Tertiary rhinoplasty and skin quality, is it possible? (Photos)

There are many things that factor into the decision about performing a revision rhinoplasty. While it is not unusual for me to perform tertiary rhinoplasties (or quaternary rhinoplasties), skin viability is of extreme importance, as is patient expectation. It is difficult to judge from your photos and I would also like to know when your surgeries were performed, and what specificially was done -- but there is nothing like being able to examine a patient in person to see and feel your nose to determine what there is to work with.

To begin with, it is sad to see and know about the mess in your nose, these things should not happen nowadays.If there is cutaneous contraction and skin shorfall we are encountering a major technical limitation, I really need to see better images, well lit, in standar whole-face views from both sides, both oblique, frontal, from underneath the nostrils and a few close-up views of the skin damages visible on the dorsum and columella.I am expert in revision, botched, catastrophic and even desperate cases, beyond tertiary rhinoplasties, my all-time record is 13th time revision.From the poor quality images posted I can detect these issues:-short nose-poorly defined tip with likely internal calcified necrosis-polly beak deformity-inverted V deformity-skin damage (could this be pressure sore wounds?)-iatrogenic assymetry at nostrils of unclear origin (intraop assessment bound)-columellar damage-septum damaged or resected? poor tip support?The main problem is the skin damage or shortfall, this may complicate or limit the internal corrections; if not due to this all the mentioned (and other) problems have a well known solution in revision rhinoplasty procedures as long as performed by expert hands.I prefer to wait and see better images to issue a more defined opinion; also I need to know when where the first and second rhinoplasties performed, and if available any technical descriptions of the procedures (this is not a must).Feel free to contact me.

Secondary and tertiary rhinoplasty can be thwarted by skin issues.  The scar contracture in the skin can cause it to be difficult to lengthen a nose, or de-rotate a nose.  It can cause the end result to not look very good even after doing a great job on the bones and cartilage.  However, improvements can be made in many cases so do not lose hope!