I have a large indentation on the middle of the top of my nose & cartilage at the tip. What are my options?

Question

my dermatologist did not send me to a plastic surgeon. When I went back he said what do you want me to do about it? He had used skin from behind my ear. What are my options?

Remus Repta, MD · Answer

Thank you for the question.  It sounds like the indented area has been skin grafted but either the fat and or the fat and cartilage has not been restored.  Fat grafting and sometimes fillers can be used to replace the volume lost from surgery that was not replenished with a skin graft alone.All the best,Dr. Remus Repta

Barbara Jemec, MD, FRCS(Plast) · Answer

It depends a little on how long ago the procedure was, - but generally you should let it settle for at least 3 months, if not 6, and then see.The indent can be treated with fillers or fat (could try fillers first to see if you liked it), the graft can be removed, and replaced by a flap, but this is a little hard to say without pictures. Flaps are generally thicker and will not leave such a dent.Ask your dermatologist to send you to a plastic surgeon, though maybe they could try the fillers for you??All the best

Adam Asarch, MD · Answer

There are options for improving a scar's appearance after initial surgery. It sounds like you had a full thickness skin graft, which can take longer to heal than a flap. It is difficult to recommend the best course without seeing pictures, but some possibilities include laser resurfacing, steroid injections, or surgical scar revision.  If the surgery was not too long ago, there can still be significant natural healing / improvement over 3-6 months following initial surgery.  I agree with the idea of revisiting the issue with your physician, or obtaining a new referral for possible scar revision. There are many good options, so don't lose hope.  Adam Asarch, MD

Inessa Fishman, MD · Answer

While it's impossible to advise you properly without reviewing your medical history and a physical exam, some nasal scars can be improved with a variety of scar revision procedures.  If after healing you are unhappy with your outcome, you would be best served by discussing your concerns with your physician and scheduling a consultation with a plastic surgeon or facial plastic surgeon who performs facial reconstruction and scar revisions regularly.  Some scars can be softened with steroids, filled out with fillers, camouflaged with surgical scar revision techniques, or removed and covered with surrounding tissue in the form of a flap.  Good luck in your recovery!

Robert Savage, MD (retired) · Answer

Without consult or photos could be hard to tell.However a significant indent in the mid nose area is usually best corrected with a local skin flap by a board certified plastic surgeon.This replaces the most similiar skin and fat as what was removed.Skin grafts to the mid nose from about the ear, sometimes will still leave an indent in that skin and fat removed with cancer surgery is replaced with skin only,they can also sometimes leave a "postage stamp" look.

I have a large indentation on the middle of the top of my nose & cartilage at the tip. What are my options?

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