My nose seems to be caving in at the tip... can this be fixed with a filler?

As the others have mentioned, the depressed area you see is actually due to prominent nasal tip cartilages combined with thin nasal tip skin. This tip bifidity can create quite a bit of shadowing and draw attention to your nose.

I wouldn't recommend a filler injection to conceal the depressed area as this would mainly result in a fuller tip.

A rhinoplasty can be done to improve the appearance of your tip greatly. Your lower lateral cartilages are very convex. By giving them a flatter appearance your tip would have a much more natural appearance.

An examination would be needed to assess your septum. If this is deviated then insurance would typically cover the septoplasty part of the precedure only.

Your pictures demonstrate that your nasal deformity isn’t related to a nasal septal deviation. Instead it’s related to a separation of your lower lateral cartilages in the presence of thin nasal skin.
                Although injectable fillers can be used to correct this type of deformity, this approach has significant limitations. The technique has to be repeated at six to nine month intervals because the filler material doesn’t last. It’s also important to realize that the use of injectable fillers for this purpose is considered an “off label” use by the FDA.

                For these reasons, rhinoplasty surgery is the best way to correct this type of problem. It’s therefore important to consult a plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic deformity and achieves your aesthetic goals. 

Careful injection of filler can camoflouge the groove temporarily, but will not actually fix what is causing the problem, and it may not give you a look that you like any better (it will add volume to the center and can give the whole tip a rounder appearance). It appears from the photo that you have prominent lower lateral nasal cartilages, and the groove you see is the space between the two sides. This is best addressed surgically. Also, a deviated septum could be addressed during the same surgery. To determine if your septum is deviated, your surgeon just needs to take a look inside your nose. If you have difficulty breathing and have a deviated septum, then insurance will likely cover your septoplasty. Your surgeon can request a pre-authorization before surgery to make sure. Some insurance companies request a CT scan for additional documentation of a deviated septum before authorizing surgery.  Insurance will not cover cosmetic alteration of your tip. If you were to get your septum fixed at the same time as a cosmetic rhinoplasty, then your insurance would pay for the anesthesia fee, facility fee, and surgeons fee related to the time spent on the septoplasty, and you would be responsible for fees related to the time spent on the cosmetic portion of your procedure. Typically if you combine the two, your overall cost is less than if you were to do both separately. Good luck!

The area that you seem to be describing in your picture is that there is a small cleft at the tip of your nose between the cartilages that form the tip-the lower lateral cartilages.  The best correction for this would be rhinoplasty, or surgery to correct the shape of your nose.  While fillers have wonderful applications, the nose is one area where caution is advised.  There is likely a greater risk of skin injury with a filler at the tip of the nose in particular.  You also appear to have very thin skin that may be more susceptible to problems.  While often a filler may look very good for some time, it will eventually go away.  On the other hand you are an excellent candidate for rhinoplasty, and re-shaping of the tip could lead to some nice improvements.  

Regarding your sinus problems, you need a thorough physical exam to evaluate what the real problem is.  A deviated nasal septum is just one of many things that can cause 'sinus' problems.  Generally, insurance will not pay for cosmetic surgery.  On the other hand, if you need septum surgery, it is the right time to consider rhinoplasty as the septum is often used for much of the nose shaping surgery.  Find a surgeon who is experienced and really understands how to deal with theses complex issues.

The thinning of your skin is most likely visible fof the cleft you see in the tip of your nose. It is the normal separation between the two cartilages that support the nostril and tip. A filler could be used to give you an idea of what it might look like with a longer term correction which would best be cokmpleted with cartilage. Correcting a deviated septum does not mean that the external appearance of your nose will change.A filler could be used
 

Candace

You have a combination of  prominent nasal tip cartilages and relatively thin nasal tip skin.  The best treatment for a nasal tip "cleft" or "bifidity" is surgery, however fillers a good second option.  If you are considering this option, I would recommend only board certified plastic surgeons to administer a small amounts of hyaluronic acid filler to correct this depression.  Too much filler in one area can compromise the blood flow. The wrong type of filler injected into the wrong place can create scar tissue and damage the soft tissues.

What you are noticing is what is described as "nasal tip bifidity", or in lay terms, you can visualize the space between the nasal tip cartilages.  Based on the photo (and experience), your nasal tip is not caving in, but instead you are likely to have relatively thin skin in the setting of relatively large nasal tip cartilages.  A filler is definitely not the treatment of choice in this circumstance. If you are unhappy with the appearance of your nose, I would suggests a tip refinement Rhinoplasty.

“Caving in” could be due to a loss of cartilage, or secondary to weakening of the nasal ligaments resulting in drooping of the cartilages. These problems can usually be effectively repaired with various rhinoplasty techniques. As far as a deviated septum, this is usually a procedure covered by insurance, but this does not include the cosmetic rhinoplasty work.

I can see from your photos what bothers you.  A long term permanent treatment would be to have a tip rhinoplasty.

Regarding: "My nose seems to be caving in at the tip... can this be fixed with a filler?
My nose seems to be caving in at the tip and each year seems to be getting worse. I have always had sinus problems and am wondering if I have a deviated septum? Can my nose be fixed with a filler? If I do have a deviated septum, does insurance cover rhinoplasty?"

You may have chronic sinus issues (?allergies).
You may have septal deviation which may or may not be associated with the sinusitis and therefore a Septoplasty MAY be partially covered by your insurer.

But - the "caving in at the tip" has NOTHING to do with any of these conditions. You have a common anatomic presentation where the separation of the "wings" of the Lower Lateral Cartilages of the nose making up the tip is visible owing to the extent of separation and the thin skin. This "Butt Nose" as some of my patients refer to it, does NOT impact on nose function in any way and correcting it will not be paid by any insurance company. Using Juvederm or Restylane will fill in "the crack" temporarily but a long term solution would require bringing the separated wings closer together with stitches using a TIP RHINOPLASTY.

Dr. Peter Aldea