Secondary tip-plasty gone wrong. Now what? (Photo)

Question

I had a rhinoplasty in December 2016. as my nose healed it got very droopy and downturned. My PS agreed the results weren’t ideal +agreed to perform a tiplasty to correct it. He took cartilage from behind my ear + only worked on tip. It’s been 4 months since the tip procedure. I like my projection now BUT the graft is so visible. The tip of my nose is now a strange circle. I don’t want to have another surgery. I’m getting married in12 months. Would fuller disguise the strange graft?

Thomas A. Mustoe, MD, FACS · Answer

Unfortunately only tip grafts run a significant risk of become visible which will only get worse over time.  It is better to gain tip projections by strong columelllar strut grafts and underlay grafts. If tip grafts are used, they must be very soft without visible edges.  Filler may help, but the best approach is probably a revision of the tip graft with softening of its contour. The timing is an issue with your wedding Ordinarily it is best to wait a year, but with limited goals, surgery could be considered slightly sooner.

David Shifrin, MD · Answer

To begin with the fullness of the tip is from swelling. You should wait a full year after a revision to be able to make a true assessment of the tip. As far as the visible graft, you may consider attempting to camouflage it with soft tissue filler such as a dermal fat graft. It can be done in the office under local. Otherwise, a return trip to surgery to completely reshape your tip with a rib cartilage graft after a year is possible. Work with your initial surgeon and communicate your concerns.Best

Michael Elam, MD (retired) · Answer

Dear MK1017,  The problem began when the surgeon decided to do a tip-plasty graft to correct the droopy downturned nose. I personally would have taken a different approach. With that said, I would speak with your surgeon regarding your current concerns or have some secondary opinions from some revision experts. You have an obvious time frame to be concerned about with upcoming nuptials however you will need a revision surgery to correct your current problem. I would not be comfortable injecting fillers in the tip. In the video attached below you will see an example of a male revision rhinoplasty procedure with similar circumstances where I removed the visible tip graft and rotated the tip without grafting. Best regards, Michael V. Elam, M.D.

Secondary tip-plasty gone wrong. Now what? (Photo)

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Everything you need to know about Revision Rhinoplasty

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Secondary tip-plasty gone wrong. Now what? (Photo)

Answers (3)

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.