Tip too pointy & turns white when smiling – what to do? Fillers or surgery?

Question

I had 3 open rhinoplasties (straight/elongated 2 times; 3rd time tip work). I can see the graft at the tip & I truly dislike the pointy look + when I smile the tip turns white (blanche?). I would like to ”round” the tip so it looks more natural + eliminate the white spot . My Q’s: a) Is it safe to do a 4th op with ”only” tip work to adress this issue? If so, how would you technically approach this? b) Do you think fillers alone can help? What are the risks related to fillers injected to the tip?

Thomas Romo, III, MD · Answer

First, whatever is done must be conservative in technique. The blood supply to your nasal tip is diminished and you can lose skin or have permanent color changes if further surgery is done. No one can predict that for. Limited fillers can be attempted but this will also stress the blood supply.

Fredric Newman, MD, FACS · Answer

Hello Nicole,
Let me begin by highlighting that there is always a risk/reward ratio with respect to plastic surgery. While there is risk with any procedure, each additional surgery to your nose increases the risk that you may not receive the results you desire. Accordingly, these four concepts impact the way I analyze revision rhinoplasty cases:
1. Safety first2. Effective techniques3. Natural results4. Less is more
In reviewing your photographs and comments, there is a chance you may be overlooking the overall structure of your nose, which can make a significant impact on the overall look and symmetry of your nose. Please provide pictures of your entire nose and your face so that I can best assess your case using these three rhinoplasty result guidelines: 
1. Nose looks good in and of itself2. Nose fits the face3. Nose looks natural
Based on the pictures you provided of the tip, there appears to be too small a space over the graft, causing lack of blood flow to the skin and resulting in the white/blanche color you mentioned. 
Adding fillers to this area would only increase the lack of space. As a surgical minimalist, I still believe it is wise to remove the graft and fix the issue rather than compensate with the addition of fillers. 
A note on non-surgical rhinoplasty: Generally, if something sounds too good to be true, it is. Non-surgical rhinoplasty falls into this category and is currently causing confusion for those seeking to refine their appearance. Fillers do not produce long-lasting rhinoplasty results. Further, injections into the nose cause inflammation and may lead to an increase in scarring, making future surgical rhinoplasty procedures more difficult.
Please remember that a revision rhinoplasty surgeon must do a full exam of the nose including the interior of your nose in order to make fully informed recommendations. 
Wishing you luck,
Doc Ric

Tip too pointy & turns white when smiling – what to do? Fillers or surgery?

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Tip too pointy & turns white when smiling – what to do? Fillers or surgery?

Answers (2)

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Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.