Will adding fascia to the tip of the nose increase the chance of a "pinched tip"?

Question

My lower lateral cartilages were "repositioned". No grafts were placed, but tip of nose was sutured with inter and intradomal sutures. And I feel like my tip is starting to look pinched already. If I have a layer of fascia placed on the tip of my nose to hide some irregularities I am already seeing, will this increase the chance of it collapsing and becoming pinched with the weight? What grafts can be placed to prevent pinching. I have thin skin

John Layke, DO, FACS · Answer

A "pinched tip" is usually caused from overresection of the lower lateral cartilages.  From your question, I am imagining that you have very thin nasal tip skin.  This means that you will likely see every contour irregularity from the cartilage underneath.  Therefore, often a fascial layer is placed to mask some of the irregularities and will not add to the "overdone" look.  Imagine a silk sheet is placed over a chair.  You recognize that what is underneath the sheet is a chair, based off of the height and dimensions.  People with thick nasal tip skin are like throwing a thick, down comforter over the chair; the result - you may not know that a chair is underneath the quilt.  In these individuals, every effort has to be made to create more definition.  Relay your concerns to your surgeon, and he or she will come up with a reasonable timeline of events to expect certain results.  Often times, scar tissue will form causing a smoothing effect.

Julie Edween, DO · Answer

A picture would determine what would be your best option.  Having thin skin allows contour irregularities to become more visible.  If you are still in the healing phase of recovery, be sure to address this concern with your surgeon.  If enough time has passed and you are considering revision surgery,  your surgeon should be able to review the options you have to maintain your nasal support while camouflaging the irregularities, whether it be fascia, grafts or a combination of both.  Best of luck!Dr. Julie Edween

William Marshall Guy, MD · Answer

Hello zzzz12345,A pinched tip usually is the result of over resection of the lower lateral cartilages.  These are often trimmed as part of a procedure to refine the nose and a sufficient amount is then ideally left intact to support the nose.  In patients with recurvature of the cartilage or very weak cartilage then sometimes grafts may be needed to prevent the scar from contracting and narrowing the nose.  Given your thin skin these would have to be placed under rather than over your existing cartilage.  If a pinched tip is developing then a cartilage graft designed to spread the tip can be used.  Also, you mentioned you had sutures to the tip so it is possible that simply incising the sutures would help with your concern.  To answer your question about fascia, no that would not contribute to an increased risk for a pinched tip.  I'd recommend you follow up with your surgeon to truly assess what is going on with your nose.  I hope this helps and good luck.

David Alessi, MD - Account Suspended · Answer

Adding fascia will not lead to a more pinched appearance.  If you are having a pinched appearance, the is most likely caused by a deficiency of the lower tip cartilages.  This can be repaired with carefully placed grafts.  Seek out a consult from a board-certified rhinoplasty expert.  Best wishes.

Will adding fascia to the tip of the nose increase the chance of a "pinched tip"?

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Will adding fascia to the tip of the nose increase the chance of a "pinched tip"?

Answers (4)

Answer: Revision rhinoplasty

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