Do I need grafts to support the tip of my nose? (photos)

During my consultations, there have been a few doctors who have suggested that I need grafts on the tip of my nose, because if the bridge is shaved, the tip will begin to droop downward. They are going to use my cartilage as beams to help support the tip. However, my top choice as the surgeon will do a closed procedure and thinks that I do not need these grafts. Do I need grafts to support the tip from drooping or will I be alright without them? Thank you very much!

Doctor Answers 7

Your rhinoplasty may well require some building up of the tip.

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Dear DB7757;

The photos are very helpful, as is your passing on information about doctors suggesting you might need graft on the tip of your nose.

The doctors are correct in thinking in terms of what happens when the bump, or bridge of the nose is taken down. If the tip is not strong enough to stand on its own, in relation to how much the bridge, is lowered, the tip will continue to fall down, and you will never have a satisfactory profile. Frankly, without feeling the nasal cartilage and getting a better sense of its strength, I cannot tell you for sure whether or not you would need to have cartilage to support the tip. Now, if you do, it is not that big of a deal to put in a tip graft.The cartilage is generally taken from the nasal septum. Certainly, it can be done via closed approach.

Another option that some people avail themselves of is doing the surgery and then, later, if needed, having a little non-surgical revision tip rhinoplasty in which a permanent filler is put into the tip. Sometimes, even with a tip graft, it is necessary to get an ideal result, so keep that in mind, because the non-surgical rhinoplasty  is an excellent "extra tool to the toolbox" to know about.

You are an excellent candidate for the procedure.The key for you is to lower the bridge as much as possible.I realize the bridge starts very high between the eyebrows, but nonetheless, you will have significant improvement by doing that, and then the nose, of course, might need a little narrowing.

You are wise to be having consultations. Look at all the options. Study hard. Visit websites and learn a lot. Websites are fabulous learning resources. Look for websites with a lot of before and after photographs to demonstrate noses that, hopefully, are similar to yours.

I am a big fan of books, and that is why I wrote two books, the names of which you see below.They are worth getting. Other doctors have written other good books too.Today, many of the books are available on line in the E-book format, and therefore, they are very inexpensive. Keep studying, keep thinking and keep asking good questions.

You are on the right track. I wish you a successful rhinoplasty.

Robert Kotler, MD, FACS
Over 4,500 nasal procedures performed

Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 90 reviews

Nasal cartilage grafts

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I don't like using cartilage grafts in first time rhinoolasties.  I believe they are overused and make the surgery unnecessarily complicated.  In my opinion they should be used in secondary cases only if cartilage is missing.  You can get a great result without cartilage grafts. I have performed hundreds of rhinoplasties on noses similar to yours and never have found it necessary to use grafts.  Keep it simple and you'll get the best result!

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 31 reviews

Rhinoplasty for cartilage grafts in the tip of the nose

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The decision to perform structural tip grafting needs to be made its time of examination/ consultation. As a general rule, we placed very few cartilaginous strut grafts in the nose. For many examples of noses similar to your own, please see the link below to our rhinoplasty  photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Do I need grafts to support the tip of my nose? (photos)

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  An exam is necessary to truly answer this question.  I perform hundreds of rhinoplasties in closed fashion, and I have not found it necessary to support the tip with grafts. 

Find a board certified plastic surgeon who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA


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Thank you for the photos - the commonest complaint after a full rhinoplasty is that with time the tip dropped because of that I generally use columella struts.  Practically you would be unaware of the but a full exam is really need say whether in your situation I would use them and I do most noses closed

Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 65 reviews

Rhinoplasty and columellar strut grafts

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The need for tip support is best determined by examination. If the surgeon you liked best does not feel like you need a strut graft and you feel like their explanation was a good one then I would trust them. Closed rhinoplasty can be less disruptive of the tip architecture as a result you may not lose the support. Good luck

Arun Rao, MD
Tucson Plastic Surgeon
5.0 out of 5 stars 19 reviews

Columellar strut grafts may be used to add structural support to your nose during Rhinoplasty Surgery.

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We place columellar strut grafts in nearly everyone undergoing Rhinoplasty Surgery to add support, and to prevent nasal drooping with aging. If a columellar strut graft is placed properly, the benefits may outweigh the negatives.

Hope this helps you.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 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.