Why Do So Many Tips Develop Pointy, Small-ish, Hardened Balls After Rhinoplasty?

Hi D,

Great question.  You have hit on the answer as well.  After rhinoplasty the skin-soft tissue envelope of the nose shrinks a bit and continues to do so for years.  It is incumbent upon rhinoplasty surgeons to leave a strong cartilaginous supporting skeleton to avoid the "shrink wrap warped" nose.  The abundance of this tip result is due to poor technique by mediocre surgeons.  It is not the normal outcome of grafting.  This is another reason for patients to do their due diligence and choose their rhinoplasty surgeon most carefully.  Good luck and be well.

Dr. P

As mentioned by the previous physicians, once rhinoplasty is completed and healing begins the skin-soft tissue envelope which covers the boney and cartilaginous structures of the nose undergoes a "shrink wrap effect".  Experienced rhinoplasty surgeons are aware of certain techniques and maneuvers in surgery to avoid the complicating effect of this healing phenomena.  Many times a "pinched tip" after surgery is caused by a surgeon not respecting the cartilage framework of the nasal tip, and thereby removing too much cartilage which leads to lack of tip support and the above complication.  Also, a surgeon takes into account other factors such as skin thickness.  Many times in thin skinned patients, especially those requiring cartilage grafting, we place temporalis fascia over the grafts to soften the graft edges and prevent the appearance of "sharp edges" after healing has taken place. There are many factors to take into account during rhinoplasty surgery which greatly influence the final outcomes and appearance of your new nose.  I suggest that patients always go to a board certified surgeon who is very experienced in this type of surgery.  Good Luck

    I rarely ever graft to the tip in a primary rhinoplasty as suture techniques and cartilage removal techniques can accomplish almost anything.  Scar formation can cause hardness in any result.  However, out of the hundreds I do each year, this tends to be a nonissue.  I will say that any plastic surgeon that has gone through an integrated plastic surgery program in the last 15 years or so represents the best of medical school graduates.   These integrated plastic surgery programs are by far the most competitive residencies in all of medicine.  These plastic surgeons are anything but mediocre.  Kenneth Hughes, MD Los Angeles, CA

 The  end result after rhinoplasty is dependent upon many factors such as the healing process, thin versus thick skin, technique performed, the amount of cartilage removed, and any grafts of cartilage placed in the tip. The nasal tip skin does tend to shrink wrap over the cartilaginous framework of the nose after the procedure been performed. 

A properly performed rhinoplasty will be in harmony with the rest of your facial features.  If all of these examples you list are from one surgeon then it may be a technical problem.  In general this is not a common problem.  

I did not know that "so many tips develop point, small-ish, hardened balls after rhinoplasty". Certainly this is possible complication but is not a normal result. Nor did I realize that there is an "over abundance" of mediocre surgeons. I'm sorry you've apparently had a bad experience but I recommend that you consult with an experienced revision rhinoplasty surgeon who can explain your alternatives to improve your nose.