Paul Mittermiller, MD

Is there a reason you want to remove the cartilage graft? The tip graft is likely adding additional projection and shape to the tip of your nose. If the tip graft is removed, you would likely require at least reshaping of the nasal cartilage in order to obtain your desired result.

Setting back and contouring your forehead brow bone would open your eyes up a bit and make them look brighter and more feminine. There are other procedures you can consider, but I think this would provide the most feminizing effect for you.

Have you considered injecting filler into the area of depression to improve the contour? It would not make the skin texture to appear better, but it would improve the contour.

Bone erosion does not typically occur with a sliding genioplasty. It occurs most commonly from chin implants such as those made from silicone. On the contrary, after a sliding genioplasty, bone forms in and around the cut(s), which helps with smoothening the contours.

Shaving the chin can be safe if there is a moderate decrease in the size of the chin. It can be accessed through the mouth and would require resuspending the muscles. When performed properly, this is a safe procedure. If you need a significant decrease in the size of the chin, it may be safer to perform an osseous genioplasty. The correct procedure will also depend on which dimensions you want to reduce the chin (vertical, horizontal, etc.).

If the scar is tethered to deeper tissue, a surgeon could attempt to release the tethering using a needle and fat graft the area. If there is no tethering, you could simply try a small amount of fat grafting or filler to the area.

Scars over the shoulders are difficult to prevent from widening over time because there is usually a large amount of movement and tension in the area. Depending on how the scar appears, you could consider re-excising the scar and then trying to offload tension on the area afterwards with taping or silicone strips. You may still get widening over time though.

The scar does look rather wide and could be made smaller with a revision. If there is firmness underneath the skin, that could possibly be removed as well. It depends on how large that area of firmness is. A new scar would likely be longer than the current scar, but it would be narrower and likely less noticeable.

It is possible to bring your forehead back further and reduce the projection of your nasal radix. Although this won't be addressing the typical brow "bossing", it will help to reduce the hooding over your eyes. This will open the eyes up and allow more light to reach your eyes, which will provide a more feminine appearance. A rhinoplasty would then be required to balance out the nose with the forehead. The upper part of your forehead can be rounded out slightly to help the forehead appear less vertical. Whether you need a type 3 cranioplasty depends on the anatomy of your skull and frontal sinuses. A CT scan helps to determine which type of forehead reduction procedure is best for you.

The options for revision depend a bit on how extreme the problems are and when the operation was performed. If the operation was performed fairly recently (within the past few months), you will want to wait since there is likely residual swelling. Also, some of the fat may not survive and the areas will get smaller on their own. If there is a huge amount of excess fat, liposuction to certain areas could be considered.