Q: Dr. Eppley, I am interested in some type of revisional rhinoplasty. I had a major depression on the tip of my nose for which I got fat grafted to the tip. But now I feel I have a bigger nose than before and the tip doesn’t really have any definition. What should I do now?
A: With fat grafting to the nose that kind of result would be expected given that a ‘blob of tissue (fat graft) was done. Fat grafts fill space and provide no definition as it is an amorphous graft filler. Why was this method chosen as opposed to fixing the tip depression by cartilage reshaping methods which can fix the depression and give the tip more definition?
Generally major depressions on the tip of the nose that have been present since birth are known as a bifid nasal tip. This is where the natural separation of the meeting of the lower alar cartilages (known as the dome of the nose) are too widely separated and this separation extends down into the medial footplates. (over the columella) This creates a groove or visible split down through the tip of the nose. This is repaired by cartilage suture techniques that bring the widely splayed cartilages together.
What can be done for your nose now is to remove the fat graft and repair the depression with either cartilage suture shaping techniques or crushed cartilage grafts for your revisional rhinoplasty.
Dr. Barry Eppley