Cold nose shrinks to cartilage, would filler be good?

Question

I had a revision tip plasty almost 2 years ago and for the last six or so months my nose will get really cold at the tip and my thin skin shrinks tight around the nose and then you can see irregularities and the white cartilage through the skin at the tip. I have thin skin which happened after a poor primary but my revision (different) surgeon didn’t use fascia. It’s driving me crazy because it happens even in low 70s. I’m worried about winter again. Any suggestions? My surgeon shrugged it off. Would dermal fillers would be a good alternative to lowering the nostrils and creating a barrier so when it gets cold it won’t show the irregularities?

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! Thin skin can be a very difficult problem to address in tip rhinoplasty. Is there any difference in color to the skin with cold temperatures (i.e. turning dusky or dark)? If so, that may indicate a decrease in blood flow and hyperbaric oxygen may help. Options for increasing the thickness of the tip skin would be temporalis fascia (as you mentioned) and microfat transfer. These provide excellent camouflage and help the skin thicken to a degree. Dermal fillers can work, but I am always hesitant to inject operate nasal skin as the risk of creating damage is much higher. Hope that helps!

Cold nose shrinks to cartilage, would filler be good?

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