Can I do a revision for supratip graft or should I just live with a depressed nose?

Question

I have had several rhinoplasties. I recently had one in which a supratip graft was removed (the one before it placed it there, two different surgeons). Given the pictures, is there any way to get a surgeon to help me out with a supratip graft or should I just live with a depressed nose? I've tried filler before and it hasn't worked longer than a few weeks.

Evan Ransom, MD, FACS · Answer

Thank you for the question and the photo. It would be helpful to see a full set of standard photos before making a medical recommendation. That said, small imperfections in the dorsal contour can be treated pretty easily with filler. The thing that concerns me in your case, however, is that you have had "several" surgeries. This means that the blood supply to the skin will be less predictable and possibly less robust; this is a setup for potential skin necrosis from vascular occlusion. Revision surgery may be a better option, but it is difficult to recommend this without an examination and review of prior records. Soft tissue augmentation for small irregularities can be accomplished with temporalis fascia (from behind the ear) or cartilage (from the ear or septum). Please visit with an experienced rhinoplasty surgeon before making your decision. Take care!

Jonathan Kulbersh, MD · Answer

I recommend getting a consultation to go over your concerns and your desired results. Revision rhinoplasty is a technically challenging procedure and I would suggest that you seek a surgeon that has a good track record for natural results. There a few select of these surgeons in each major city.  I would look at their reputations, board certifications, and before and after pictures.  
I hope this helps.

Nima Shemirani, MD · Answer

I would consider a more permanent filler such as Bellafill or even liquid siliconeWhen placed in small amounts (like the supratip area), it should not cause any long term issues or consequencesIf you could avoid another surgery, that would be idealWhen you are ready, please visit a revision rhinoplasty specialist who can address your concerns
Best, Dr. Nima

Toby Mayer, MD · Answer

Revision rhinoplasty or not?  A graft can be placed in the supratip and the slight hump can be filed down. This  should be done by a very experienced revision rhinoplasty surgeon. The one thing you don’t want to do is take any backward steps which would make this worse.   See several experienced surgeons and have look at their results.

Jill Hessler, MD · Answer

Revision rhinoplasty is a more complex surgery than primary rhinoplasty.  I would recommend you have a consultation with a board certified specialist focusing on rhinoplasty to review your previous surgical procedures and discuss your current concerns.

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. I suggest that you move forward and consult with a board certified facial plastic surgeon.
Best wishes,

Eric W. Cerrati, MD · Answer

I recommend that you see a revision rhinoplasty expert to discuss your concerns and options.  With each prior surgery, the revisions become more challenging.  Additionally, I would advise against placing fillers into the nose with a history of multiple prior surgeries.  For this, I believe the risk is greater than the temporary reward.  From the limited photos, it looks like your area of concern is limited to the dorsum and would be fairly straightforward.
Best of luck.

William Portuese, MD · Answer

Since you have already had multiple surgeries in that area, there will be extensive scar tissue present which will make grafting more difficult. It's also important to know how much cartilage is left over on the inside of the nose for potential grafting purposes. If there's no cartilage left on the inside of the nose, then consider ear cartilage. Ear cartilage will feel more firm in that area the nasal cartilage, and is not the optimum grafting source.

David Alessi, MD - Account Suspended · Answer

Fillers would help but are only temporary.  A revision by a revision expert is your best choice.  This would involved a carefully placed supratip graft and lowering the bridge a tiny bit.  Best wishes.

Michael Elam, MD (retired) · Answer

I would speak with some expert surgeons and discuss your concerns with your current result and what you would like accomplished in the end. If the desired nose can be attained with revision surgery then you can move forward. If you have a copy of your operative reports and your original photographs these are always helpful for the secondary opinions. Best regards, Michael V. Elam, M.D.

Can I do a revision for supratip graft or should I just live with a depressed nose?

Answers (10)

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