Would it be safe to add tip grafts (ear/rib) to increase the length and sharpness of the nose tip, without making it bulky because I have thick skin? I recently had alarplasty and alar rim grafts and would be happy if some tip grafts could be added. I do not want to modify any other part of the nose. Please help. I have attached a photo of my previous nose. Sorry about the antibiotic cream on my alar base.
Is Adding Grafts to Nose Tip Safe?
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Doctor Answers 17
A Fifth Rhinoplasty would be much more difficult
Since you have had 4 rhinoplasties, anyone considering your surgery will be very cautious. That many procedures leaves the nose with low blood supply and hence more at risk for additional procedures. Grafts in these noses have less blood supply and are more likely to have decreased volume and action that they were intended. That needs to be understood.
Tip grafts can make your nose more defined but thick skin prevents the details from showing. You can always make the skin less thick by reducing the fat underneath the tip but this can be risky but possibly the only way to define the tip in this situation in addition to the tip grafts.
Grafts to nose tip are safe, in theory
Grafts can be quite effective at increasing definition in thick skinned patients. However, as was pointed out by several other surgeons, your result looks quite good in spite of your photos being from the immediate post operative period. I would caution you on trying to improve an already good result. You could suffer a complication or injury to your nasal skin during a fourth rhinoplasty. There are no guarantees and the risks go up with each surgery. Remember, there is no such thing as a perfect nose, no matter how many surgeries you get.
Nasal tip grafts
You should be able to safely get a tip graft. The septum would be the best first choice for graft material. It appears also that you would benefit from narrowing and refinement as well. Don't get too crazy with the rhinoplasty surgery unless you want to wind up like Michael Jackson. Best to get it all done and move on.
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Tip grafting an option
Tip grafts actually give the tip of the nose more definition
Tip grafts were very trendy about a decade ago. Then, it became known that in patients with thin skin, the grafts may become visible through the skin after a number of years. For thick skin, this is less of a chance. Tip grafts are actually one of the ways we create definition in thick skin noses. The graft presses into the skin creating contour where it didn't exist before.
Are Tip Grafts Needed in Primary Rhinoplasty
In most primary rhinoplasties, tip grafts are not needed unless the patient has thick skin, is a male, or if it is an ethnic rhinoplasty that needs sharper tip definition. In most cases, tip grafts add an additional risk for variability, resorption, and asymmetry long-term. I would advise against using tip grafts in most primary rhinoplasty patients.
Proceed with caution
To answer your question about a tip graft; graft material from your own tissue is the best to use when a graft is indicated. One must understand the limits of skin thickness and realize there are risks with any surgery. However, after multiple surgery your "situation" is not like a first time rhinoplasty or first revision rhinoplasty.
These are recent post-operative photos with swelling from surgery and do not provide any indication that additional surgery should be considered. I would not consider anything for 1 full year post surgery (after a first operation). In your case, after several operations the healing time is actually longer than 1 year and you should be very patient.
Sometimes the enemy of good is better. Perfection is an unrealistic and dangerous expectation. Unless there is a real problem with the nose after a year and a half, I would not consider further surgery.
The question really is "Is there a problem with your nose?" I would seek expert advice for that answer and would not rely on your own opinion.
Tip grafts to improve definition
Tip grafts are an excellent way to improve definition, especially in noses with thick skin. The best source is the cartilage from your ear(s) -- it is also easy to harvest. Wait at least 6 months after your alar grafts and narrowing.
Safety of adding grafts to nose tip
Having tip cartilage grafts to the nose is a safe alternative, but it needs to be done for the correct reasons. Adding cartilage tip grafts to the nose will add width and bulk depending upon where they are placed. Full healing takes a year for all of the swelling to subside, so this is not an operation that is done lightly. Thick skin will need to be addressed many times in the postoperative phase in ethnic rhinoplasty by placing cortisone injections into the supratip area in an effort to resolve some dermal fibrosis, scar tissue and edema that tends to heap up after surgery.
Use own body tissue when adding grafts to the nose
Any surgical procedure can have complications. Every surgeon should consider the benefit: risk ratio before doing any surgical procedure.
When used correctly, cartilage grafts (septum, ear and rib taken from your own tissues) have high benefits and low risks. Cartilage taken from another person or cadaver has much higher risks if implanted in the tip as does bone and artificially made implants. These are more likely to extrude, resorb, or become infected. Grafts added to the tip are often necessary to get the desired result and carry very little risk if used correctly.