I will prob undergo revision o add some fascia under my skin and add some volume and soften the tip. I also have a small notching at my alar sidewalls that would look more natural if this area was somehow smoother. I have been told that this is usually treated with ear carti. I am extremely worried about this.What is the best way to just smoothen only the small part of notching and avoid to get my tip too big? my nostrils are already a bit flared..i want a softer appearance without changing..
Can Someone Enlighten Me on the Risky Aspects of Correcting a Tip in Revision Rhinoplasty?
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Doctor Answers 4
Cartilage and fascia grafts in revision tip rhinoplasty.
Depending on the specific nature of the undesirable nasal tip aesthetics, the status of the underlying cartilage framework and the quality of the overlying skin envelope, cartilage and fascia grafts are often key maneuvers in achieving the desired changes without visibly adding to the size of the tip. Alar notching is generally best treated with carefully contoured and accurately positioned cartilage grafts. If the notching occurs along the nostril margin then an alar margin graft is used. If the notching occurs along the surface at the interface between the nasal tip and the nostril then an onlay graft may be necessary to reinforce and reshape the intermediate and lateral crus of the lower lateral cartilage.
Revision rhinoplasty of the nasal tip may be necessary for a variety of reasons following previous surgery. One of the more common reasons that patients seek out revision tip rhinoplasty is a nasal tip that is isolated from the rest of the nose with sharp, irregular or asymmetric contours. This is invariably due to an unsatisfactory contour of the underlying cartilage framework. In addition, an overly thin skin and soft tissue envelope will aggravate the problem.
In order to improve nasal tip aesthetics during revision rhinoplasty it is important to identify the features that need to be modified and then execute the appropriate preoperative plan. A variety of techniques may be necessary including tip cartilage modification, tip suture techniques or tip grafting with either nasal septal cartilage or ear cartilage if there is inadequate remaining tip cartilage. Temporalis fascia is an excellent grafting material that can be laid over the nasal tip cartilage framework when the skin envelope is too thin. This will help “soften” the overall appearance and camouflage any subtle irregularities without visibly adding to the size and volume of the tip.
Mario J. Imola, MD, DDS, FRCSC.
Risks of Nasal Tip Revision
Adding fascia to smooth the nasal tip and small cartilage grafts to correct notching at alar margin will not add significant bulk to your tip when this is done by an experienced revision rhinoplasty surgeon.
Risk of ear cartilage graft to ala
Cartilage grafts at the alar sidewalls shouldn't necessarily cause permanent fullness in the area. The cartilage used is quite thin so once the swelling subsides the result is typically quite subtle.
Ear cartilage is certainly possible, but so is septal cartilage if you have enough available to harvest.
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