If a shield graft is used to lengthen the nose slightly, what does it look like?

Shield grafts can help define the tip of the nose as well as lengthen the nose. The way the shield graft looks really depends on a number of factors. If placed on the bottom of the tip it can solely lengthen the tip. if it protrudes slightly above the tip cartilages it can help create shape and definition. If it's placed well above the nasal tip it imparts even more shape. The thickness of the skin has a lot to do with how this will look from the outside. With very thick skin, any graft will be camouflaged. If you have thin skin the graft needs to be cushioned under the skin and the edges beveled vary carefully.

Dear nosetake2 in Los Angeles, California:
Shield graft is used to give a more defined and projecting tip.  It is typically used when the tip is round and the cartilages are soft and without the addition of a graft there is less chance of satisfaction with respect to the appearance of the tip, both in terms of projection.  The most important thing is to have some rational approach to correcting your problem.  It may be that you could be helped by fillers, temporary or permanent, and you should look into that.  The best way is through the consultation route. 

Do your homework before consultation. Prepare well for your consultation.  When you search, look for rhinoplasty super-specialists. There are other super-specialists for every procedure, e.g. revision breast augmentation, or body sculpting. Impossible for any one MD to be the master of ten or 15 cosmetic procedures. Look for surgeons whose practice is the majority or entirely devoted to rhinoplasty, septoplasty, and associated procedures.  This would include both primary and revision rhinoplasty surgery.  Why not have the most specialized talent in your service?  Consider how much experience the surgeon has doing the procedure you are considering. We all get better at what we do with time and so those surgeons who have a long run of experience are the ones who have learned the most from experience. Residency and fellowship are where the learning begins, but for all of us, time and experience is where the talent and wisdom are amplified.                         

A consultation without computer imaging is, in my opinion, of much less value.  Why shouldn’t you see the predicted result of the procedure the doctor is proposing?  At consultation, photos are taken of you and loaded into a computer system that morphs your present appearance into the anticipated “after” based on your and the nasal surgeon’s input.  Imaging is an incomparable learning tool because it provides a forum for doctor and patient agreement on what would satisfy the patient and what is, based on the doctor’s talent and comfort zone, achievable.  After all, cosmetic surgery is 100% visual.  It is about appearance. So, without a visual evidence of what is planned, how can you make a decision as to whether or not you might be satisfied?  Talking about what your result will look like is worthless and confusing.  To anticipate a successful outcome, there must be a visual meeting of the minds between surgeon and patient. When you shop for clothing, you usually try on the outfit, right. How else can you tell if you would be satisfied?

One subject that should be raised is whether you are a candidate or not for the non-surgical or filler alternative. There are permanent and temporary fillers now available. For some patients, whether as a substitute for their rhinoplasty or as a practical and economic substitute when a revision rhinoplasty is contemplated, fillers can make great sense. So, ask if fillers might do the job for you.

Part of your preparation for consultation should be preparing a list of questions beforehand.  Bring a notepad, or I-pad or laptop, with you and take notes as the surgeon answers the question you are asking.  You should spend more time with the surgeon than with the office staff, because you need to get a sense of whether you are comfortable with the doctor.  You should not feel rushed such that you are on a consultation conveyer belt.  If the presentation by the office staff seems a bit to “sales-ie”, that’s also a yellow or red light. Take a friend or relative along since two heads are better than one in gaining information and understanding.  In the end, the purpose of the consultation is for you to be educated, not to be “sold”.  Ask yourself two key questions: “Is this surgeon teaching me or selling?” And secondly, “Can I put my my face ― and my life ― into this doctor’s hands? Can I completely trust him/her?”

There are excellent books out there that you can read and use to study up. It is worth the homework time you put in up front so that you make the right decision with respect to choosing a surgeon who has the talent, experience, and degree of super-specialization that you certainly want to have. You want to do it right the first time.

When you visit doctor’s websites, the most important feature on the site is the before and after gallery.  If there are just a few examples of rhinoplasty or revision rhinoplasty, you wonder how much experience the surgeon has performing such surgeries.  You need to see dozens examples.  The more examples there are, the more likely you will see one or more that demonstrate situations similar to yours.  Look closely at the photos for natural results.  That is what you want.  Nobody wants to carry a sign saying “I have had a rhinoplasty.” You also need to see the computer imaging section of the site. See how closely the actual “ after” matches the computer-generated after. Nothing better displays a doctor’s artistic and surgical talent.                                   

Reviews, particularly right here, on RealSelf, are very important and should be carefully digested. The larger the number of reviews the better. accurate the. A consensus is generally correct.

Best wishes,

Robert Kotler, MD, FACS 

Shield grafts are not for lengthening the nose, but for adding definition and sometimes projection (depending on the shape and size) to the nose tip.  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.