Is revision rhinoplasty my only option to remove cartilage at the tip of my nose? (photo)

I had a rhinoplasty at 18 for cosmetic reasons. I was always happy with my results, until recently, which is now 8 years later, that I noticed what appears to be a piece of cartilage at the tip of my nose. It seems to only be getting bigger and more sensitive. The tip of my nose since surgery has never softened, but the spot where the possible cartilage is, is even harder. I'm nervous that a surgeon will suggest surgery, but am afraid it could be my only option.

Doctor Answers 7

Revision Rhinoplasty for Tip Bossae

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It sounds like you have "bossae" formation, which is very common after first time rhinoplasty—especially in thin-skinned individuals or those who have had excessive cartilage removed. Revision rhinoplasty is the best treatment, but I recommend you see an expert who specializes in revision surgery. Also, discuss the use of temporalis fascia during the surgery to soften the region.

Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

The tip

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Over time with healing, your tip cartilages have become asymmetric, with the right tip becoming more defined-  likely some type of partial division or narrowing of the tip was done in your original surgery.  To repair, as my experience has taught me, given what appears to be your somewhat thin skin, it is not enough to simply trim the cartilages, as this will with some time likely lead to the appearance of irregular cartilage again-  therefore some type of sculpting with reforming of a soft right nasal tip will be necessary.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
4.7 out of 5 stars 145 reviews

Tip Cartilage Asymmetries

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The cartilages the form the nasal tip, the lower lateral cartilages, are often sutured during rhinoplasty to both narrow and provide more refinement to the tip.  A very common suture is the dome binding suture.  This suture pinches the cartilage at its most prominent point, the dome.  The nasal skin continuously contracts after surgery, so it is not unusual for imperfections to become visible many years after surgery.  The only way to correct tip cartilage asymmetries is revision surgery. 

William D. Losquadro, MD
Westchester Facial Plastic Surgeon
4.9 out of 5 stars 30 reviews

Is revision rhinoplasty my only option to remove cartilage at the tip of my nose?

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I think your request to remove the cartilage graft is reasonable and can be performed with a closed rhinoplasty.  Cartilage grafts can become palpable and visible.  They can thin the skin and become unsightly as well.

Find a board certified plastic surgeon who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA

Revision rhinoplasty

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If you have a tip graft that has shifted or is not smooth, it may show through like in your description. But, yes, if treated it would have to be done surgically.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Is Revision Rhinoplasty My Only Choice?

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It would help to have more than one view of your nose. Having said that a revision by a rhinoplasty specialist is your best choice. You're a very young lady; the results will last you the rest of your life.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Possible cartilage at tip of nose

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The only definitive method of altering the cartilage of your nose is to do so with surgery.  Sometimes, it is possible to help camouflage small imperfections of the nose with an injectable filler, but this is more so on the top of the nose and not the tip.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 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.