Nose contouring for atrophy - fat graft v silicone?

-anesthesia resident, s/p tertiary revision 5/2012-bridge and tip widened with septal cartilage I have a persistent issue plaguing me- ATROPHY ALONG ENTIRE RIGHT LATERAL NOSE WALL AND TIP. ALSO SLIGHT 2-3 mm DEVIATION OF TIP TO THE LEFT. I believe the atrophy is causing the deviation due to reduced firmness. Fat graft v silicone v ? Goals: to restore fullness to R side and symmetry, restore straightness and discrete line of light, nonsurgically preferably. Will be in SoCal in May for consults.

Doctor Answers 6

Skin and soft tissue atrophy can be difficult to correct

Damage to the skin soft tissue envelope can be difficult to correct.  There are a variety of tissue that can be used to improve this.  Fat, fascia, cartilage and bone are optons. The best option should be natural and closely recreate the tissue that you are trying to replace. If structure is needed for support you may want to consider a more firm tissue.

Toronto Facial Plastic Surgeon
4.7 out of 5 stars 11 reviews

Quaternary Revision

   Fat or filler can be used, but you would prefer something durable such as a cartilage graft.  An examination would be necessary to determine anatomical constraints and concerns.  Find the board certified plastic surgeon with ELITE credentials who performs hundreds a year.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Why risk it?

Silicone injections in the nose?  Very risky, I think.  If it gets infected, you could have very major problem. Crushed cartilage, temporalis muscle or fascia would be worth considering.

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
4.5 out of 5 stars 25 reviews

Silicone to the nose

Do not consider using silicone in the nose, or any other fillers. After 3 rhinoplasties, the nose will never be perfect.  Building up the sidewall can be accomplished with several options including cartilage and fascia.  Best to look for a revision  rhinoplasty specialist that has thousands of rhinoplasty surgery procedures under their belt.   This will be a challenging procedure, so weigh the benefits/risks.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Nasl deformity

Asolutely no silicone injections. You are a doctor review the literature about long term silicone injection problems.

Find a board Certified Plastic Surgeon in your area to work with. It may take more than one modality of treatment to achieve the results.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Definitely not silinone

First off, there is no reason to go to Southern California unless you live there or are from there.  There are plenty of good and plenty of bad plastic surgeons everywhere regardless of zip code.  


If you prefer a non-surgical route then try Restylane first and see if you like it.  Do not go to fat right off the bat and stay as far as you can from Silicone or Artefill.  Surgically, fullness can come from crushed cartilage, fascia or Alloderm. You have to evaluate the tip from the base view and see if in face it deviates or is it an illusion due to the lateral nasal wall depression. 


Good luck

Shervin Naderi, MD, FACS
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 106 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.