is not appropriate for everyone and
is often used for non-surgical revision rhinoplasty. For you, it might make sense.The illustration certainly fortifies the
concept with respect to raising the bridge.
Non-surgical rhinoplasty works because tiny drops of Silikon
1000 are injected just under the nasal skin. Over time, the body walls off
those drops with new tissue which provides the plumping action and fills in
divots or marks in the nose. The same effect can happen with plain salt water
to provide a preview how the nose will look on completion of treatment. The
Kotler Saline Demo lasts perhaps two hours, but long enough to take a photo of
what the finished nose will look like.
Rhinoplasty questions and de-rotation of the nasal tip
Thanks for this question. The best approach would be to use septal cartilage to reshape the nose. This cartilage can be used to rotate the tip down as well as to build up the dorsum.
Tip Derotation Rhinoplasty
What you are striving for is to lengthen and turn down the tip of the nose. Such a maneuver will allow you most likely to get away without doing anything to the dorsum. However be aware that it takes a substantial driving force to rotate the tip downward with your thick skin. Using the septum for a columellar strut and onlay grafting of the tip with ear cartilage may be enough to achieved that objective. It is also possible that stronger and more substantative small grafts from the rib may also be needed for maximal support.
Thank you for the photos and your questions and the straight forward answer is that Yes you can get the desired result without the use of ear cartilage
Low Scooped Out Bridge
If you decrease tip rotation and projection and do not change the bridge as you morphed you will increase the width of your tip which will not be desirable. Some augmentation of the bridge ( I would use diced septal or ear cartilage wrapped in fascia) will give you more definition an improve nasal proportions.
Rhinoplasty for upturned nose bulbous tip and low bridge.
Rhinoplasty for upturned nose bulbous tip and low bridge can help achieve your goals. See a very experienced rhinoplasty surgeon.
Keeping my low scooped-out bridge. Will I have to use ear cartilage?
Extended grafts can be used to lengthen the nose and the tip can be refined. Septal cartilage can be used if available for the grafts.
Kenneth Hughes, MD
Los Angeles, CA