The ear cartilage at my nasal tip was showing through in a round shape, so I visited about seven clinics for removal consultations. They seemed to have three approaches: 1. Revision using autologous costal cartilage (or donor rib cartilage) — I did not want such a major surgery, so I quickly left places that suggested this. 2. Trim the nasal tip cartilage and cover it with artificial dermis — this was the opinion of several clinics, including the one that performed my first surgery and revision (A/S). But they said it could recur, presumably because the remaining cartilage might protrude again. 3. Remove all the nasal tip cartilage and cover it with artificial or autologous dermis — the suggestion was to leave the supporting structure and remove only the protruding nasal tip cartilage. Most recommended artificial dermis, while only one slightly favored autologous dermis. They said that if too much artificial dermis remains after absorption, it can become lumpy. They recommended autologous dermis if I dislike that, but I am also worried that too much autologous dermis might be absorbed, causing the area up to the support to sink and the nasal tip to split (the commonly mentioned “butt nose”). I also considered the possibility of additional problems, such as a butt nose or the tip dropping too severely. They said that if the previous surgery used autologous dermis, additional reinforcement with autologous dermis would be possible and it would not be a major surgery, whereas if artificial dermis had been used, additional reinforcement would be complicated. I have already decided on complete removal of the nasal tip cartilage, but I am struggling so much over which type of dermis to use. How should I approach this? I am prepared to accept some degree of tip drooping. My purpose for a second revision is to minimize any further contour or protrusion at the nasal tip.
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