Rhinoplasty thin skin and grafts (Photo)

I know you wrote this a while ago, but I just saw it and thought I'd throw in my two cents.

Adding anything to this nose will make the tip look bigger, and won't alleviate how the graft(s) are pushing against the skin, and I don't think you'd appreciate a bigger tip.

And there may be other fundamental things to address. For example, you only posted this highly-cropped frontal view, but to my eye it looks as though the graft is holding the tip down, which means that the profile and especially the 3/4 views might make the nose look too long. If that's the case, the process of elevating the tip can greatly assist in the process of making the tip look less prominent and not stand out as much. Adding stuff to the tip will make the tip stand out more. I'd love to see the other views of your nose, and I might be able to give you better advice.

Yes, it would be a complicated operation, but lots of operations are complicated. The pertinent question is how much improvement is possible and how predictable would it be to get that improvement.

Depending on your examination, microdroplet Silikon-1000 nasal injections maybe considered for filling the indentation in between your tip cartilages, and also for achieving several millimeters of lowering of your columella, depending on your examination. I hope this helps! Sincerely, Dr Joseph

Based on your photo, a revision rhinoplasty can certainly reshape the tip graft and improve your columella. Usually the cartilage of your tip graft just needs to be shaved down some. But it's important to see a rhinoplasty expert that can do computer imaging at the same time to help you understand what can be done.

Hello and thank you for your question. This is the exact reason I always place a mastoid fascia tip graft for camouflage in the tip. You will likely need a revision with tip derojection and a fascial tip graft. If your surgeon is not an expert at doing this, you may want to consider other consultations,. 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

Thank you for your question,
When extending the nose—especially to make it longer or more projected—it’s not just about cartilage. The flexibility of your skin plays a major role too. If the skin is tight or resistant to stretching, your surgeon may recommend doing the surgery in stages. In the first step, the nose might be lengthened by about 5–10%, allowing the skin to gradually adapt. Then, a second surgery can help refine and complete the extension.
If a graft (a support made from cartilage) isn’t strong enough to resist the tension of the skin, the skin can actually pull against it over time. This might lead to twisting, tip drooping, or a shorter-than-intended result. That’s why strong, stable grafts are so important—and why more complex cases often benefit from a 2-step or even 3-step approach, depending on the goals and expectations.
A true extension of the nose also requires support from the base—what we call the footplate. If that part isn’t extended along with the rest, the nose may not achieve a stable or lasting projection.
The decision about which graft to use is usually made during surgery, based on what the surgeon finds. If your own septal cartilage (the cartilage inside your nose) is strong and well-shaped, it can often be used. But if it’s weak, deviated, or previously damaged, your surgeon will need to have a backup plan.
The most important thing is trusting an expert who can make the best choice in real time, based on your anatomy and long-term goals.