What is going on with my nose tip? (Photo)

Question

Since about 6 months post op (I am currently 13 months out from surgery), my nose tip is lumpy and one side appears to be a white circle, the other side is a bossae. I saw my plastic surgeon and he suggested shaving down the bossae, but it would cost me an additional $1000, he refused to address the other side of my nose tip. Can you please explain what this round lumpy side is? I am so disappointed and feel that my nose looks botched.

Andrew Miller, MD · Answer

Based on your photos, your tip does need some revision. The price of $1000 is quite reasonable because surgical supplies are needed and possibly anesthesia. You would need to have confidence in your surgeon, however. If it's not working out, see at least two rhinoplasty specialists for consultation to see what should be done, but usually the nose should be opened and the cartilage reconstructed in the area of the bossae.

Gianfranco Frojo, MD · Answer

That is likely the cartilage grafts or the lower lateral cartilages. We do a lot of tip suturing in those cartilages and usually add a septal extension graft of columellar strut (sometimes even a tip cap graft) to increase nasal tip projection. I would have a very serious conversation with your surgeon. If things do not go well or you wish to see another surgeon....I would recommend a surgeon board-certified by the American Board of Plastic Surgery. Ideally, one with extensive rhinoplasty experience.

Eric M. Joseph, MD · Answer

Based on your photos you appear to have relatively thin nasal skin and thin nasal skin is associated with visible tip cartilages after rhinoplasty, unfortunately. I would not recommend having the bossa shaved down. Based on our 25-year experience, it may be best to have a revision tip plasty to avoid sequela like this in the future. The other option, depending on your examination, maybe a permanent non-surgical nose job with microdroplet Silikon-1000. Sometimes adding pinpoint volume to somebody's asymmetrical nasal tip may lead to a more symmetrical and less operated nasal appearance without the expense or inconvenience of revision rhinoplasty surgery. I hope this helps! Sincerely, Dr Joseph

Ronald J. Edelson, MD · Answer

You have a prominent piece of your tip cartilage or possibly  a cartilage graft. A minor revision would correct this. Otherwise your nose looks good. As far as cost every surgeon is different in what they may charge. Some charge nothing but many charge a lot more than $1000.

Mats Hagstrom, MD (license on probation) · Answer

To make an accurate assessment regarding the outcome of any plastic surgery procedure we generally always need to see a complete set of proper before and after pictures.
If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
Plastic surgery outcomes are generally based on patient candidacy combined with the skill of the provider.
Without seeing before and after pictures, we can’t really make a quality assessment regarding your outcome.
 Each provider will have their own policy regarding doing revisions.
This should always be discussed during consultations.
Rhinoplasty surgery is considered fairly complex and mastering this procedure does not happen over short periods of time.
For those considering rhinoplasty, I suggest having multiple in person, consultations with local providers who seem to have extensive experience with rhinoplasty surgery.
I generally recommend looking for providers who focus either exclusively on rhinoplasty surgery or have this as a major part of their practice, and have at least one or two decades of experience.
 There’s no correct number of consultations needed to find the right provider.
Considering the complexity of the procedure, I think having four or five consultations before considering scheduling surgery seems appropriate.
I don’t have a good answer for your question.
The outcome of your rhinoplasty is a result of your candidacy for the procedure combined with how well the operation was done.
Without seeing what you look like before we can’t compare.
The correct person to follow up with is your provider. Your provider is responsible for the outcome of the procedure just like you are responsible for choosing that provider.
If you want a proper second opinion consultation, then schedule those as an in person consultations with other plastic surgeons in your community.
For second opinion consultations, come prepared to bring with you a complete set of before and after pictures and a copy of your operative report.
 These are all available from your current providers office if you request them.
Best,
Mats Hagstrom, MD

What is going on with my nose tip? (Photo)

Answers (5)

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