Visible Graft Showing Through Thin Skin? (photo)

Through an endonasal approach ("closed" where all the incisions are inside your nose) it is possible to remove the offending graft.  As you touched on in your question, fascia works wonderfully as a camouflage graft to smooth contour irregularities in areas of thinned skin.  An alternative is cadaveric dermis, such as Alloderm or hMatrix which also provide a soft, pliable layer of camouflage which becomes fully integrated into your nose.  

    The grafts can be pulverized, thinned, camouflaged, or removed.  My usual sequence is to remove them first and determine the status of the underlying cartilage and bone.   From there, this can usually be altered to avoid the use of grafts.  Kenneth Hughes, MD Los Angeles, CA

Thank you for your question and photos.  Graft visibility after rhinoplasty is a potential complication. If it is not painful or threatening the skin, it can be shaved with a needle in some cases or camouflaged with fillers. The use of fascia or dermis at the time of surgery helps to camouflage cartilage in thin skinned patients. In your case it sounds like the graft is causing pain and threatening the skin.  In this situation, removal of the graft through an open rhinoplasty approach would be the best option. This would allow for correciton of any further contour irregularity. Hope this helps. Best wishes.

from the limited photographs that are available it is apparent that there is a subluxation, dislocation, ofa spreader grafts that may have been placed to straighten the nose and secure the middle vault.  You also have very thin nasal skin which reveals any irregularities beneath the skin.  Then the skin can also become hypervascular after a rhinoplasty creating the redness over the nasal dorsum.  There also appears to be a parenthesis deformity which is an indentation between the tip and the sidewall of the nostril.  The least invasive and most limited approach would be to have a nonsurgical rhinoplasty with injectable fillers.  The skin had an adequate amount of softening over the nasal skin to reduce the visible irregularities.  This could be done with intense pulse light to reduce the dilated vessels over the nasal dorsum.  This would be a more temporary improvement.  The other option is to again perform a revision rhinoplasty directly trimming the irregular pieces of cartilage and thickening the skin with the placement of temporalis fascia.  This may not relieve the redness over the nasal dorsum and intense pulsed light me still be necessary. I would recommend you see a facial plastic surgeon with a great deal of experience with revision rhinoplasty.

Hi there, thank you for your photos. The grafts can be removed during a Revision rhinoplasty. Depending on the set aesthetic and functional goals they can be refined and replaced, or other surgical manoeuvres need to be introduced to give you smoother contours. 
Good luck!

First, see a surgeon who is experienced in this type of surgery - in fact, see more than one. However, even in the best of hands, results cannot be guaranteed - but there is a higher likelihood of success. The existing grafts can be modified, reshaped an replaced and other tissues may be used to soften the results, such as fascia. For the depression along the left side of the bridge a non-surgical option would be the placement of a small amount of dermal filler, such as Juvederm of Radiesse. Although temporary, it is a minimally invasive and relatively predictable treatment. Best of Luck  Dr Harrell

The grafts can be removed or shaved down and camouflaged with fascia or alloderm.  Best to be seen in person.

The grafts can be removed and replaced with fascia or the thickness can be reduced, eliminating the sharp edges which you can see. Consult with a surgeon who specializes in revision rhinoplasty.