Weird sharp edges at my tip are a twisting shield graft? My radix was made taller with bone drilling or diced cartilage (Photo)

Question

how hard is it to take out the shield graft and just get a soft feminine tip, how hard is it to reverse the heightening of my radix which was done with bone drilling or diced cartilage wrapped in fascia, not sure which technique was used. the last picture is my old nose with a nice soft tip and lower radix, i just want my old nose back

Gianfranco Frojo, MD · Answer

I would recommend a revision tip rhinoplasty. The edges of the shield graft are not camouflaged properly (if this is truly in fact a shield graft).

Steven M. Denenberg, MD · Answer

I think you've diagnosed the problem accurately: the tip graft has pointed sharp edges, and that's what's giving the tip of your nose the unnatural appearance. In these posted photos, the radix doesn't look all that high, probably because the tip is so over-projected. At the same time as softening the tip, the tip should be brought back closer to the face, and then, as you predicted, it would be important to evaluate the height of the radix.
The good new is that, in expert hands, these changes are some of the more predictable to make, even in a revision.

Ruslan Zhuravsky, DO · Answer

Hello, Revision rhinoplasty is a complicated and difficult surgery, but it is possible to remove grafts and restructure the nose into a more feminine / softer / smoother appearance as you mentioned. Revisions are more difficult primarily because we have to deal with with scar tissue, altered anatomy, and in most cases damaged cartilage. Difficult and complicated does not mean that it can't be done, it just requires a very high level of expertise specifically in revision rhinoplasty surgery. In your case, yes, the grafts should be removed. However, we must then see what cartilage remains and how can we shape it to create the desired structure. The first steps should be to have a few consults with reputable and experience rhinoplasty surgeons. Discuss your specific case in regards to the desired results, what it might take to achieve those results, and realistic expectations. I find that computer morphing software is extremely helpful in this process for communication purposes as well as to get an idea of how the nose will fit the face. An operative report from your prior surgery will be very helpful to have during these consultations. Good luck!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you are a great candidate for a Revision Rhinoplasty.  Maneuvers for your surgery would include Nasal Tip deprojection and placement of a mastoid fascia tip graft to smooth your tip, among other maneuvers.  With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Weird sharp edges at my tip are a twisting shield graft? My radix was made taller with bone drilling or diced cartilage (Photo)

Answers (4)

Answer: Revision rhinoplasty

Answer: Revision rhinoplasty

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Everything you need to know about Revision Rhinoplasty

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Weird sharp edges at my tip are a twisting shield graft? My radix was made taller with bone drilling or diced cartilage (Photo)

Answers (4)

Answer: Revision rhinoplasty

Answer: Revision rhinoplasty

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.