I had my first surgery in the 1990s. I felt like something was slightly sticking out at the nasal tip, so I removed the silicone, added autologous fat, and only reinserted silicone because my bridge was too flat. For the past 3 months, there has been pigmentation at the nasal tip, and a thin line has gradually formed from the tip toward the bridge, so now I am looking into removal because I am older and worried that revision could cause more side effects again.
Among the big 3 clinics here: 1. [Clinic A] said during consultation they would remove it, reposition the cartilage, remove the capsule, and if possible place AlloDerm; if I did not want it, they did not have to place it. Non-open surgery is possible. 2. [Clinic B] I went today, and they said because contracture is present, they have to do an open procedure and place a septal strut. I said I wanted non-open because I have keloid-prone skin, and they said they could do that, but even if they remove the capsule and reposition the cartilage, the nose will still rise, so if I accept that and want to proceed, they can do it. If the bridge becomes uneven during removal, they may shave the sides a little.
But the problem is that the side effects keep happening at the nasal tip, so this time I want everything removed. If a nose with contracture is fully removed, does it rise a lot? They said it could still rise even with a septal strut, so then I would have to do it again, and that would mean having an open procedure twice. I am thinking maybe I should just do complete removal non-open first, and if it rises too much, then do the septal strut with an open procedure later, but I do not know what to do. I avoided revision because I did not like the open procedure in the first place,. If I just remove everything, will it rise a lot?