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

7 mo post op, thin skin before surgery and now cartilage shows even more through the tip. No grafts were placed in my nose, tip just shaved down. My dr's plan-revise at a yr thru closed procedure, take fascia from my ear to lay over the tip of my nose. Experts-agree? Should I trim some off the tip so projection is not added by the fascia? Should this be a closed procedure? Lastly, is this fairly easy or complex revision? ONLY want to change white tip and "boney" cartilage look of tip... soften

Doctor Answers 10

Treatment of "White" Nasal Tip

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.


Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Fascial flap on nose for revision

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.

Arian Mowlavi, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 44 reviews

Thin skin over nasal tip

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.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 136 reviews

Cartilage graft showing very white tip.

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., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Revision

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


Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 59 reviews

Tip cartilage after rhinoplasty

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.

Jeffrey Jumaily, MD
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Nasal tip

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.

Michael F. McGuire, MD, FACS (in memoriam)
Los Angeles Plastic Surgeon
5.0 out of 5 stars 7 reviews

Outline of nasal cartilage

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!

Elbert T. Cheng, MD
San Jose Facial Plastic Surgeon

Tip cartilage

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.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 25 reviews

Thin skin

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


Regina Rodman, MD
Houston Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

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