Parenthesis Tip Deformity After Rhinoplasty

I had rhinoplasty 13 months ago, and now have a parenthesis tip. I have no nasal obstruction or valve collapse (i breathe normally), but esthetically its not pleasing. My question is, can this be fixed through closed surgery? and can I use fillers to fill the supra-alar crease instead of going through another surgery?

Doctor Answers 12

Surgical or non surgical revision Rhinoplasty

You do have a couple of options, depending on your preference. I would not suggest injection, since the filling effect can also add volume intranasally. Yes, the cartilage may support against this, but the creation of nasal obstruction from filler going deep instead of lifting superficially is a potential. 

From what I can tell from your picture, there are two other options that seem reasonable. One is very straightforward, and would be the most likely answer surgeons may suggest. That is to take a little ear cartilage and use that to support and reshape the ala and supra-alar crease (I can't honestly tell where your maximal depression is on your picture). In any event, that could honestly be done with endonasal incisions, and even under local or oral sedation. Little or no down time.

The second option is about the same scope of involvement, but would take a better evaluation of your current anatomy in person  A few years ago there was a technique published called a J flap, where you can remove a small but precise amount of cartilage and intranasal lining on the lateral extent of the nasal cartilage. It just tightens the ala a little, and lifts that deep supraalar crease. Great, quick, very effective, and even less down time. Normally, it is used to restore the airway. But truthfully someone would have to take a look at you first in order to make sure you are a good candidate for that. 

Madison Facial Plastic Surgeon
4.7 out of 5 stars 14 reviews

You appear to be an excellent candidate for a Non-Surgical Rhinoplasty.

I will routinely fill the "supra-alar crease" (nice description) with Silikon-1000 for a natural, permanent result. You could likely have other Injectable Fillers to this area, but Silikon-1000 is my personal preference for a permanent result. Liquid injectable silicone must be administered by a physician experienced in the serial puncture, microdroplet technique. Silikon-1000 works particularly well in the nose, and these indentations above your nostrils are easily corrected without surgery.

If you'd like to try another filler, ask your doctor to see photos of other patients with simillar concerns.

I've attached photos for your perusal.

I hope you find this helpful.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

Parenthesis Tip Deformity After Rhinoplasty

One can have nasal airway collapse after rhinoplasty and it can happen in both primary and secondary. Most of these can be corrected through an open approach and after the use of grafts for contour correction of the specified area.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 62 reviews

Parenthesis nasal tip deformity can be corrected

The parenthesis tip deformity can be treated by one of two ways. Further narrowing of the actual dome itself and either rim grafts or alar batten grafts placed via closed rhinoplasty technique, provided there is extra cartilage in the nose or on the ear for this. This can be done through closed rhinoplasty in experienced hands.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Tip deformity after rhinoplasty

From your photograph, it appears that you have a mild depression just to both sides of the tip of your nose. If this is bothersome to you, I would suggest adding a small amount of sculpted cartilage (preferably from your nasal septum but possibly from your ear) carefully placed in the region of the depressions. This should give you a better contour of your nasal tip. In general, I do not feel that


work well in this region of the nose.

Sigmund L. Sattenspiel, MD
Freehold Facial Plastic Surgeon

Correction of the parenthesis deformity after rhinoplasty.

Correction of this as well as the supratip depression can be done by the closed method. Fillers for the supratip can be done alone. See an experienced revision rhinoplasty surgeon for this.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Please send side view picture

From the front view you seem to have depresson above the tip. The side view can be very helpful. The use of filler is a good option. Please send more pictures .

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 122 reviews

Parentheses deformity options for correction

You certainly can have the lower lateral cartilages repositioned inferiorly through the closed approach or you can have grafts placed through the closed approach. Fillers can be of some benefit but as you know the results will be limited and temporary. If your surgeon is comfortable with the closed approach then that is a very reasonable option.

Jason B. Diamond, MD, FACS
Beverly Hills Facial Plastic Surgeon
3.7 out of 5 stars 14 reviews

The parentheses appears to be from nostril deficiency

It appears that the tip is well proportioned to the rest of your face. The problem seems to be deficiency of the alar cartialges (specifically the lateral crura of the lower lateral cartilages). This may be a result of over resection of these cartilages during the first rhinoplasty or this may have been a problem that was unrecognized at the time of your first surgery. Fillers would likely not remedy your problem as they would push into the nostril and not push out the concavity that I see. Grafts to the nostrils can be placed via a closed approach if that is what is required. They can come from your septum and if there is no cartilage there, your ear cartilage is very good for this purpose.

Philip S. Schoenfeld, MD, FACS
Chevy Chase Facial Plastic Surgeon
4.7 out of 5 stars 30 reviews

A natural looking tip should blend into the nostrils

What can occur from rhinoplasty is when the tip starts to look "separate" from the nostrils. IF this is the only problem with a prior rhinoplasty, placing grafts through the endonasal approach can correct this. I have tried filler with mild success. This is a very delicate area and fillers can sometimes soften the area but can also create lumps since the skin is taught.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 125 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.