Am I able to get a revision? (Photo)

Question

I got my tip done about three years ago but I feel like there really was no difference. When I went back for a consolation I asked if I could get the tip even more refined and also my nostrils smaller. He said he could do the nostrils but he can't do the tip again because my skin is too thick and he took out as much as he could.Any more and I cold end up with problems he said. I really want my tip more refined I feel it's still to big. Should I seek a second opinion. I have before and after pics

Nima Shemirani, MD · Answer

Hi @Daisypaw! I recommend seeing an expert revision rhinoplasty specialist for an in person examination. There are several options for you that can be determined after examination. Best of luck, Dr. Nima!

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. Based on your photos, you do appear to be a candidate for revision rhinoplasty. I believe your nasal bridge and tip can be narrowed and refined, as well as minimize the flare of your nostrils. It is true, however, that nasal skin thickness may limit what can be achieved surgically. It is best to go for an in-person consultation with a reputable board-certified facial plastic surgeon, particularly one with a strong rhinoplasty portfolio. Such experts will have the optimal skills, knowledge of the most advanced surgical techniques, as well as artistry and knowledge of facial aesthetics, harmony, and proportion, helping you achieve the most natural-looking results. During your consultation, your surgeon will evaluate your nose, determine your eligibility for revision rhinoplasty, recommend the best approach, and ensure the best possible outcome.

Edward J. Gross, MD · Answer

Depending on the time elapsed since surgery, you are a candidate for revision rhinoplasty with tip plasty. Your tip appears amorphous and wide. Tip plasty would help narrow and define your nose. Dr. Gross

Marc Polacco, MD · Answer

Thank you for your question. I would have to know what maneuvers were performed during the first procedure, but most likely further refinement could be achieved, along with reducing alar flare. An in-person exam is the best way to determine what can be performed. I hope this helps, and all the best to you!
-Dr. P

Christian L. Stallworth, MD · Answer

Thanks for your question.  Skin thickness is definitely one of the limiting factors for any rhinoplasty surgeon, but there are ways to counteract this.  Definition is better achieved in a thicker skinned patient with the ADDITION of sharper and more rigid cartilage framework, NOT the progressive removal of underlying the cartilage.  There are also some conservative, yet limited, ways to thin the underlying tissue as well.  I cannot say for certain if these are options for you without an in-person exam.  A second opinion is never a bad idea and it would be helpful to have a copy of your operative report to have an idea of what was done in the previous surgery.  
Best wishes!

Eric M. Joseph, MD · Answer

Based on your photos, there is minimal change in the width of your tip and nostrils. Thick skin can limit results, and the thickness of your skin would require an examination. Consider getting a second opinion from another reputable rhinoplasty specialist. Good luck! Dr Joseph

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Afternoon! If you have thick nasal skin, your ability to get very refined results becomes more limited. But, with careful evaluation, you may be able to obtain improvement. Stretching the nasal skin with strong grafts made of cartilage leads to refining of the tip skin. An open approach is a great way to be precise with graft and suture placement. After the procedure, to condition the skin, I will have my patients tape and undergo steroid injections carefully into the tip. You should seek a second opinion if you want to learn more. Hope this is useful!