Is There a Rhinoplasty Procedure That Can Augment the Tip Quite Significantly Without the Risk of Extrusion?

I recently talked to a plastic surgeon in my city and he told me that he takes extra precaution when clients ask for tip augmentation rhinoplasty because of the risk of extrusion through the skin. He told me he only augments tips minimally so that the extrusion risk is minimized. He also prefers to use Medpor for augmentation. I was wondering, however, if there is any procedure where the tip of the nose can be projected quite significantly without the risk of extrusion. Thanks.

Doctor Answers 10

Is There a Rhinoplasty Procedure That Can Augment the Tip Quite Significantly Without the Risk of Extrusion?

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I have performed rhinoplasty for over 20 years and IMHO, I'm just not sure why the plastic and cosmetic surgeon, you spoke with, was so worried about skin extrusion when augmenting the nasal tip.  The best method that I have found to reliably and safely, I might add, of creating augmentation to the nasal tip is a cochal cartilage ear graft.  It's soft yet strong enough to provide tip definition and support and unlike rib cartilage/bone it doesn't dissolve unevenly over time.  You may want to get a second opinion.  

Skin erosion is most commonly associated with an L-shaped silicone dorsal implant IMO.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Rhinoplasty and Tip Augmentation

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Hello Romanceex,

Implants in the nose are a controversial subject among plastic surgeons and facial plastic surgeons because of their higher risk for infection, malposition and extrusion compared to cartilage grafts.  A general consensus is that implants are relatively safe in the bridge area, though.  As for tip augmentation, the vast majority of qualified rhinoplastic surgeons would agree that foreign material like implants should be avoided because of an even higher risk of complications.

Without exception, the tip of the nose can be augmentated with your own cartilage.  This material is taken from the septum, ear, or sometimes even rib.  Commonly, the tip can be augmented by adjusting the shape and postion of your natural tip cartilages as well.  The ability to routinely augment and reshape the nasal tip without implants is a hallmark of an experienced rhinoplastic surgeon, and the use of something like Medpor for any nasal augmentation is concerning.

You should consult with a surgeon who is considered a rhinoplasty specialist in your area.  That person will be  certified by either the American Board of Plastic Surgery or the American Board of Facial Plastic Surgery.  Looking at photographs of their patients is very helpful too.

Best of luck.

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Tip augmentation

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I think the best and safetest material to use is your septal cartilage. Also, ther ar procedures that advance the medial cruse giving more projection. You need other opinions

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon

Tip Rhinoplasty to Avoid Extrusion of Nasal Implant

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The best method to avoid extrusion of a nasal implant with rhinoplasty to the avoid the implant all together. Nasal implants are typically made of silicone, goretex, or other polymers. Implants placed around the tip are more likely to push out of the skin or extrude, as compared to implants on the bridge only. 

Tip rhinoplasty may be performed by avoiding a nasal implant. Nasal tip cartilage is strengthened and refined with a variety of techniques, which includes cartilage grafting. I have not heard of cartilage grafts extruding.

Only after a comprehensive evaluation can a plastic surgeon help determine appropriate options for you. Best of luck.

Dr. Chaboki


Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Extrusion risks for nasal tip augmentation are low when using one's own cartilage

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The extrusion rate for tip augmentation is significant when artificial materials are employed such as Medpore or silicone. When your own cartilage is employed, this risk is very minimal.

You definitely should seek out another opinion for your nose with another board certified plastic surgeon.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Augmenting the nasal tip is best done with your own tissue.

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Augmenting the nasal tip is best done with your own tissue. You can increase the tip projection as much as you want and even overproject it if you wanted to do this.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Natural materials have least risk in rhinoplasty

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You will see from multiple comments that natural cartilage grafts have the least problems and are the preferred material for most during rhinoplasty. Cartilage grafts will not extrude, and infection is very uncommon. If you have found a surgeon who only uses Medpor for augmenting the nasal tip, you may wish to have another opinion.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Nose shape: Natural tip suppor is better

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Increasing nose tip support and definition is best done using the available "resources" within the structure of the nose itself, by suture techniques and rearrangements.  When this is not enough, best alternatives include:

  1. Ear cartilage.  Excellent shaping to the nose tip can be achieved using small grafts from the back of the ears.  Donor sites are minimal and very well tolerated
  2. Rib cartilage.  More involved procurement procedure and more uncomfortable.

Using foreign materials in the nose tip is usually not a good option due to the high risks associated.

Mario Diana, MD
Plano Plastic Surgeon

Nasal tip augmentation

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My recommendation, custom, and practice, is to avoid alloplastic materials such as silicone and porous polyethylene for isolated nasal tip augmentation.  The use of suture technique on the lower lateral cartilages, cartilage tip grafts (single or stacked), advancement of the lower lateral cartilages via columellar strut graft and/or septal to medial crural sutures all eliminate the risk of extrusion.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

Tip augmentation with your own cartilage works best

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I prefer to use your own cartilage with a suture method to advance and shape the tip.

If done well, significant advancement can be created

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 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.