Is it possible to slim down a nasal tip without the use of a tip graft? Would defatting, cephalic trim, or other be enough?

You can certainly have defatting of the nasal tip skin, cephalic trim, and tip defining sutures, but these may or may not be enough depending on what your native anatomy is like and how much change you are looking for.  Some of the limitations that you will encounter in Asian noses is the skin envelope, which may be too thick to achieve what you're looking for without tip grafts.  Additionally, your lower lateral cartilages may be thin and small, in which case a cephalic trim would not be helpful.

Some patients have concerns that their nose tip might feel too firm following tip grafts; I find that utilizing ear cartilage for the tip grafts make it a little softer than utilizing septal or rib cartilage.

You should discuss with her surgeon your concerns about tip grafts, and what can realistically be achieved if you choose not to have them in your rhinoplasty.

A rhinoplasty specialist will be able to comprehensively address the issues you have with your nose.One thing to keep in mind though is that there is a limitation to the amount of tip refinement you can achieve (how small/narrow) depending on the thickness of your skin. While there are a variety of approaches and techniques employed by various surgeons, it is up to you to do your due diligence to find a rhinoplasty specialist experienced in Asian rhinoplasty in order to achieve the best results possible. Using autologous grafts (tissue and cartilage from your own body) will provide the safest and most permanent results.Consult with 2-3 of these surgeons in person and determine your comfort level with their approach, demeanor, and before and after results. Good luck.

All the procedures you described can definitely narrow your tip and give your tip a more defined look. But if your nasal skin is really really thick and often times just those changes won't show and you will need some kind of tip graft to enhance it. 

Defatting and cephalic resection can narrow and define your tip a little bit, but it will also decrease your tip projection. Adding a cartilage graft on top will match the original height and has an effect of tip narrowing. If you have a thick dermis, this cartilage graft is usually necessary even though you might want a slight change. In any case, a thorough face to face consultation is a must. Thank you.

In general, we utilize extended-shield tip grafts liberally to achieve nasal tip narrowing in Asian patients. This is typically combined with a cephalic trim, columellar strut graft, and sometimes defatting the tip. An examination would be necessary to answer your question, and the decision to place a tip graft is often made in the OR - especially if it makes the nose look better. Hope this helps. Dr Joseph