What is the best way to add projection to a nose that was reprojected in rhinoplasty? Patient has thin skin.

A variety of tip suturing techniques, manipulation of the different segments of the lower lateral cartilage via maneuvers such as “steal” or “overlay”, and finally application of tongue in groove technique +/-  caudal septal extension graft, the latter being amongst the more versatile and advanced techniques to manipulate the tip projection can all achieve more projection of the tip without the use of grafts. However, as you appropriately mentioned, it will be impossible to comment on the proper tip projection options without taking the rest of the nose and it’s characteristics into the consideration.

 The most common way that I add retraction to the nose is to first establish good midline support of the caudal septa. This is sometimes done with just the septum alone or, more commonly, with a caudal septal extension graft. The tip cartilages are than projected along this midline support of cartilage. This allows for a natural and stable result.  If further projection is needed, then gently crushed cartilage grafts and sometimes even fascia or perichondrium is used to add further projection. 

In all honesty there are a variety of methods to do this and there is probably no absolute best way.  There are many very experienced, very good rhinoplasty surgeons that would approach this problem using different techniques. Your question is a good one.  Having thin skin does make it more likely that you could see what was done to add projection to the tip.  Because of this, no matter what is done you have to be very careful to do things carefully, camouflage them well, and have smooth edges to everything that was done.   I would suggest you schedule a consultation with several experienced rhinoplasty surgeons in your area and pay attention to before and after pictures of their patients who have had similar concerns. The key is picking the right surgeon and then letting them do what they think Is the best technique for your particular problem. Good luck.