How can a supratip depression be amended? (Photo)

Question

Hi everyone, My nasal tip is rather asymmetric after a rhinoplasty about half a year ago. This is due to the supratip lacking sufficient cartilage. Can this easily be amended with a closed rhinoplasty or will an extensive open rhinoplasty be required?

David C. Pearson, MD · Answer

It's possible that some of these asymmetries and the supratip area can be fixed in-office with just fillers and may not require surgery at all. I tend to use Juvederm to start with since it's temporary. Then, if the patient and I like the results, it can be fixed essentially permanently with Artefill once the Juvederm has dissipated. If a filler is insufficient, though, a more formal surgical revision would be required. Open approach is going to be most commonly recommended, but closed approaches are also possible.All the best,--David C. Pearson, M.D.Pearson Facial Plastic Surgery®

Eric M. Joseph, MD · Answer

You appear to have this nasal skin and an indentation along your left bridge. Depending on your examination, this may be filled. We prefer to use Silikon-1000, an off-label filler for permanent results.Hope this helps you.Dr. Joseph

Steven J. Pearlman, MD, FACS · Answer

We can fill minor dents with filler, either temporary or permanent. However to straighen a crooked nose, more exensive surgery is usually necessary. It's not about open or closed, I use both depending on the circumstances. The incision is so tiny it is visible only when looking up close with a magnifying mirror. It's more about what is the best approach for the best result. You should seek a specialst in revision rhinoplasty, board certified in either Facial Plastic Surgery or Plastic surgery.

Andrew Miller, MD · Answer

Even after 15 of performing rhinoplasty, I never call a revision rhinoplasty "easy." After primary rhinoplasty, the scarring forces can be strong over time causing distortion of the remaining cartilage. During revision rhinoplasty, I use an open technique so that a clear view of your remaining cartilage can be seen. Then exact maneuvers can be carried out to correct the asymmetries and strengthen the tip for support. Be sure to see an experienced rhinoplasty surgeon for consultation regarding your revision.

James Shire, MD · Answer

There are a few issues you need to consider in secondary nasal surgery. First  you need to wait at least 12 to 15 months before a second surgery so the edema has resolved and healing is maturing. Then seek a consultation with an experience rhinoplasty surgeon who does a lot of revision noses. This is important. I recommend an open approach with cartilage structural grafts for revision surgeries. Being patient and doing your homework your nose can be successfully corrected.  Best of luck.

Tae Ho Kim, MD · Answer

From your photo, it appears that the right mid to upper nasal vault is depressed more than the left side that extends into the supratip area.  The revision depends on how it all looks with a detailed examination.  There are other things that you may want to consider to improve overall shape of your nose.  I would advise you to see a board certified plastic surgeon who has experience with rhinoplasty.  Good luck!

John Frodel, MD · Answer

I recommend that you seek consultation with an experienced surgeon well versed in rhinoplasty.  Whether the approach is "open" or "closed" is not important, as there are excellent surgeons who prefer both approaches.  The bottom line is that the problem is correctable.

Robert A. Guida, MD · Answer

This problem can be done closed, though the nose should be carefully examined and the specific issues causing the asymmetry need to be determined before deciding on "open vs closed".  Through a closed approach, soft, carefully placed cartilage grafts, ether from the septum or possibly the ear, can be used.  I would suggest seeing your original surgeon, as he/she knows your anatomy best.  Sometimes, primary  rhinoplasty surgery offers a significant improvement, but not necessarily perfection and occasionally small, minor revisions can be done which can further enhance the nose's shape.  Best of luck

How can a supratip depression be amended? (Photo)

Answers (8)

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