Is a rhinoplasty my best option for a more defined nose? (Photos)

Question

I’ve always had a nose with a dimple / divot running through the center of it almost like a continuation of my philtrum. Although it is not a major concern per se, it contributes to my overall sense that my nose is not particularly flattering to my face and that a more defined shape would better suit my features. Surgery is inherently a risky proposition, and most of the photos I see of rhinoplasty before and after cases are of people with more extreme bumps, humps etc. I have considered filler as well (and have some filler in my cheeks and under eyes already) but have heard that fillers in this area are extremely risky. My board certified dermatologist injector does not perform this procedure and neither does my previous ENT plastic surgeon (unrelated procedure). In any case, is this the type of problem that could satisfactorily be addressed through rhinoplasty? I’m wary of perfection being the enemy of the good!

John M. Hilinski, MD · Answer

Thanks for your thoughtful question. A subtle midline indentation or cleavage in the nasal tip can indeed contribute to a feeling that the nose isn’t ideally suited to your face. While most rhinoplasty cases online highlight dramatic changes like large bumps or humps, more refined aesthetic concerns like yours can also be addressed with surgery. A well-planned rhinoplasty could help smooth the contour and enhance nasal definition, improving overall facial harmony.

You’re right that filler in this area is risky due to the vascular anatomy, and not all providers offer it for that reason. Consulting with a board-certified facial plastic surgeon who has experience with subtle nasal reshaping would be the safest and most effective next step.

You’re right that filler in this area is risky due to the vascular anatomy, and not all providers offer it for that reason. Consulting with a board-certified facial plastic surgeon who has experience with subtle nasal reshaping would be the safest and most effective next step.

Alejandro Nogueira, MD · Answer

Do view any anatomical illustration of the internal nasal anatomy; you'll see there that the lateral crus or lateral crura of the alar cartilages are convex, forming domes with the belly ourwards; some individuals are born with them convex, inverted, like happens in your case, this creates over sharpened tip domes and a very peculiar shape of the tip. Additionally you have a cleft or bifid tip due to lacking or having small nasal tip fatty pad.

There are two solutions:
-simple one: adding a "visual filter" to mask all this, using the superficial temporal fascia as layer between skin and the skeleton, so that no skeletal transparency is visible; pros: local anestesia, quick recovery and cheap; cons: won't increase your tip definition and actually your tip and alae may augment about 1-1.5 mm; nevertheless this solution is absolutely terminating and effective (considering your expressed goals)
-complex one: performing a lower nose structure rhinoplasty, to evert and cross locate the lateral cruras, tutorize them with grafting, suturing the cleft at the midline and applying a Peck-style tip grafting; pros: all, cons: cost and technical difficulty for a low-skilled surgeon; this is the one I recommend

Fillers? No way, very dangerous, research about "blindness facial fillers" or "blindness nasal fillers".

See the link below to know more about concave or inverted lateral cruras congenital conditions.

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have relatively thin nasal skin which reveals the entire anatomy of your nasal tip cartilages that lie underneath. You are visualizing this cleft because it lies in between your right tip and left tip cartilages. We have had excellent success in camouflaging these clefts when they are bothersome. Microdroplet Silikon-1000 nasal injections, there is never a risk of necrosis, embolus, stroke, blindness, infection, or biofilm formation, because the size of a Silikon-1000 molecule is smaller than that of a red blood cell. I hope this helps! Sincerely, Dr Joseph

Andrew Miller, MD · Answer

Based on your photos, you are a great candidate for rhinoplasty. Fillers to the nasal tip can be done (usually with minimal risk if the injector knows what he/she is doing), but the result will only be temporary. Rhinoplasty can give a permanent result while refining other parts of the nose at the same time. Be sure to find a rhinoplasty expert for consultation that can do computer imaging at the same time so you can see how you might like your nose to be.

Kyle Kimura, MD · Answer

Thank you for your question and providing photos! 
To me, it looks like you likely have something called a "bifid tip" which is essentially where the lower lateral cartilages of the nose (what gives the nasal tip its shape) diverge slightly at the midline and cause a central line or indentation. There are certainly degrees of this as well and I would say yours is on the fairly minor side of that. 
As far as options to address this, I think it depends on how bothersome this is to you, but you could have a fairly conservative rhinoplasty just addressing the nasal tip without making other significant changes. This often involves suturing these cartilages closer together (less of a gap) and potentially adding a graft of some sort between them so the skin does not indent as much. 
While filler is also an option, this is a somewhat controversial topic among rhinoplasty surgeons and you need to find someone who does this alot and most importantly, that they do it SAFELY. Personally, I don't love that option as much, but something you could possibly consider.
Hope this helps and best of luck!Kyle Kimura, MD

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Zoran Potparic, MD · Answer

Separated cartilages and thin skin are reason for this tip “deformity”. It is very likely that injection of soft tissue filler would solve the problem. Tip surgery, including placement of fascia graft are options. In person consultation with a board certified plastic surgeon, expert in rhinoplasty, is recommended. Good luck.

Ajaya Kashyap, MD · Answer

Thank you for your query. A tip rhinoplasty is your best option, based on your photographs and the concerns you have expressed. Please find an experienced board certified Plastic surgeon who can examine you and help you with all your concerns. All the best!

Steven M. Denenberg, MD · Answer

From what I can glean from the photos: the dent is there because of the prominence and strength of the two cartilages that form the tip of your nose; the dent is the space between those cartilages. What would be done to minimize the dent depends in part on whether there are other areas of your nose that you might want to change at the same time. When more is done, usually there are more options for doing something else, like fixing a dent.

If the dent is truly the *only* thing you want to change about the nose, the options as I see them are: 1) don't fix it, just leave it alone. Many people have small dents like that, and it's off the radar of most people, meaning they'd never see it unless you point it out. 2) A surgical fix would entail opening the nose, getting some cartilage from your septum, crushing the cartilage up and using it like spackling to fill out the dent. That would have to be done very judiciously, in order to NOT make the tip look bigger. Almost certainly the goal would be a substantial reduction but not total elimination of the dent. It would be unusual to approach a real operation with that small goal, but it's not crazytown: with care it can be accomplished with some reasonable amount of predictability.

I wouldn't use filler. It's either temporary, or it might go in places you don't expect, or it might make things look too big, or you might get one of the rare complications.

That's my two cents!

Ronald J. Edelson, MD · Answer

Personally I don’t find your nose unattractive at all. You could try filler to fill in the deep spot if you like. Personally I wouldn’t even bother with that