How Can The Crater On My Nose Be Removed?

Q: Dr. Eppley, have a little crater on the outsite skin on the top of my nose. I tried filler, excision, laser and dermabrasion. Nothing helps. The crater is 2/3 millimeter deep. Now a doctor in Switzerland want to put a little piece of cartilage under the skin to lift the crater. But I have no confidence because they all have no experience in this case. Can you help me? It’s no problem for me to visit you because I love your country….

A: It is hard to comment on such a nasal defect without seeing a picture of it and knowing where in the nose it is located. The key question is whether this defect is located to just within the skin (dermal indentation) or whether it is located in the subcutaneous tissues between the skin and the underlying bone/cartilage. Only a subcutaneous defect will be positively affected by any implant placed

underneath the skin as this will push out the overly skin indentation. If, however, the indentation is a result of dermal thinning (which I suspect may be the case) then no implant under the skin will help as it will just make a bump appear with the skin indentation merely pushed outward….actually making it look worse. Dermal skin indentations, which are common in the nose, are virtually impossible to improve as you can’t smooth down the surrounding skin and there is no way to make the dermis thicker. In rare cases, it may be possible to place an allogeneic dermal graft directly on the underside of the dermis but even this approach does not assure elimination of the skin crater. This type of nasal scar is very difficult to improve regardless of the method of scar revision that is tried.

Dr. Barry Eppley