What is the best solution to fix the indentation on my nose?

Question

I have an indentation on the tip of my nose which was caused by the infection I had a year ago and my ENT doctor removed the silicone implant. I just had a reconstruction over 2 weeks ago, my doctor put an alloderm graft but I do not see a big improvements. She also sew the front tip cartilage together to give me a little bit of height on my tip and so it won’t droop. My doctor suggested a temp filler to fill the indentation but I am not sure if this is a good solution. I want a permanent solution.

Thomas A. Mustoe, MD, FACS · Answer

You have a challenging problem that absolutely needs cartilage from septum or rib as well as careful release of scar tissue, and probably a small secondary procedure for the scar.  I would carefully select a surgeon with experience in revision rhinoplasty.

Robert H. Hunsaker, MD · Answer

VERY difficult problem......especially if you want to do something "small". Without being able to assess the actual tissue characteristics one cannot know what might be best. My guess is this area is actually damaged scarred skin and for a complete change you could even require full thickness replacement of the subunit of skin there. Perhaps a well performed full-thickness skin graft of the entire subunit or even a subunit reconstruction with nasolabial flap tissue.There is a premier nasal reconstruction surgeon in Chicago you could see for a super experienced evaluation.

Steven Wallach, MD · Answer

You have a difficult problem with no great solution.  The indented skin is damaged skin and filled may stress the skin and cause it to necrose. Excising the skin will usually leave a poor scar on the nasal tip.

William Portuese, MD · Answer

First of all, this is a very difficult problem to fix, so choose your revision rhinoplasty specialist based on extensive experience with this specific issue. It's important to wait at least one year before undergoing any revision rhinoplasty procedure to allow full healing to occur. Cartilage grafting techniques utilizing the patient's nasal or ear cartilage or will be required to build up this area. The scar may also require further work after the structure has been built up underneath the depressed area.

David Reinstadler, MD · Answer

I would suggest visiting with some revision rhinoplasty surgeons. These cases are very tough since there is a combination of lost support and excessive scar tissue. I would find someone in your area to see in person and have an honest discussion about expectations. Best of luck

What is the best solution to fix the indentation on my nose?

Answers (5)

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