Nasal Tip Too Bulky and Wide After Graft

Question

two years ago, my doctor added a tip cartilage graft to my nose which added width and bulk to the tip. If I get the tip graft removed, would my tip shrink back down to the size it used to be?

Jonathan Kulbersh, MD · Answer

It may not be possible to simply remove the graft without consequence. The graft may need to be replaced with one that has a similar function, and more knowledge of your surgery would be necessary to provide you with advice. The following questions would need to be addressed prior to having a revision procedure:

	1) What was the initial purpose of your tip graft?
	2) Is it possible to replace it with a smaller graft that will leave your nose appearing less wide?

	I would recommend communicating with your surgeon and discussing options with him or her. I hope this helps, and I wish you the best of luck.

Donald B. Yoo, MD, FACS · Answer

The result of removing a graft is not always as simple as simply returning to its prior form. Scar tissue could have formed in the interim that will prevent the tip from simply "shrinking" back down. That being said, in most cases there will still be ways to reduce the size of the tip and improve the aesthetics of the nose during revision rhinoplasty.

Evan Ransom, MD, FACS · Answer

Thank you for the question. In most cases, tip grafts are placed to control the projection, rotation, and shape of the nasal tip. Removing the tip graft will therefore affect all of these things. A revision rhinoplasty may be needed to reduced the size of the graft or replace it with a graft of a different shape or size.

Nima Shemirani, MD · Answer

Dear Jessica44,

	
		It depends on what kind of graft was placed
	
		It may be best to either removed it entirely, or remove it, trim/replace the graft for a nice looking nose
	
		When you are ready, please see a rhinoplasty expert who can go over all of your concerns


	Best regards,

	Nima Shemirani

Pablo Prichard, MD · Answer

Dear Jessica,

	Thank you for your question.

	This depends on what was done in addition to the tip graft. If the alar cartilages were altered in any way, then simply taking out the graft will not give you the result you had to begin with.  The alar cartilages need to be re-adjusted.  On the other hand, simply contouring the tip graft may be the way to go if it is just too wide. Difficult to give you specific advise without photos.

	Best Wishes,

	Pablo Prichard, MD

William Portuese, MD · Answer

While it is certainly possible to remove cartilage grafts from the nasal tip, there is no way to be sure that tip of the nose will revert back to its normal anatomical shape. Important to bring your operative reports from the previous surgery to your new surgeon so that they understand what other procedures were performed other than cartilage grafting to the tip

Steven Wallach, MD · Answer

Tip grafts are placed for tip projection as well as definition.  Removing it completely will afffect both things.  Hard to say without evaluating you.

Kimberly Lee, MD · Answer

The real answer is that it depends. It depends how big a graft was used, how much the skin has stretched, and what is needed to achieve a more defined nasal tip. Please consult with a board certified specialist in the face who can assist you in achieving the results you seek.

Stuart H. Bentkover, MD (retired) · Answer

Tip grafts can be removed or modified. Tip grafts are used to hide irregularities of cartilage in the domes of the tip,to give more definition to the tip (especially in a nose with thick skin) and to change what is called the tip defining point. If you think the tip is too wide, your surgeon may be able to thin the graft a bit and achieve what you want. He/she will know why the graft was placed and what it was supposed to accomplish. Also, sometimes the skin is the limiting factor in how narrow your surgeon can make your tip. I have attached a link below. Some of the tips are narrow; some are wider; all the patients seem to be happy.

Jay M. Pensler, MD - Account Suspended · Answer

It is possible to remove a graft that was previously placed.You should consider modification of the graft rather than removal so that you do not revert to your situation which caused you to have the initial graft.

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