What grafting techniques or implants best can be used for tip elevation, projection & definition?

I have thick, oily skin that needs to be debulked in revision, rotated, & elevated. I have a wide, flat, droopy, overprojected nose now & would like better support of my tip from above, w/nice columellar & nostril show. I do not think I need my bones rebroken, but I do need structural support. I have a wide nostril base. I know an only graft is one option, but I want a nose that feels soft & natural. What can add medial/tip support w/out making a nose too hard or bulky?

Doctor Answers 4

Nose grafting

Do avoid any alloplastic materials (silicone, medpore, etc) because of infections, extrusions and unnatural results.
Bone is neither recommended, looks artificial and resorption rates are high. Other autollogous materials show similar behaviour.

The right materials to be used as graft are cartilage from the patient's concha auricularis, septum or even rib cartilage. Also temporalis fascial may be used with success.


Spain Plastic Surgeon
4.9 out of 5 stars 41 reviews

Tip elevation, projection and definition in a thick skinned nose

Thank you for asking about your rhinoplasty.

I am sorry things didn't turn out as you hoped with your first rhinoplasty.
  1. In general, cartilage is the best graft material for the nose.
  2. I have on rare occasions used a silicone graft on a very thick male nose - when the man had no ear or nose cartilage to use and would not accept a rib or human-derived graft.
  3. Exactly what is needed should be planned in-person with your surgeon and realistic expectations discussed.
Always consult a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Revision rhinoplasty candidate

Without pictures, it's impossible to give any opinion on what may or may not be required. Some patients require cartilage grafting techniques, and others do not with revision rhinoplasty. There are many variables that  go into the decision-making process such as current amount of cartilage in the tip, thickness of skin, thickness of the cartilage and the multiple tip support mechanisms. Some patients do not require any cartilage grafting to give increased rotation and projection, while some do require grafts.  Any time cartilage grafts  are added to the nose, it will make the nose harder and stiffer, since you're adding bulk to the  tip of the nose. We do not recommend synthetic implants to the nasal tip, due to the potential of infection. Instead of trying to pick which type of cartilage grafts you may or may not require for your nose, it's better to pick your surgeon, since  revision rhinoplasty is the hardest operation to perform in the field of cosmetic surgery. For many examples of increasing tip projection and rotation, please see the link and video below.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 139 reviews

Cartilage grafting for revision rhinoplasty.

Cartilage grafting for revision rhinoplasty is what I have used for 35 years without infection or absorption issues. I NEVER use silicone because of infection issues. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 33 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.