Remember : the enemy of good is perfections. Sometimes you have to settle for good and just accept what you have. Another surgery might muck up the good result.
Fourth rhinoplasty procedure?
The photographs demonstrate a very acceptable nose especially since it's been done 3 times in the past. Due to the complicated and intricate nature of the cartilaginous/ bony anatomy of the nose, and the unpredictability of the healing process, it is best to leave well enough alone.
Nose Tip Revision
A revision can be done for the tip. However because this would be a fourth revision, it is important to review the details of the past surgeries in order to figure out the best course of action. The cost will vary depending on what needs to be done.
it depends on:
1. what was done/not done during your previous surgeries
2. how much of your tip aesthetics are secondary to cartilage issues
3. whether your surgery was done open or closed and how much scarring/support your nasal tip has
once you have gotten up the confidence, an exam with a qualified surgeon ought to shed light on these issues and help you decide whether or not this is worthwhile
In order to fairly judge the possibility of a fourth rhinoplasty making a more defined tip, I would need to see your initial "before" photo, and the "after" photo for each surgery you had. It is certainly possible to have a tip-plasty that addresses only the tip of the nose. As far whether you will get the result you are looking for, it depends on the elasticity of your skin and its thickness. That being said, you may get the result you are looking for with a medpor implant, even if you have thick skin.
I would be happy to discuss this further in a private consultation in my office.
Best of luck,
Dr. Michelle Yagoda
I think that doing a 4th may not make an improvement. If 3 times didn't correct it, why would you think a 4th time would? I have reservations. Some people's tissues limit the kind of refinement that patients sometimes want.
Thick nasal skin may limit the narrowing in one's tip after rhinoplasty surgery.
Digital images are not a replacement for an examination, however we have met patients with thick skin and wide nasal tips after rhinoplasty that is completely due to the overlying skin, not the underlying cartilage. An examination by a rhinoplasty specilalist may be helpful for determining what is causing your persistent tip wideness after three rhinoplasties.
Hope this helps you.
It appears that you have a remaining bulbous tip. This should be addressed with reshaping of the remaining cartilage, and cartilage possible grafting, NOT more cartilage excision, as it will only create more deformities and not produce the result you want.
Your particular case requires finesse and experience, as you have had previous surgery before, which makes subsequent surgery more challenging. Also, most surgeons will require you to wait at least a year from your last surgery, and at least 6-12 months after accutane treatment.
This is a cosmetic procedure, your nose looks good already, whether more surgery is "worth"it, is a subjective decision, that only you can decide on.
I would consult with an experienced rhinoplasty surgeon in your area, if you decide to pursue this.
I think that a 4th revision on your thick skinned tip is unlikely to make you happy.
Reducing the width of the tip may decrease the tip's projection, which is currently excellent. This will then need a tip graft which in a scarred thick tip is risky. The blood supply to the tip is already compromised from previous surgery. A fourth dissection and tension from a tip graft is risking skin slough.
Thick nasal skin
It is very difficult if not impossible in some cases to achieve a very well-defined thin nose if the skin is thick to begin with.If work has been done on the nasal tip in the past and all 3 occasions them the risks of a fourth surgery on the nasal tip is high. She have to take that into consideration before she go for a fourth rhinoplasty on the nasal tip.
In your consultation you should specifically ask your surgeon if he or she has had similar patients in the past and if the results were good or not. That will help to make her decision about proceeding with a tip plasty or leaving it alone.