Need experienced surgeon for revision tip plasty - bulbous tip/hump. Looking to book in 6 months! Miami/London/Sydney (Photo)

Based on your photos, I share your evaluation and concerns. Yes, in my opinion- your goals are achievable pending physical exam. In order to make a final commitment- a Board Certified PS would require physical exam prior to final comment. But- yes- it can be done in the right hands.

I think that your Surgeon under promised in the hopes of "over delivering".  This is actually the correct approach to expectations on the part of your Surgeon in a tertiary Rhinoplasty, such as you will undergo.  Your current photo shows evidence of a pollybeak deformity, which may be related to scar tissue, height of the dorsal/caudal septal interface or both.  There is no guarantee that you will have as much tip definition as the morphed photo, but I believe that further tip refinement may be possible.  An examination would be necessary to confirm or refute this supposition. Regarding a closed approach, I personally think this is a bad idea for a tertiary procedure.  In experienced hands, there will be no difference in outcome of perceived scarring with an open Rhinoplasty, which I feel is definitely the right approach in this situation. 

I can help you.  However, you did not mention Austin, TX, USA.  If you have serious interest we should start a dialogue now.  I am usually 2-3 months booked out.By the way, I would perform open rhinoplasty.  And keep in mind, it a rare nose that only needs the tip addressed.  The shape of the tip is affected by all other features of the nose.We can talk about that if you have an interest in coming to Austin.  Let me know.

Hi Alexx1988 - You have developed a pollybeak deformity. This is sometimes a result of inadequate reduction of the dorsal cartilage but loss of tip projection commonly causes this deformity as well. Your photos suggest a loss of tip projection. In these cases, a rigid septal extension graft is necessary to hold the tip complex in position against the scar process. The key question for your revision is what material is left to use for grafting. A rib cartilage graft might be necessary if there is not adequate cartilage or bone remaining in your septum. An open approach is necessary. I am glad that you are doing your homework on this because I'm sure you want this to be your last nasal surgery. Best of luck.

 When patients have thick skin, the postoperative followups are just as important as the surgery itself which includes management of the soft tissue envelope to prevent a poly-beak deformity from occurring again. Treatment for the poly-beak can include  the  revisional surgery, steroid shots, and taping in the postoperative period.

   Hi, I have performed and taught many Rhinoplasty Surgeries for over 30 years.  From the photos, your nose is quite wide along the entire nose, there appears to be some dorsal, septal, cartilage in the supra tip area (making the tip appear wide) which can be seen on the profile view.  The nasal tip is wide, the skin is thick, the nasal tip is under rotated (makes the nose appear long) and your chin is weak.  Rhinoplasty, not merely a tip-plashy is required due to the increased nasal width along the mid and upper nose segments to thin, refine and rotate these areas and the tip.  Rhinoplasty however will not address the facial imbalance from a weak chin as explained below.  A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective. I frequently perform Rhinoplasty or Revision Rhinoplasty in combination with Chin Augmentation to achieve facial harmony and balance.Hope this helps

I have performed over 1200 revisional nose surgeries and lectured on the true finest refinements. I trained with the top revision specialist of all times and taught revision to the top professional societies and have lectured at the rhinoplasty society a technique I would do on yours I have no doubt I can satisfy you

Thanks for your pictures.From the look of your current profile, it looks like you might have a combination of a high dorsum at the supratip and underprojected tip. The high distal dorsum looks like it can be a strip of excess dorsal cartilage.For a poly beak caused by thick, scarred skin, I would have expected to see a lower dorsum.So, if there is too much distal dorsum, I would shave it a millimeter by millimeter to get it just right and then project the tipIt would be best if you have residual septal cartilage, for tip grafts, to project the tip.The front view shows, what I think, is an unrealistic narrowing of the nose and tip cartilages.