Why did my nose split down the center of the tip? (Photo)

Question

Six months ago I was on the drug accutane for my cystic acne. I noticed that my nose started to get smaller and now the tip of my nose has a split down the center. It was not there before accutane. Is there a reason for this?

Steven J. Pearlman, MD, FACS · Answer

Thick skin camouflages irregularities, hills and valleys in the nose. If you needed Accutane, you likely had thick oil gland laden skin on the nose (called sebaceous skin). The thinning out of this skin unmasked what already existed below, domed nasal tip cartilages that have prominent contours. As a matter of fact, some surgeons are actually using Accutane BEFORE rhinoplasty in patients with very thick skin to gain more definition of the tip after surgery. This condition can be treated by nasal tip rhinoplasty.

David Tauber, MD · Answer

Your pictures demonstrate a bifid bulbous tip. The use of Accutane has lessened the thickness of the overlying skin by diminishing the activity of the oil glands. This has revealed the natural shape of your lower nasal cartilages. You picture also demonstrates a wide mid-vault and dorsal hump. This bifidity can be addressed using suture and cartilage grafting techniques to refine the nasal cartilages and obliterate the slit down the center. A dorsal hump reduction and nasal bone in-fracturing can complement this refinement.See the link below for more information on rhinoplasty.A detailed examination will help delineate the best treatment. Consultation with a plastic surgeon certified by the American Board of Plastic Surgery would be the next best step.

Reza Momeni, MD, FACS · Answer

It appears the tip cartilage of your nose have a separation, which can often be a normal variation of the anatomy.  If you don't like it of course rhinoplasty can be considered, Without an exam, it will not be possible to fully evaluate you and give you recommendations. Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.

Farhad Rafizadeh, MD · Answer

The thicker skin with the sebaceous glands were hiding the shape of the pair of cartilages at the tip of your nose. The melting away of the oil glands under the skin reviewed the shape of the tip cartilages and the fact that they were split apart. The good new is that a tip rhinoplasty in expert hands can correct the problem. You would most likely need an open approach to increase the level of accuracy.

Steven M. Denenberg, MD · Answer

Click on the "Learn more" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_kellimelissa2.html
I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.
I narrowed the tip of your nose. Also, however, I elevated the tip upwards a bit, and I brought the entire nose back closer to your face.When the tip cartilages are strong enough to make the tip wide, like yours, they are usually strong enough to hold the nose out forward from the face more than we might like, and they tend to hold the tip down, making the nose tip look a little droopy. Perhaps you can see those changes best in the animation. The woman in the short video above had all three of those features, too.The "split" is just the space, the depression, between the arches of the two cartilages. That depression can be filled out during a rhinoplasty operation.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Learn more" link on how to stay out of trouble while searching for a rhinoplasty surgeon. You should only have surgery if you are able to make yourself very confident in your surgeon's skills. Read that page very carefully. Most plastic surgeons are quite poor at this operation, and I believe my advice will go a long way toward keeping you safe.
I'd love to hear what you think of the morph. Did it seem to address your main concerns?
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
In your case in particular, you need to find a surgeon who understands all of the issues I mentioned, and how they fit together, and who can actually accomplish them in surgery.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your photographs, the split you see is a division of your lower lateral cartilage.  This could be fixed with a rhinoplasty surgery if you would like.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

John Paul Tutela, MD · Answer

Thanks so much for reaching out.  Accutane shrinks the glands in your nose and this has shrunken your overall skin.  It has shrunk around your underlying support structures of your nose.  These structures in your tip include your alar cartilage.  Once your treatment is complete you could seek out rhinoplasty with tip work to reshape these underlying structures.I hope this helps :)

Christopher Khorsandi, MD · Answer

I have never seen this specific response in a patient taking accutane.  However one of the things accutane does is to shrink oil gland production and thus gland size.  The tip of the nose has a high degree of the glands and it may be that the glands in the skin were really big before you started the medication.  Now with them smaller you see more of the underlying shape.  Some fillers may correct this.

Paul N. Afrooz, MD · Answer

One of the ways that Accutane works is by decreasing the activity of sebaceous glands in your skin.  These are the glands that secrete oil, and they vary in density in certain areas of the face.  The tip of the nose is an area that generally has more sebaceous gland activity.  As a result of Accutane, the sebaceous gland activity in the tip of your nose has probably decreased and as a result your skin is thinner or less spongy in this region.  As a result the contours of the underlying cartilage is more visible and less camouflaged.  
When you complete the Accutane treatment, there is a good chance that your skin will plump up a little bit, and thus provide some camouflage of the contour of the underlying cartilage.

Richard Mark Winters, MD · Answer

First off, it seems that you've had a nice response to Accutane... although I do not profess to be a skin care expert, it seems that Accutane can thin out the skin a bit whilst affecting the sebaceous glands to reduce acne... as such, the underlying cartilage and bony structures of your nose are more clearly visible than they were before...there seems to be consensus amongst dermatologists that these atrophic changes will revert over time

Why did my nose split down the center of the tip? (Photo)

Answers (11)