What could have caused an indentation on my nose and which procedure would be best for treating it? (photos)

Question

I have this small indentation on the top of nose ...almost like a small dip shaped like an inverted triangle ....,..it developed within the last 10 years ...what is it and how can it be treated

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, the area of indentation is in your supratip, which is very common in some patients. You may benefit from a tip refining rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts may also be used to help improve tip refinement. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Eric M. Joseph, MD · Answer

I believe you are seeing this more now because you have thin nasal skin, and the skeleton of the nose may become more prominent with the aging process. We have had excellent success in permanently camouflaging small nasal indentations with microdroplet Silikon-1000 nasal injections. I hope this helps. Sincerely, Dr Joseph

Ruslan Zhuravsky, DO · Answer

Hello. As we age, the skin slowly thins out and we begin to see more of the anatomy underneath.The area you're referring to is between several cartilaginous structures of the nose, and in your case there is an increased amount of space between them. Above the indentation is the end of your septum. If you run your finger down the bridge of your nose, you feel it suddenly drop off at that point. Below the indentation are the tip cartilages or more specifically the domal segments of your lower lateral cartilages. These are often in closer proximity to the septum, which helps give them support. In your case they seem to be lower, thus creating a gap. Based on this photo and finding, I would assume that if you press on the tip of your nose (inward toward the face), it drops / compresses very easily. If the indentation is the only thing those worries you, you have two options. One is to make a little incision inside the nose, and support the tip up to the septum. This is basically a limited closed rhinoplasty. The other is to do a liquid rhinoplasty and use filler. HOWEVER, you cannot simply fill the hole. If you do, it will result in a polly beak appearance. You have to place filler at the tip, columella, and radix in order to a even out the proportions. I hope that helps!

Shabnam Ghazizadeh, MD · Answer

Excellent question. This looks like it may be where your lower tip cartilages have fallen off your septum and are not properly supported. It may be caused from trauma or a weakeness in ligament attachments you were born with. I recommend a consultation with a rhinoplasty specialist. Best of luck, Dr. Ghazizadeh

Mats Hagstrom, MD (license on probation) · Answer

If you did not have a previous procedure or event than this is possibly just the shape or the cartilage junction between the Ala, upper lateral cartilage and columella. 
Fillers may work well for correcting this. 
Best,
Mats Hagström MD

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