Nose indentation from nose piercing? (photo)

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.


Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hello and thank you for your question. In terms of the issue you have identified, you likely have unfavourable scarring secondary to a previous piercing. There are options for management of this, including injectable filler vs scar revision with excision of the scar and good multilayered closure for tissue approximation. A detail in person consultation with a facial plastic surgeon may be of benefit to you.

Given the location and size of the nasal tip indentation, I suspect that you have either warping or loss of some of the lateral aspect of your right lower lateral cartilage.

Seek an experienced rhinoplasty surgeon in your area for evaluation and management.
This will likely require a rhinoplasty to correct this acquired deformity.
If the cartilage is warped, underlying cartilage grafts can often be used to support this.
If the cartilage is missing from infection, then a new cartilage graft will need to be placed. This is often taken from the conchal cartilage (bowl portion of the ear).

I'm really sorry that this has happened to you.
I would suggest that you consult with an experienced, board certified cosmetic dermatologist scar treatment specialist to discuss subcision, a technique that I have been using with gratifying results for elevating and smoothing all kinds of Indented scars from all causes for thirty years.
Although subcision is often accompanied by the use of a filler, such as an HA filler, in order to enhance new collagen and new elastic fiber synthesis, I would be reluctant to use it in this case, since the indentation is located on the sidewall of the nasal tip, rather than on the midline problem, where the potential risk for vascular occlusion with a filler would be increased.
Traditional subcision on the other hand (I.e. without the addition of a filler) does not pose this risk.
Be wary when offered expensive light and energy-based treatments, as the hard science to support the use of these expensive gizmo treatments lags well behind the social media and marketing hype. So, buyer beware.
Hope this helps and best of luck.

Several modalities may be helpful for your nose.
1.Hyaluronic Acid or Other Dermal Fillers
Purpose: Non-surgical correction of nasal depressions or irregularities.
Mechanism: Injectable fillers can restore volume and contour, lifting depressed areas by filling the space beneath the skin. This can help mask visible deformities due to cartilage collapse.
2.Subcision
Purpose: Release tethered scar tissue contributing to nasal depression.
Mechanism: A needle or specialized tool is used to break fibrous bands beneath the skin that pull it down, allowing the tissue to lift and creating a smoother contour.
3. Enerjet (Jet Volumetric Remodeling)
Purpose: Stimulate collagen production and tissue remodeling to improve skin texture and volume loss.
Mechanism: Uses high-pressure jet injections to deliver hyaluronic acid or bioactive compounds without needles. This stimulates deep dermal remodeling and filling of the depression.
Combination Approach
Filler alone or in combination with Enerjet and Subcision for tissue remodeling.
Complex Cases with Cartilage Collapse: May require a surgical consultation for grafting or more invasive reconstruction if non-surgical approaches are insufficient.
Good luck.
Jeff Rapaport MD FAAD
Realself Hall of Fame
Castle Connolly Top Doctor