I have a vertical crease in the middle of my nose and it’s quite bulbous.

Question

Would I be a good candidate for tip rhinoplasty or do you think a filler would rectify the crease?

Steven M. Denenberg, MD · Answer

Click on the "Learn more" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_jame79.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.Your tip cartilages are strong enough, and your skin thin enough, to show the outlines of the two tip cartilages, and you can see the little depression between them. 
I narrowed the tip of your nose. Also, however, I lowered the bump on the bridge, elevated the tip upwards, 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 that I posted with this answer had all three of those features, too.You didn't post any direct profile views, but I'll bet that your profiles show that the tip is strong in its forward projection away from your face, and it sits a little low, too.See if you think the morph captured what you're looking for.Filler would make your nose look bigger, and I don't think you'd like that very much.
You should understand that the changes I demonstrated in the morph, particularly the work on the tip, 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. Rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. Read that page very carefully. 
I'd love to hear what you think of the morph. Did it seem to address your main concerns? I could modify the morph to your taste if you wish.
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.

John Layke, DO, FACS · Answer

If you are happy with the rest of your nose, you may be the perfect candidate for a nonsurgical rhinoplasty.  Hyaluronic acid can be used to fill in the "line," otherwise known as bossa.  I recommend meeting with a Board-Certified plastic surgeon who is experienced in rhinoplasty and nonsurgical rhinoplasty.

Jonathan Pontell, MD, FACS · Answer

Hi and thanks for your question and photos.  If you look at patient 78 on the second page of my rhinoplasty gallery on my website, you will see a patient with a very similar nose to yours (Please see link below).  Filler would be helpful, but a rhinoplasty would take care of the issues with your tip and bridge permanently.  My office in Wayne, PA in the Philly suburbs, so I would be happy to see you for a consultation with computer imaging.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The vertical line is due to separation of your lower lateral cartilage.  Based on your
photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can
accomplish this by trimming, suturing, and reshaping the cartilage in your
lower nose. Make
sure you specifically look at before and after pictures of real patients
who have had this surgery performed by your surgeon and not just a computer
animation system. 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

Eric M. Joseph, MD · Answer

You appear to have a large nasal appearance with a bulbous droopy tip, and a profile bump. Rhinoplasty surgery may be your best option for achieving a smaller and less distracting nasal appearance. Consider consulting with several Rhinoplasty specialist so you can see what might be right for you. I hope this helps. Dr. Joseph.

Paul N. Afrooz, MD · Answer

I would recommend a rhinoplasty.  This would be a permanent and more predictable solution to filler.

William Portuese, MD · Answer

The bulbous nasal tip is reduced and refined with suture techniques and conservative cartilage removal applied to the nasal tip cartilages. These techniques will also obliterate the cleavage between the two nasal tip Cartilages. The dorsal hump can also be shaved down  and the bridge line narrowed. All this can be performed with a closed rhinoplasty approach with all the incisions placed on the inside of the nose. No external insertions are required. Placement of fillers in  the tip of the nose is only temporary, and can have  Significant complications. For more information and many examples, please see the video below

Robert Singer, MD · Answer

Every nose is different and unique to that individual. If the appearance of your nose concerns
you enough to do something about it, it can be improved with a natural
artistically performed full rhinoplasty or possible tip rhinoplasty. What would be the best option and exact
procedure would depend on an in person examination (not just an online
consultation) and discussion about desired outcome. Excellent results can
be achieved with either a closed or open technique. 
Non-surgical
procedures like fillers or micro-fat grafts will make your nose look larger and
will not produce an improved cosmetic result in a patient with your anatomy.

Keep in mind that following advice from a surgeon on this or any other website
who proposes to tell you exactly what to do and how technically to do
it based on two dimensional photos without examining you, physically
feeling your tissue, assessing your desired outcome, taking a full medical
history and discussing the pros and cons of the operative procedure would not
be in your best interest. Natural appearing results need to be individualized
and what is appropriate for one patient is not necessarily the best for someone
else. I would suggest that you find a surgeon with extensive rhinoplasty
experience certified by the American Board of Plastic Surgery and one who is
ideally a member of The American Society for Aesthetic Plastic Surgery
(ASAPS) that you trust and are comfortable with. You should discuss your
concerns with that surgeon in person.

Robert Singer, M.D., FACS

La Jolla, California

David R. Broadway, MD, FACS · Answer

The vertical crease that is visible on your nasal tip is because you can see a separation between the lower lateral cartilages. This crease can be camouflaged with filler injections on a temporary basis, and certainly you could try this option first to see if this meets your desires and expectations. Another option would be a tip rhinoplasty which could permanently correct the crease. Best of luck!

Joshua A. Halpern, MD, PA · Answer

The crease represents the space between your nasal tip cartilages. Fillers are a good non surgical option. They are temporary and will need to be repeated. Another option is nasal tip plasty depending on your goals for your nose this crease can be treated using suturing techniques and or adding a filler like a cartilage graft. When performing nasal surgery, I incorporate the FINNESSE technique which I invented. I typically do not pack the nose. Pain and recovery are minimal Versus traditional techniques. I hope you find this information useful. Please watch the enclosed video.

I have a vertical crease in the middle of my nose and it’s quite bulbous.

Answers (14)

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