What to Do About Divided Domes?

Ever since my rhinoplasty over 10 years ago i have had asymmetry of my nostrils. When I feel my tip one piece of cartilgege feels to be higher than the other (the two that meet in the middle). Because the higher part is pushing against my skin the edge looks like a white knuckle at the tip in certain light. It seems to be getting more apparent as I age. Could this be due to divided domes? How can this be fixed? This is my native cartilgege I have no grafts my tip.

Doctor Answers 6

Tip Asymmetry Can Be Fixed With a Revision Rhinoplasty

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The effect you are seeing is due to asymmetric tip cartilages (unclear if this is actually due to divided domes) which can be fixed with a revision tip-plasty. At the time of the revision surgery the exact reason for the asymmetry will be identified and fixed. This is relatively routine surgery for an experienced rhinoplasty surgeon. Find a few in your area and consult with them. Good luck.

Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 28 reviews


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Your nasal asymmetry can be improved by an Open Rhinoplasty performed by an experienced expert in Facial Cosmetic & Rhinoplastic Surgery. 

Robert Shumway, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Rhinoplasty revision

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What you are describing could be due to division of the tip cartilages (dome) at the previous surgery. The way to fix it is expose the tip cartilages (usually via an open rhinoplasty approach), realign them to each with sutures and if necessary place sutures that will reshape them as well. In some cases additional camouflage with a cartilage graft placed over the tip cartilages in the dome is required.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

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Divided nasal domes

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From your description it sounds like you have had an asymmetric domal division or suture.This can be corrected by revision tip plasty. Hands on exam and photos are important. See a PS .

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon

Revision of Divided Nasal Domes

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You describe asymmetrical divided nasal domes which can be corrected or improved with revision surgery. Pictures would help us be more specific but this is a problem I have unfortunately seen numerous times over the past 30+ years when patients were referred to me.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

What to Do About Divided Domes?

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 What you are desribing is called a bossae and is a localized lump along the tip cartilages most often associated with older type tip thinning techniques.  If this is the only issue, the bossae can be reduced with a localized tip procedure.  An experienced Rhinoplasty Surgeon should be able to make the determination.  Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.