Is Adding Grafts to Nose Tip Safe?

Question

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.

Ivan Wayne, MD · Answer

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.

Rod J. Rohrich, MD · Answer

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.

Dean Fardo, MD · Answer

Tip grafts in the nose are safe, but not always the best option. I prefer to avoid them in most cases. 
Grafts can absorb or shift over time. This can occur even several years after surgery.  In most cases, suture modification of the existing cartilage is a better choice in my opinion.

Eric M. Joseph, MD · Answer

You appear to have refinement of your tip and narrowing of your nose in your post-op photos. It's too soon from your latest surgery (1/18/10) to even consider more surgery. You'll see refinement of your tip as your swelling resolves. Nasal lengthening surgery is difficult to impossible and should be avoided at all cost.
After around 2-3 months, if you feel like you'd benefit from lowering your nostrils, you could consider consultation for a Non-Surgical Rhinoplasty from an experienced physician. 
I've attached photos for your perusal.
I hope this is helpful for you.

Toby Mayer, MD · Answer

You should see an experienced revision rhinoplasty surgeon who does many noses like yours. He can examine your nose to see if tip grafting will accomplish what you desire. Look at before/after photos of his work before deciding.

Otto Joseph Placik, MD · Answer

This is your third question you have posted and in the most recent two you have not disclosed that you have undergone 3 previous rhinoplasty procedures. I would highly recommend for your ultimate safety and outcome, that you discuss this with any surgeon who considers treating you. You could end up with a Michael Jackson type nose if you continue to seek operations to radically transform the appearance of your nose.

Steven J. Pearlman, MD, FACS · Answer

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.

Phillip Langsdon, MD · Answer

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.

	Good luck.

William Portuese, MD · Answer

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.

Steven Wallach, MD · Answer

Just from the frontal view, it seems that your nose is significantly improved.  Revision surgery adds another dimension, and may not give you what you want to achieve.  
A great example is a famous musician who just recently died. He had a decent looking nose after his first surgery, and then went on to have several more that I thought made it look worse and unnatural.  Be careful what you wish for!

Is Adding Grafts to Nose Tip Safe?

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