Dr. Sam Lam Plastic Surgery Forum

I have a drooping nose and a wider tip due to a aging nose. I've read that the cause of a aging nose is due to a lack of support of the lower lateral cartilage. If I resolve the drooping nose and the wider tip through a rhinoplasty, is it wise to place a graft in the tip to prevent a further aging tip?

If not, what could be other solutions?

hi,
the aging of the nose is a consequence of many factors including weakness in the lower lateral cartilages as well as weakness in the interconnection between all of the cartilages and also weakness of the bones and cartilages besides the LLC's. with a rhinoplasty to correct aging of the nose and FOR ALL rhinoplasties you should add extra support to the tip because the tip loses strength after a rhinoplasty and needs that support or it will drop naturally. hope that helps.
best,
sml

Dear Dr. Lam,

And how could you add extra support to the tip? With grafts or other aspects?

Kind regards,
Cindarella

yes, with a graft called a columellar strut as well as potentially sutures like a dome-binding suture. i typically overcorrect a bit to allow for the tip to sink back a little over time.
best,
sml

Okay, thanks for your answer doctor. With placing a graft, is there a increasing probability of scar tissue development in the tip?

Kind regards,
Cindarella

dr. lam wrote:yes, with a graft called a columellar strut as well as potentially sutures like a dome-binding suture. i typically overcorrect a bit to allow for the tip to sink back a little over time.
best,
sml

well, yes but that is a good thing. scar is what holds tissues in place and provides structure. if you are talking about on the surface of the skin, of course no since it is below the skin that the operation is occurring. if you are talking about under the skin in an excess form that could lead to a bulbous tip that would have very little to do with the placement of a graft but the nature of your nasal skin with the thicker the skin being required for longer periods of taping so that the skin sits on the new framework without scar developing between the two. i tape everyone but i tape for longer periods of 3 to 4 months for those with thick skin like Asians, Hispanics, and African skins and of course some Caucasians depending on what i see.
best,
sml

Okay, so in order to prevent a bulbous tip you tape the nose for a longer period. That sounds good. Do you also resect cartilage in the tip for patients with a thick skin? Or is only suturing sufficient?

Regards,
Cindarella

it depends. when i need to i do resect cartilage but it is less common than in thinner skinned patients. the reason is that if the framework (cartilage) is overly reduced the thick skin will not sit as well on the new reduced framework that may lead to more bulbosity. that is why taping is so important.

I understand, thanks doctor for the answers.

One question remaining, provides placing a alar batten graft or a lateral crural strut graft a wider tip?

if you are asking if these grafts would widen the tip, the answer is yes they can. i would have to see your tip to get a better read on that possibility.
best,
sml

I had a rhino a couple years ago and I had grafts like you're discussing here. Dr. Lam, have you ever seen grafts that become visible? I didn't notice this until a short while ago. I was coming home from skiing, and I thought my nose looked funny because it was so cold. Later, the color was still there and remains there. It is a slight yellow showing through the tip. I know you don't like to talk about work you didn't do (this was another doc), but have you seen something like this? What can I do?

Thanks,
Creta

yes, that is possible. that is why i only put external grafts in thick skinned asians or africans (ethnic noses) that would be suitable for that. if it is not very perceptible some injectables to cover the graft may be a good thing. if that does not fix it then the graft would have to be removed but that may risk changing the tip in an unfavorable way. you have to way the pros and cons with a physician who is examining you to determine the best course of action.
best,
sml

Thanks Dr. Lam. If I may impose on you with one more (graft related) question? I have some kind of graft under the columella. Would this possibly be why my nose snaps out of place when I laugh hard? If I laugh big, or smile big, it'll often move out of place, akin to popping a knuckle. I have to gently right it, pressing it back into place. Have you heard of something like this? (On the bright side, I miss my manual transmission and now I have a manual nose.)

Thanks.

yes, that is a columellar strut. that can happen. that is why my struts are slightly shorter so that should not happen. but in any case that is what you have.