Visible Cartilage Graft Bump on Nasal Tip - What to Do? (photo)

I underwent my 3rd revision about 6 years ago and have noticed a small round bump at the tip of my nose. I had ear cartilage shield graft to the tip for projection and also a columella strut graft. Is this bump from cartilage or could it be possible scar tissue? My nose otherwise is fine and I am happy with the results. However, the bump does bother me quite a bit as it looks like a pimple or blister of some sort on the tip of my nose. Can the bump become more visible if I leave it alone?

Doctor Answers 6

Nasal Tip Revision

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Your tip abnormality is most likely caused by the tip graft that was placed in your prior surgery.  As stated in a prior answer, this is caused by the shrink wrap effect  of the nasal skin and soft tissue contracting tightly on the cartilage graft.  You probably have thin nasal skin as well.  This is something that needs to be evaluated and recognized preoperatively, and certain measures need to be taken if cartilage grafts are to be used with thin nasal skin.  If you do in fact display thin skin I would suggest first shaving the edges of the graft and then camouflaging the graft further with a temporalis fascia overlay graft.  This fascia will help to give the graft edges a softer look.  Good Luck

Philadelphia Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

This Is a Good Example of Shrink Wrappage

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After a rhinoplasty, the skin continues to shrink down and onto the underlying bony/cartilaginous framework.  It continues to happen years after the surgery and it is called the shrink wrappage effect.  It is this effect that has caused the visibility of the graft of the tip.  In your situation, you will need the edges smoothed, and I would also add material to slightly thicken your skin to prevent this from happening in the future.  I would use temporalis fascia to place over the graft to slightly thicken the skin.  


I hope this helps.  

Cartilage graft visible

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The ridge you see is most likely from your cartilage graft which potentially can be shaved down under anesthesia.

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

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Visible Nasal Tip Graft

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I would agree that at six years postoperatively you are not going to see any significant change in the appearance of the tip.  You will need a revision in order to shave down the lump that bothers you. 

Michael Sundine, MD
Orange County Plastic Surgeon

Cartilage Graft Bump on Tip

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After 6 years this bump will not get better but may become more obvious with time. As best I can tell from the picture you submitted it is probably an edge of the tip graft which can be trimmed with a minor revision under local anesthesia.

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

Cartilage Tip Graft

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   This is probably the graft.  There are other ways to improve tip projection than by placing an onlay graft.  The graft can be removed and tip projection improved.  Find the plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties each year.  Kenneth Hughes, MD Los Angeles, CA

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.