In general, patients with thick skin are not always able to achieve the level of definition they desire. However, improvements can still be made. An exam would really be necessary to provide you with the best advice. I would recommend seeking the advice of a board certified revision rhinoplasty specialist. He/she may use computer imaging software to morph a photo of you, which will give you an idea of how the final result may appear. I hope this helps, and I wish you the best of luck.
I do not use cartilage grafts unless necessary for structure, because it creates just the issue you have brought to light. I would remove the grafts unless necessary for overall height of the tip or the dorsum. The tip can then be refined through other methods.
Kenneth Hughes, MD
Los Angeles, CA
Dear Kiyomi, thank you for your question.Revision rhinoplasty is a complex procedure
that requires experience and skill, and is a focus of our San Diego practice. Look for an experienced board certified
Facial Plastic Surgeon who can demonstrate excellent results. Good Luck!
It is very important to have realistic expectations regarding thick skin and revision rhinoplasty. The thick skin will be an impediment to seeing a very fine result in the tip. Also important to bring your surgical op notes from your previous surgery to your new perspective surgeons, so they can review what was performed in the first surgery. For many examples of rhinoplasty, please see the link below
It is certainly possible to reduce a bulbous tip, but it is essential to be evaluated in person to examine you and see what can be done.
It is possible to make a bulbous tip smaller. It is difficult to say what has happened in your case without examining your nose or looking at some photographs, but it is possible that you have some scar tissue that has formed in the tip. Some times, the judicious use of injected steroids over a period of months will diminish the scar and significantly improve the result. Other times, a revision surgery is required to reshape the tip, remove some of the scar and improve the size and shape of the tip.