Right side of nose tip never dropped - 9 years later (Photo)

Question

I was told by my surgeon the right side of my tip would drop like the left side did, but it never happened. It’s been 9 years and I’ve been getting fillers in my nose to disguise the unattractive notched/asymmetrical appearance but I’m just wondering if there is anything else I can do. This was my second surgery aa my first rhinoplasty left me with a drooping columella and alar notching. So far I have only been brave enough to use fillers after 2 bad surgeries. Any other options? Is it bossae?

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have very thin nasal skin and visible tip cartilages on both sides where the right side is higher than the left. You also appear to have excessive nostril show on both sides, possibly worse on the right. Depending on your examination, microdroplet Silikon-1000 may be considered for permanently camouflaging your nasal tip irregularities and for lowering your nostril margins without the inconvenience and uncertainty of another nasal surgery. I hope this helps! Sincerely, Dr Joseph

Steven M. Denenberg, MD · Answer

It's not classical bossae, though it has some elements. The tips of the two tip cartilages are prominent under your skin, and asymmetric (as they almost always are naturally). "Bossae" are more classically when the two tip prominences are also much farther apart than yours.

One of the features I see is that the tip cartilages stand out prominently from the position of the brige just above them. That's probably where you're getting the filler? to make that transition less abrupt? I'd love to see a profile view or two, because if the tip could stand to be brought a little closer to the face, then an operation could be designed to make the tip cartilages less sharp and prominent, and closer to the face, and that would help a bunch, and hopefully remove the "need" for the filler, which is probably something you don't want to use forever. At the same time, achieving more symmetry of those two tip cartilages could be attempted.

How *much* to deproject the tip, or smooth the transition between tip and bridge, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Right side of nose tip never dropped - 9 years later (Photo)

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Right side of nose tip never dropped - 9 years later (Photo)

Answers (2)

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Everything you need to know about Revision Rhinoplasty

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