Is there a permanent filler to fill a dimple-like indention under the tip of my nose? (Photo)

This can be treated well with microneedling and/or fillers, I typically use silicone or Artefill for this since it is more permanent.  However, HA type fillers can last many years in this area specifically Voluma and work well for people who are nervous about more permanent fillers.  See someone who is an expert in the using fillers and fixing scars.  Best, Dr. Emer.

Any filler after multiple nasal operations carries an increased risk of tissue necrosis because of scarring and diminished blood supply to the skin.  I would encourage you to consider a small cartilage graft to this area.  This could be performed under local with or without mild oral sedation.  Cartilage would likely be from your ear and would not cause a change to the shape of your ear.  Since this would be your own tissue, it would be less likely to extrude or become infected.If you are still dead set against surgery, then I would recommend using a non-permanent filler.  The obvious benefit of permanent fillers (silicone, Artefil, etc) are that they don't need to be "maintained" by repeat injections.  The downside is that if they become infected, they are a nightmare to remove.  An implant is fairly easy to remove, but getting every microscopic sphere of filler out of the tissue is nearly impossible without cutting away wide swaths of tissue.  Given that you have had at least 2 rhinoplasties, the blood supply is going to be at least somewhat compromised and this increases the risk of infection (most of your immune cells are carried through the blood stream). Lastly, in the unfortunate event of a filler being injected into a small blood vessel, at least the hyaluronic acid (HA) fillers such as Juvederm, Restylane, etc, are potentially reversible and skin necrosis that would ensue could be mitigated.  This is not the case with permanent fillers.I would encourage you to see someone who is very adept at both revision rhinoplasty as well as fillers so they can properly guide you through these decisions.  All the best!

This is a tough question to answer from the photo. It will depend on a few factors which would require an in person evaluation. If the dimple is just a void of support underneath, filler maybe an option. If there was an implant there and it extruded, there is likely scar tissue attaching that dimple to the underlying tissue (similar to an acne scar) and the scar tissue must be released prior to filling the defect. Either of these procedures can be done in the office under local anesthesia. If the defect ends up being larger after the scar tissue is released, you may benefit from some cartilage placed for more fullness, this may require a more in-depth procedure. I would still recommend visiting with a rhinoplasty surgeon and discussing your options in person.Best of luck