The skin on my nose tip has become very thin 5 years after cartilage implant. Is this going to keep progressing? (Photo)

Question

I've had rhinoplasty 5 years ago with a tip implant from the septum cartilage. 2 years ago, I began to notice the skin on the tip of my nose becoming thinner - The tip used to feel somewhat round, but now it has noticeable edges while the shape of the cartilage is more pronounced. Visually, I can almost see the cartilage at the tip due to stretching of the skin. I'm a little worried that my skin may keep thinning until the cartilage becomes completely exposed. Is this a possibility?

John Michael Thomassen, MD · Answer

The cartilage will not become exposed; however, the outline of the cartilage may become more apparent with time.  Some warping of carilage grafts does occur that can make the grafts more visible.  Best wishes, Dr. T.

Michael Bowman, MD · Answer

Thank you for your question, the short answer is that no, your nasal skin is not likely to ever breakdown if you had a cartilage graft done.  It looks like you have relatively thin skin, see #2 below.  Problems with graft exposure are VERY uncommon with cartilage grafting.  Graft exposure is always rare, but when it does happen its usually with artificial graft materials like gore-tex, med pore, silicone, etc.  This is a reason why most surgeons avoid those artificial grafts unless no other alternatives exist.3 things about rhinoplasty:1.  The nose will change very slowly with time after rhinoplasty, even years later.  These changes are not good or bad...but you will simply notice some subtle changes if you compare photographs over time.  Your nose will continue to change and age, just like the rest of your body.  2.  The thickness of your skin makes a big difference to your rhinoplasty result.  Thicker skin will make it harder to  make changes to the appearance of the nose, but is more forgiving.  Thinner skin makes it easier to make dramatic changes in the appearance of the nose but, at the same time, every minor change will show up, making minor asymmetries and irregularities more noticeable.3.  Even with dramatic changes in nasal shape, most patients don't have a very painful recovery.  There is always swelling, sometimes bruising, but pain is usually not a major factor in recovery.Best wishes to you,MKB

Bradford A. Bader, MD · Answer

Cartilage grafts in the tip of the nose need to be used with caution because of the tendency for the graft to become visible, especially in thin skinned patients. There are ways to camouflage a cartilage graft both at the original surgery and during a revision procedure. If the visibility of the graft bothers you then I recommend consulting with a very experienced revision rhinoplasty surgeon. There are both non-surgical and surgical options to help improve this problem.

Jeffrey Jumaily, MD · Answer

Thanks for posting. If the implant is made of your own cartilage (from your septum, rib etc) then it is unlikely to extrude (come out through the skin) but it is possible the skin can keep thinning and the edges can show even more. With synthetic implants (you don't have it based on your question), then it can come out through the skin which is a big problem. If the edges become more visible and that bothers you, you would need a procedure to fix it. Good luck

Francis (Frank) William Rieger, MD (retired) · Answer

I would doubt that your natural septal cartilage graft would push through the skin as would a silicone or artificial graft, because of the natural healing that should  have occurred up to this time.  You didn't describe an injury, any evident drainage, displacement, injury to the tip nasal skin, etc.  If any of these situations may have occurred, this may change the outcome.  If you have any doubt or concern, check with your local board certified Plastic Surgeon or ENT SurgeonGood luck to you.Frank Rieger M.D.  Tampa Plastic Surgeon

The skin on my nose tip has become very thin 5 years after cartilage implant. Is this going to keep progressing? (Photo)

Answers (5)