Dent in my nose that keeps getting bigger, what are my options? (Photos)

Question

There's a dent in my nose that barely existed a year ago and it just keeps growing bigger and I don't know why. I do have a deviated septum and was hit with a metal door in my nose a few years back so could that be a reason? I don't know what's causing this dent and it got so much worse after I finished taking accutane. I'm desperate, please help

Samir Undavia, MD · Answer

It looks like the tip cartilages have a gap between them. There are two ways to go about it. 1.  Tip rhinoplasty where the gap is surgically closed. This is permanent.  2.  Non surgical rhinoplasty where filler is used to fill in the gap. This is the fastest way, but is not permanent. If you wanted a quick fix for an event this might be your best option. Good luck!

Alejandro Nogueira, MD · Answer

Yours is the typical cleft nose, which essentially is the same than a boxy tip with the relevant difference of the absence of the interdomal fibrofatty tissue between the cartilagenous domes in the cleft tip.Solution of the squaredness is domal plication and plasties, as well as trimming out the excess of cephalic excess. If this tip work only is bound to be performed this could be done under locar and a slight sedation; however, I recommend you revise the entire nose to achieve a better balanced rhinoplasty.If before the cleft was not present and the nose was boxy then means for some unknown reason your interdomal fibrofatty tissue has dissapeared; might be the medication taken is behind this phenomenon, or other idiosincratic issues with your adipous deposits.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you may benefit from a tip refining rhinoplasty, which can help close the cartilage gap. Your surgeon can
accomplish this by trimming, suturing, and reshaping the cartilage in your
lower nose.  Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Steven J. Pearlman, MD, FACS · Answer

You posted a photo of the tip of your nose showing a dent. The gap in the middle of the tip id called a bifid tip. This is spreading out of the horseshoe shaped tip cartilages. As they separate the dent gets wider. This can be treated during rhinoplasty. The reason it got worse after Accutane is thinning of the thick oily skin by the medication made the skin over this already existing anatomic situation. Thick skin hides many cartilage flaws but also doesn't allow a delicate refined nasal tip. This can be treated at the same time as repairing your deviated septum.

Andrew Miller, MD · Answer

While it is possible to have a dent in the nose that is a result of trauma and deviated septum, an exam in person would be required to know for sure. A well performed rhinoplasty can usually make a big improvement in irregularities like this because the cartilage can be grafted, reshaped, or sutured to make the contour much better. Be sure to see a rhinoplasty specialist for consultation.

Eric M. Joseph, MD · Answer

The indentation that is bothering you is the space between your tip cartilages. Your photos revealed you may have extremely thin skin -you can see the configuration of your the entire nasal skeleton. We have seen good success filling clefts of the nasal tip utilizing silicon 1000, and off label filler for permanent results, in treating patients with similar concerns. I am uncertain of the relationship to Accutane. Hope this helps! Dr. Joseph.

Anthony Corrado, DO · Answer

The cleft you are referring to is from the normal divergence of the nasal tip cartilage.  This cleft can be corrected with tip rhinoplasty.  Typically, the cleft can be closed by placing tip sutures.  Sometimes temporalis fascia or crushed cartilage can be used to fill in the area.  I suggest consultation with a surgoen specializing in rhinoplasty to discuss your options.  Good Luck!

Reza Momeni, MD, FACS · Answer

The diet you see is the space between the to lower cartilages of your nose, where they ordinarily come together at the tip.  In some patients like you, there's a space between the two.  The treatment can be to fill the space with a filler (nonsurgical rhinoplasty), and you'll have a temporary improvement.  For a permanent improvement, you would consider a tip rhinoplasty surgery.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.

William Portuese, MD · Answer

The dent that you are referring to is the normal cleavage between the left and right nasal tip cartilages.  This can be addressed with a rhinoplasty procedure with suture techniques and a small morselized cartilage graft placed in that area.  For more information about rhinoplasty, please see the link and the video below

Steven Wallach, MD · Answer

It looks like it is a splaying out of your tip cartilages. This can be corrected with a tip pasty using sutures to bring the two cartilages closer together. Good luck.

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