Is a tip lift via filler possible if I have a columellar strut graft from previous surgical rhinoplasty? (Photo)

Question

Hi! I had surgical rhinoplasty a couple of years ago to partly address my pointy tip. Unfortunately, after healing, my tip appears pointier. Is it possible to achieve a lifted tip with filler if I have a graft there that makes the tip relatively inflexible and hard to manipulate? Ideally, I’d like to go from left pic to edited right pic

Steven M. Denenberg, MD · Answer

What you drew, as you said, is an elevation of the tip. Filler isn't anti-gravity, and it can't pull things upward. Putting filler below the droop would make the droop droopier, and putting filler above the droop would make a bulge above the droop.

Getting the tip elevated would entail going under the skin to see where the graft is, find out what it's doing to hold the tip down, and make modifications to all that.

Donald Groves, MD · Answer

Hello and thank you for your question and the pictures. Unfortunately no, you actually have a VERY difficult problem to fix. Your tip issue after a prior rhinoplasty is due to the initial surgery and subsequent healing/scarring process. What you're describing is a "hanging columella"- where your tip/columella hangs lower than the nostrils. There are certain maneuvers which can be performed during rhinoplasty surgery to prevent this issue and assure all aspects of the nose are balanced at the time of surgery and throughout the healing process- I actually perform these preventative maneuvers in all my rhinoplasty surgeries for this very reason. Filler is NOT able to address your issue for a couple reasons: 1) filler is not strong enough to overpower the extensive scar tissue present after a prior rhinoplasty, and more importantly, 2) your issue requires taking tissue/cartilage away from the columella/tip (instead of adding volume to is). Because of these reasons, you would need a revision rhinoplasty to properly correct your issue and to solidly reinforce the entire underlying framework to assure you get the BEST long term results. Anyone who tells you otherwise is doing you a HUGE disservice!

Revision rhinoplasty is truly a surgery of millimeters- they are the most technically challenging procedures in all of plastic surgery! Because your nose is the DEFINING feature of your face- I would only recommend seeing a surgeon who specializes in revision rhinoplasty procedures, and who has significant training and experience performing these surgeries. I actually trained under one of the world leading revision rhinoplasty experts (who performs 1,000+ nosejobs annually).

I recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with revision rhinoplasties) to thoroughly discuss your surgical goals, undergo a formal examination, evaluate your options, and develop a personalized plan just for you. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Eric M. Joseph, MD · Answer

Based on your photos, I doubt that an injection rhinoplasty procedure would lead to any significant elevation of your nasal tip. I suspect you may need to have your collar strut graft repositioned, or possibly you may require a tip graft. Please consider meeting with several reputable rhinoplasty specialists to see what might be best for you moving forward. Thank you for your question. Sincerely, Dr Joseph

Anna Chacon, MD, FAAD · Answer

It's understandable that you're looking to further refine the results of your rhinoplasty.
Non-surgical rhinoplasty, or a liquid rhinoplasty, using dermal fillers can sometimes be used to subtly change the shape of the nose. However, in your case, given the presence of a graft and the hardness of the tip, this option might be challenging.
Dermal fillers add volume, and in a nose with a pointed tip, adding more volume might not give you the desired effect. It may even make the tip appear more prominent or larger.
Moreover, injecting fillers in a previously operated nose carries risks such as infection, skin necrosis, or even blindness, especially if there is scar tissue or a graft.
A better option might be a revision rhinoplasty, where the surgeon can modify the existing graft or use a different surgical technique to achieve a more lifted tip.
It's important to have a thorough consultation with a board-certified plastic surgeon who specializes in rhinoplasty. They can assess your nose, consider your desired outcome, and discuss the best and safest options for you.
Remember, every surgical or non-surgical procedure carries potential risks and complications, so it's essential to have a clear understanding before making your decision.

Is a tip lift via filler possible if I have a columellar strut graft from previous surgical rhinoplasty? (Photo)

Answers (4)

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