What can be done to eliminate any cartilage that is prominent? Would revision be best? (Photos)

A ridge like that *could* be scar tissue, but scar underneath the skin would only rarely cause such a distinct shelf like that. I'd have to see the operation report, but it's more likely to be a piece of cartilage that was grafted into that position, and you're seeing the mass of the cartilage through the skin. Softening that shelf would entail getting inside the nose, confirming what's going on, and I'll just be that the graft can be significantly thinned, or even removed, without damaging anything about the shape of your nose.
If you decide to have something done, I'd recommend evaluating the rest of your nose, too. You mentioned that one of the goals of your operation was a tip lift, but, respectfully, the tip still seems a bit low to me. *If* you had the preference to have the tip higher, that would be important for you to know before having more surgery, because *how* that ridge/graft is handled during the operation depends heavily on whether one of the goals of the operation is to further elevate your tip.

How *much* to further elevate the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that revision rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery.

I believe you were seeing these irregularities 3 years after your surgery because you have relatively thin nasal skin which tends to show edges of underlying cartilage grafts, or altered nasal tip cartilages. In our experience, microdroplet Silikon-1000 injections may be a welcome alternative to revisional surgery to camouflage these edges of cartilage for a less operated nasal tip appearance. I hope this helps!

The causes of your problem are unclear, it is hard to believe this issue was not present at earlier stages; rare explanations for a late onset might me:
-grafting applied was not secured with suturing, so a late dislogement has happened
-grating became necrotic overtime due to any internal medicine disease or due to extreme cold (weather)
-grafting is not actually yours (conspiracy theory but do not rule it out) but from artificial material
-something was forgotten inside and now a granuloma is trying to expell it

In any case you are bound to a full revision of at least the lower 40% of the nose (bridge could be better too, but not a bad one for your face), soft tissues, under general anesthesia and under the hands of a surgeon with real experience in revision rhinoplasties and atypical cases.

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include placement of a mastoid fascia tip graft to provide a smoother tip contour nasal tip deprojection, tip elevation, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon