A simple subcutaneous lesion such as an epidermoid cyst can present a challenge when located in the nasal tip, as regards aesthetic surgical management. Even when performed parallel to relaxed skin tension lines, a direct transcutaneous incision (commonly used for epidermoid cyst removal) distorts the nasal tip subunit, resulting in a conspicuous, disfiguring scar. This should be avoided, especially in children.
A 13-year-old girl was referred by her dermatologist for diagnosis and treatment of a slowly progressive dermoid cyst located on the tip of her nose. The cyst was removed using a subcutaneous open rhinoplasty approach, leaving the aesthetic nasal tip subunit intact.
For aesthetic reasons, open rhinoplasty should be considered as a treatment option in patients with subcutaneous lesions in the nasal tip.