Can a double alar rim graft that is too bulky be corrected? (photos)

Evaluation of a nose can be difficult even when it has never been operated on. But when three procedures have been performed, simple pictures on a two dimensional computer screen are not sufficient to form a good opinion. From a simple viewpoint, your nose does not look overly bulky or unnatural, but a visit to a highly experienced rhinoplasty surgeon can result in a much better opinion. He or she can examine the nose inside and out, test its functionality, and look at it from all angles to determine what, if anything, can be done. Also, when additional grafts are put in a revision case, it can take even longer than a year for the skin to tighten down around them so it still may improve. Good luck.

From the photos you have provided it is difficult to appreciate the bulky appearance you are referring to.  It is possible that a graft in the area could cause such a problem.  A first step would be an in person examination with an experienced revision rhinoplasty surgeon to both see and feel the area to try and determine the underlying cause.

The best view to judge about the alar rim grafts are full profile and head tilted back (warms eye) views. It is hard to judge how thick these grafts are from the included photographs. In general, I prefer a septal or rib cartilage for the alar rim graft since a single layer ear cartilage is not firm enough to deliver the intended changes and a double layer graft is too bulky. One option is to replace the existing 2 grafts with a, preferably, septal cartilage graft (which I assume is not available otherwise the surgeon would have used that rather the ear cartilage) or a thin rib cartilage graft. However, a rib cartilage graft could be an overkill from the limited pictures that you have included. You may want these options with your surgeon.  

Based on your limited photos, you do not appear to have an unnatural-looking nasal appearance. The feasibility or advisability of performing a fourth rhinoplasty would need to be determined during a consultation with reputable and experienced rhinoplasty surgeons.Hope this helps you.Dr. Joseph

Your photos show a very nice alar contour.  It is not that clear that the graft is too bulky but maybe this is an issue of photo quality.   Grafts can absorb a bit with time so one option is to wait and see how the graft behaves and it may not be an issue.  Discuss with you surgeon the option for thinning the graft but then it may not provide the support you need for the ala.  Best wishes!