I have thick skin and am worried about deformities from a Bilateral Cephalic Trim - Is it a good next step? (photos)

Thank you for your question. Tip refinement, especially with thick skin, is a challenge. While cephalic trimming is indeed one maneuver that can help, one must be careful to avoid over resection, as this can lead to collapse of the cartilage when breathing in. Sometimes a bulbous tip is caused by the orientation of the cartilages themselves, and instead of making them smaller, a solution may entail reorienting them. Ultimately form and function both come into play, and the technique used will depend on your anatomy as well as surgeon preference. I hope this information is helpful to you, and all the best.

It would probably not help to only do cephalic trims. Your lower cartilage is quite curved and techniques are needed to make the curves straighter. That will allow your skin to tighten over the cartilage better. You will always have a somewhat bigger nose, but an experienced rhinoplasty surgeon should be able to make an improvement.

Based on your photos, you may be having inflammation that's causing your tip to swell. You demonstrate a less swollen nose after a steroid injection. That said, it may be worth continuing a trial of dilute steroid injections to your supratip area. Ask your surgeon if he used any permanent suture material during your rhinoplasty. Occasionally these may be a source of inflammation. Please keep revision as a last resort. Thank you. Dr Joseph