Nose Cartilage Fallen? (photo)

Question

I'm in dire need of help. I'm getting married in 5 months and this has been a problem for quite sometime that I've ignored but not any longer. I have a pointed, small nose (I'm African American) and I've noticed that on the right side of my nose toward the tip of it the cartilage is beginning to cave in. It looks horrible. I do not use any drugs but I do use nasal spray as a decongestant for my sinuses. I just want my nose to loo perfect on my wedding day. What can I do to correct this? Help please!

David C. Pearson, MD · Answer

Congratulations on your engagement!

	Non-surgical options for the nose, i.e., injectable fillers, are indeed more difficult to do at the nasal tip given the tight adherence of the skin to the tip cartilages. However, it's a great option for minor nasal defects where a surgical approach would be too drastic. This is an area where I like to use a temporary filler like Juvederm first. If that works really well for a patient but they want to make it a permanent solution, then Artefill (a permanent filler) can be a good choice. From the standpoint of your wedding, fillers also have the convenience of little to no downtime and the temporary fillers are completely reversible with hyaluronidase if the patient didn't like it. So it's very forgiving in that respect.

	All the best,

	--DCP

	Pearson Facial Plastic Surgery®

Nelson Lee Novick, MD · Answer

Nonsurgical Rhinoplasty using volumizing filers works well in properly selected cases of drooping nasal tips and other irregularities of this region (as well as other areas of the nose). A number of different injectables have been used for this purpose. My favorite for this particular purpose is Perlane L, which is a hyaluronic acid based product mixed with lidocaine to reduce treatment discomfort, which is important when injecting the nose, an especially sensitive region. 

	Perlane L is known for its excellent lifting capacity. Results with this agent tend to last somewhat longer than with its sister product, Restylane, making it my choice for this region. In experienced hands, treatment should take only about five minutes to complete.

David C. Mabrie, MD · Answer

Looking at your photos, you are a good candidate for non-surgical rhinoplasty using fillers. 

	
		I would recommend restylane as it is soft but gives very predictable lifting.  It is also immediately reversible if needed. 
	
		The effects last a year, with most patients getting touch-ups at 6 month intervals.


	Overtime, the skin starts to mold to it's new shape and with collagen synthesis, the results begin to last longer and longer.

Minas Constantinides, MD · Answer

Thanks for submitting your photos. They are really helpful. What you are seeing is probably a concavity in the underlying cartilage of the tip on your right side. Nasal decongestants will not do this. There are two options, one surgical and the other non-surgical. The surgical option is to have a limited procedure that will premanently fill in the depression on you tip with cartilage taken from your nasal septum (inside your nose). This procedure will create swelling that will last for several months, but if you hurry you can still look great in your wedding photos. The non-surgical option is to try to fill the depression with an injectable filler. The problem is that it may not work since the tip usually is difficult to fill. However, it may be worth a try. If it works, it will last for about one year, long enough for your wedding photos! If it doesn't you can still have surgery. Finally, if all else fails, a make-up artist can temporarily fill in the depression so that you will still look good in your pictures. Good luck! Minas Constantinides, MD

Nose Cartilage Fallen? (photo)

Answers (4)