I have thick skin and am worried about deformities from a Bilateral Cephalic Trim - Is it a good next step? (photos)

Question

I had a rhinoplasty 10/19 and am unhappy with the tip of my nose as it is still bulbous. I'm working closely with my Dr and have received steroid shots which help (see pics), but my nose remains bulbous from the front. My Dr is suggesting a bilateral cephalic trim, but I am worried about deformities based on reviews I've seen. I have thick skin, so he's indicated I'm a good candidate with limited risk. I'd love any thoughts on this procedure and if it seems like a good next step.

Marc Polacco, MD · Answer

Thank you for your question. Tip refinement, especially with thick skin, is a challenge. While cephalic trimming is indeed one maneuver that can help, one must be careful to avoid over resection, as this can lead to collapse of the cartilage when breathing in. Sometimes a bulbous tip is caused by the orientation of the cartilages themselves, and instead of making them smaller, a solution may entail reorienting them. Ultimately form and function both come into play, and the technique used will depend on your anatomy as well as surgeon preference. I hope this information is helpful to you, and all the best.

Andrew Miller, MD · Answer

It would probably not help to only do cephalic trims. Your lower cartilage is quite curved and techniques are needed to make the curves straighter. That will allow your skin to tighten over the cartilage better. You will always have a somewhat bigger nose, but an experienced rhinoplasty surgeon should be able to make an improvement.

Eric M. Joseph, MD · Answer

Based on your photos, you may be having inflammation that's causing your tip to swell. You demonstrate a less swollen nose after a steroid injection. That said, it may be worth continuing a trial of dilute steroid injections to your supratip area. Ask your surgeon if he used any permanent suture material during your rhinoplasty. Occasionally these may be a source of inflammation. Please keep revision as a last resort. Thank you. Dr Joseph

Nilay Shah, MD · Answer

Cephalic trims may probably not help in your case. Your lower cartilage looks quite curved and it may require a bit straightening to allow the skin to tighten over it better. However, would suggest that you take an in-person appointment with experienced rhinoplasty surgeon to for better recommendations.

I have thick skin and am worried about deformities from a Bilateral Cephalic Trim - Is it a good next step? (photos)

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