Cartilage showing very white tip. Happy with dr and nose but not cartilage show and want as many experts to weigh in.

Your doctor has a very progressive plan, bravo!  Your skin is quite thin, so this is a difficult problem to correct.  Further reducing the cartilage can compromise the appearance of the tip, and the skin will still be thin, so his plan is a good one.

your tip is nice and symmetrical and your overall look quite nice.  I would leave the tip alone.  However, you do have a hanging columella and asymmetry there.  That is a very simple revision just slicing a little cartilage off.  This can be done closed and even under local anesthesia.  Failure to shorten the caudal septum can lead to this and that is what your tip looks like.  Fortunately a pretty simple fix.

I think fascia to cover the cartilage is a fine method to help camouflage the underlying cartilage which is visible. A closed approach is an excellent choice as well. Best of luck!

I agree with what has been said, that thin skin is a difficult and tricky problem to solve (without making the problem worse).  Some surgeons used very finely crushed cartilage to mask this, but in your case this may create too much bulk.  I agree with the fascia graft, but he is taking it from your ear?  Do you mean from behind the ear?  Temporalis fascia is usually the graft of choice, which is taken from a small incision above and behind the ear.  The scar is hidden in the hair.

Best of luck,

Dr Rodman

Thank you for your question and photos. I do notice the tip area that you are talking about. This can happen with thin skin after rhinoplasty. Unfortunately without better photos and details of what was done in the procedure, it's hard to comment on the projection etc. If the tip cartilages are in good position and not too separated then fascia is a reasonable solution. Open or closed is surgeon preference so it varies. Good Luck.

Fascial graft overlay should do well if you don't like the white outline; a little white spot is desirable for the nasal tip which is referred to as the tip defining point.

Thank you for the question and photos and if you have trusted your surgeon so far I would go along with his adviceDr Corbin

From the appearance of your tip in the photos, I would consider apposing the alar cartilages to create a single tip light reflex as well as using fascia as a camouflage under the very delicate and thin skin.  A closed approach would be appropriate.

After reviewing the pictures of your nose it appears that the white color of your nasal tip skin is secondary to pressure from the underlying cartilage. If you're happy with your surgeon's work I suggest you continue to follow his recommendations. Fascia grafts are a reasonable approach to mask this problem.

Any of several techniques to provide coverage over the cartilage graft should work to your benefit.  Either fascia or morselized cartilage would be my choice.  I would also use a closed approach and try to bevel the edges of the cartilage graft to soften them slightly.  Trust your surgeon.  Regards,Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)ABC-TV Extreme Makeover SurgeonBeverly Hills, California