How Can I Get Rid Of These Indents On My Nose After My Rhinoplasty?

Q: Four years ago I had a rhinoplasty for a tip deformity. After the surgery my nose looked extremely nice and I was receiving excellent comments. However, about one year later a dimple appeared on the tip of my nose. I asked my plastic surgeon about it and he referred me to a dermatologist.  I have spent a year going from one dermatologist to another and no one was able to help me. One of the dermatologists took a biopsy but the biopsy revealed nothing. After being exhausted I went back to my plastic surgeon  and he diagnosed that the cause of this dimple may be some stitches that did not go away after the surgery. He operated on my nose again and told me after the surgery that his diagnosis was correct and he removed all the stitches from my nose. However, the dimple was not removed. He asked me to be patient. I went to him several weeks later as my situation didn’t change so he did a minor surgery in his clinic and again with no success.  I then went to another plastic surgeon who was able to remove the dimple and he said there was some white cheesy stuff behind it that he completely removed. However the surgery resulted a scar in my nose. What do I do now?

A: Your rhinoplasty problem is rare but not unheard of. Your explanation of the events is perfectly understandable and it paints a very clear picture to me. Undoubtably what has happened are sutures reactions to internal sutures used to reshape the nose cartilages. This is common practice. I use dissolveable sutures for this purpose but other surgeons do not always do so. While rare, they can cause a delayed inflammatory reaction which is the initial culprit in your case. Now because of the biopsy and subsequent excision, there is an indented scar.

This leaves two options for treatment. First, and it sounds like you have already done it, is to try and excise the indentation to get a more level scar. Unfortunately, that frequently fails on that part of the nose. (tip) If that has not been done, I would try that first because the worst thing that can happen is that it ends up where it started. The alternative approach is to build up the indentation from underneath using a dermal graft. The graft can come previously prepared from allogeneic dermis or can be harvested from the back of your ear.
It will likely require several small procedures to get the best result.
Indianapolis, Indiana