Worried rhinoplasty could worsen the bulbous tip because I get keloid scarring, is it a good idea to get one?

Question

I really want a rhinoplasty because of how round and bulbous my tip is. I only want some slight changes though, not like a whole knew nose. Anyway, I worry because I get keloid scarring and think that could worsen the outcome and make a rhinoplasty not worth it. I would like a surgical rhinoplasty to avoid repeating costs. Is it still a good idea to get a rhinoplasty when I have this kind of scarring?

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. You are an excellent candidate for rhinoplasty. I agree with your assessment and think it is one of the most beautifying surgeries that we do as plastic surgeons. A large portion of my practice is dedicated to rhinoplasty surgery, and I have almost never seen keloid scarring from rhinoplasty. It is important to only see plastic surgeons with extensive experience in rhinoplasty, ie perform at least 6 per month and have performed hundreds of cases. Also, critically evaluate on-line galleries to see if their art form resonates with yours. Rhinoplasty is definitely a grey haired plastic surgeon's sport. Best wishes to you

Ashley B. Robey, MD · Answer

Keloid scarring in Caucasians is pretty uncommon; what most people interpret as a keloid is actually a hypertrophic scar, so that is good news! Also, the only external scar on a rhinoplasty is across the columella; those tend to heal quite well.

Meet with a plastic surgeon; show him/her your other scars. Discuss the pros and cons of your procedure.

Meet with a plastic surgeon; show him/her your other scars. Discuss the pros and cons of your procedure.

Zoran Potparic, MD · Answer

Based on these photos you seem to be a good candidate for rhinoplasty, possibly only tip-plasty. However, only on the basis of in person evaluation and discussion about your scarring risks a proper decision can be made. consultation with a board certified plastic surgeon with known expertise in rhinoplasty would help. Good luck.

James C. Marotta, MD · Answer

Surgical rhinoplasty is the only way to address a bulbous nasal tip.  Tip-plasty alone can be done in cases like yours where there is no hump and the bridge is lower than the tip.   Keloids are relatively rare in rhinoplasty surgery in rhinoplasty surgery.  If you have pierced ears and no keloids you are not likely to keloid from the surgery.   A bulbous tip can be addressed  by reducing the tip cartlages, suture maneuvers, tip grafting, and thinning the nasal skin.  Hope this helps :)

Stephen Kleid, MBBS, FRACS · Answer

I don't think you have anything to worry about,The reduction of your bulbous tip is done by trimming and folding your lower lateral cartilages, and thinning the overlying skin.
I think that is best done with an Open Rhinoplasty.Keloid scarring only occurs on incisions, and almost never occurs on the columellar incision of an Open Rhinoplasty. The scar is usually barely visible.Injecting steroid into the columellar incision before closure can further reduce that miniscule risk.

William Portuese, MD · Answer

The bulbous tip can be reduced with a closed rhinoplasty approach with all of the incisions placed on the inside of the nose. We have never seen a keloid in the nose in over 30 years. You most likely require some steroid shots placed in the nasal tip for the first few months to prevent swelling and that tip after the surgery to reduce fluid retention and scar tissue formation in that location

Kenneth R. Francis, MD, FACS · Answer

Dear ScarletWallen,
Having keloid prone skin should indeed be a concern for someone planning an elective surgery.  With that being said, I have never in 30 years of practice seen a keloid occur on, or in the nose!  And I deal with a large ethnic patient population in my practice.  That is also not to say that it can't or hasn't ever happened.  The first order of business would be to determine if you in fact have keloid prone skin, or another condition known as hypertrophic scarring.  Seek consultation with an American Board of Plastic Surgery board certified plastic surgeon for an examination and discussion of your options.  Good luck!

Darryl J. Blinski, MD · Answer

Nice posted photos but I think besides tip rhinoplasty you need alar wedge reduction and septaloplasty with cartilage grafting. Fee $10,000. Best to virtual consult with…..

Worried rhinoplasty could worsen the bulbous tip because I get keloid scarring, is it a good idea to get one?

Answers (8)

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