Revision tip plasty - what are your thoughts? (Photo)

Question

Hi! I had tipplasty 1 year ago. Asked for subtle changes, the surgeon did a cephalic trim on my left side and adjusted my tip to align it with my right. I have thin skin and cartilage is showing through now that the swelling is gone. Surgeon now wants to pull my tip points closer together, do some more cephalic trimming on both sides and also use perichondrium or diced cartilage to camouflage irregularities. I like my nose in 3/4 profile and want it slightly up/supratip break.Appreciate any help

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, the domes of your lower lateral cartilage have been asymmetrically sutured and can easily be visualized through your thin skin. I would recommend tip deprojection and a mastoid fascia tip graft to provide better symmetry and camouflage. 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.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have a very thin nasal skin and we can see that your skin has retracted onto the entire bony and cartilage and a skeleton of your nose. This is called shrink wrap. The base view of your nose may indicate that you are experiencing a bit of external nasal valve collapse. My concern about another cephalic trim is that this may lead to nasal obstruction. Moving forward, I believe you may require a complex revision rhinoplasty with tip plasty, nasal straightening, dorsal reduction, and perhaps repair of your narrow external nasal valve. If you have a significant improvement after your rhinoplasty surgery, it's always a safe bet to live with what you have. Thank you so much for your question I hope this is helpful. Sincerely, Dr. Joseph

Revision tip plasty - what are your thoughts? (Photo)

Answers (2)

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