I have a bulbous nose, thick skin, and small nostrils. Can I get a more straightened, refined, sharp nose with grafts? (Photo)

Rhinoplasty for boxed tip and thick skin can be done with refinement of the tip and excision of subcutaneous tissue. See an experienced rhinoplasty surgeon. 

The tip can be refined through cartilage removal, suture techniques, and soft tissue thinning in most cases.  Evaluate before and after pictures and reviews to select your surgeon.Kenneth Hughes, MDLos Angeles, CA

Dear Chopra82;



The
photos are very helpful. Whether or not
it is appropriate to have a “sharp nose through grafts” is something to
consider. Your nose can be improved with
standard techniques. Without feeling the
cartilage and evaluating the skin, it would be unwise to make a specific
recommendation if you need grafts or not. However, the most important thing is to have
consultations with surgeons who specialize in nasal cosmetic surgery. You should have computer imaging.Computer imaging, uploads an existing picture of the patient into a
computer. Then, the surgeon and an artist sit down and work up a predicted picture
of what you most likely will look like after surgery and healing. (The
technology is also known as computer
morphing.) The final, healed patient picture is included so the three-picture
panel is known as a triptych. In many
cases, the actual after surgery, healed results look better than the predicted
picture. Look for a practice that offers that service; it’s the best way to get
a glimpse into the surgeon’s mind of what he or she is thinking about the
changes that can be made to your appearance.

From the
profile, and this may be an inaccurate observation because of the pose, but it
looks like you have a significantly receding chin. Remember, the chin is an important part of
the profile, right up there with the nose, so when you go for consultation, you
may want to raise that issue, if that is something that interests you. 

Regarding general reconfiguration of the nose: the surgeon must take
into account the strength and shape of the cartilage and
thickness of the skin. It is important
that all elements be taken into account because they all have a bearing on the
outcome. Not every operation requires
tip grafts. As a matter of fact, often
it is a combination of both surgical and non-surgical techniques that wins the
day for patients.There is a value to
fillers.Remember that one nice thing about fillers is
that they represent the “extra tool in the toolbox” such that after the
surgical result has become pretty well settled in at six months or so, then you
make a decision whether or not you wish to consider fillers to help put the
“frosting on the cake,” and then, of course, you would be wise to have that
saline demo so you can see the results of the outcome.



Finding a good cosmetic plastic surgeon starts with a
computer search of surgeons in your (or distant) areas. Best results come from
super-specialists (a medical, not an
advertising term) who do the procedure you want at least weekly and have done
it for at least a decade.
Once you narrow in on the website of a surgeon who looks
good to you, focus on the before and after pictures, looking for patients who
have had the procedure you want. There should be dozens and dozens of such
photos.
Many good, plain language booksabout cosmetic plastic
surgery are on Amazon.com or Barnes&Noble.com.

As you read, write down questions that can be asked later in
consultation with a surgeon. My two books (listed below) are designed to help
with all the nuts and bolts of cosmetic plastic surgery consultations and
questions about before and after surgery matters.Best regards,



Robert
Kotler, MD, FACS

The bulbous tip is approached through an open-rhinoplasty approach with reductions of the alar cartilages and then inter-crural buried permanent sutures to bring a better angularity to the tip. I wouldn't use a cartilage implant. I would carefully also try to reduce the fibrosebaceous thickness of the tip, but a thick tipped nose is a challenge and your expectations should be of improvement.

There are a number of ways to improve the definition of a nose with thick skin and bulbous tip.  Among them are the use of cartilage grafts to improve cartilage projection, refinement of the cartilages which you already have in place, thinning of the soft tissue envelope, etc.  I would recommend you consult with an experience plastic surgeon who offers Vectra 3D Imaging so that you may visualize what your nose could look like with various versions of the rhinoplasty procedure.