How much volume/bulk will a temporal fascia graft add to the tip of the nose? (Photo)
Doctor Answers 5
Increased Tip Volume Secondary to Fascia Graft
A single layer fascia graft will provide the thickness absent due to very thin skin so the irregularity secondary to the underlying cartilages are not visible. This is different than using multiple layers when the goal is nasal augmentation.
Revision rhinoplasty with a more experienced surgeon.
Rhinoplasty is difficult to do well, but if it is done right you would not see these problems, even with thin skin. I would advise you to see an experienced rhinoplasty surgeon, who can give you an honest opinion about the way your nose looks now and what needs to be done to change it to make it look great. Good luck!
Management of Nasal Tip Appearance after Primary Rhinoplasty
It appears that your surgeon may have placed a cartilage tip or shield type tip graft which is clearly too visible with your thin skin and soft tissue envelope. If this is the case, for your revision I would consider taking this tip graft out altogether. Your natural tip cartilages may offer you all definition you need without the side effects of a visible tip graft, which detracts from a natural appearance in the photo. Suture techniques along with the possible onlay of fascia or Alloderm could be considered as well, once the tip graft is removed.
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Rhinoplasty and fascia grafts
Rhinoplasty is a surgery to improve the shape of the nose for breathing or appearance.
Patients with thin skin have the potential to have visible edges of the cartilage structures, particularly in the tip. Fascia or soft tissue harvested from the side of the head (temporalis) or the chest (rib perichondrium) can be grafted to camouflage sharp edges. They add very little bulk, less than 1 mm of change. There would be more swelling while recovering, but it will settle down with time. I would discuss this with your surgeon as it would involve a second operative site to harvest the fascia. Safety comes first.
Temporalis fascia graft is one of the most common and versatile types of camouflage or so called "blanket" grafts used in both primary and revision rhinoplasty. It can be used over the dorsum or tip with adding little bulk by itself or as a cover over augmentation cartilage grafts if more projection is desired. A downside of this graft however is that it can occasionally be associated with a long period of swelling which usually resolved spontaneously.