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Steven M. Denenberg, M.D.
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One of the advantages of using an artificial material to build up the nose (as I did here) is its easy availability: just unwrap the package.  Many plastic surgeons like to use the patient's own cartilage to augment a nose like this.  Frequently, however, a nose that has been injured has broken and injured cartilage inside, which might make that cartilage unavailable for the task of augmenting the nose.


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current: Left oblique

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Next: an example of the solid advice Dr. Denenberg gives patients on RealSelf.com.
Get that advice for your own situation by emailing your photos to Dr. Denenberg.

Questioner: What Can Be Done to the Tip of my Nose for Revision?
I feel like it still looks droopy and it sticks out and looks meaty on the tip! The part that's under the tip seems to be too meaty looking. I did a photoshop version myself to show what i mean by wanting fixed. Can this be done? How?
(Questioner submitted photos)

Dr. Denenberg's answer: Another maximum attempt at raising and narrowing your tip
Hi. It seems that the attempt at raising and narrowing your tip didn't work, or it didn't work well enough. The way I see your nose, it requires the very best effort at raising and narrowing that tip. See my "Web reference" link for a morph I made of your nose. There can be two main factors in your drooping tip. One, the cartilage might still be in a position to keep the tip of your nose wide and drooping. That would be good, because modifying the tip cartilages to raise and narrow the tip is one of the more predictable changes that can be made in a revision rhinoplasty. It would not be unusual for this to be the case, because raising the tip involves complicated work on the tip of the nose, something not every plastic surgeon can do. So perhaps your surgeon left the cartilages in a long, wide position, and another operation, addressing those cartilages better, can get you closer to your goal.

The other factor can be scar tissue: perhaps lots of scar tissue is making your tip look long and wide. The scar tissue can be addressed, by removing all that can be removed, but it's generally less predictable than working on cartilage.

When selecting a surgeon, you must be certain to look at his before and after revision rhinoplasty photos, to see if he has been able to make these kind of changes for his other patients. That's the only way you can reasonably research your doctor.

Link to this question on RealSelf.com