Thick skin nose: how can revision rhinoplasty make nose balanced & tip more defined? (Photos)

Hello and thank you for your question. I am sorry to hear you are so unhappy after your prior revision surgery, I truly empathize with you, as no one should feel uncomfortable in their own skin. First, it is super important to remember that after rhinoplasty (nasal surgery), the nose can become REALLY swollen, particularly around the tip, and this swelling can take a LONG TIME to resolve (up to 2 years to fully resolve). I would recommend that you continue to observe things for now. Steroid injections can help with the swelling in some areas, such as the supratip. You are still only 8 months post-op, so ultimately you should still wait to see what your final results will be. I constantly remind all my rhinoplasty patients how important it is to be patient after rhinoplasty surgery as it can take up to 2 years to see what the final nose will look like. I would not advise you to consider a revision operation prior to that time, so everything can be evaluated once all the swelling has completely resolved. I hope this helps!
Best Wishes,
Dr. Donald Groves
Plastic Surgeon

You may have thick skin but in your photographs it shows that your nasal columella angle is quite poor, less than 90 degrees. Your nose needs to be shortened even more and your tip needs to be rolled up higher. It is possible to defat the tip to look thinner. So improvements can be made.

Best Wishes,

Gary Horndeski, M.D.

It's not clear-cut from these photos that you have particularly thick skin. In my revision experience, inadequate elevation of the tip is almost always due to inadequate modification of the tip cartilages, and cannot be pinned on thick skin. That's quite rare. So it's completely reasonable for you to be seeking a revision based on your results.
How *much* to elevate the tip, or narrow the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.