Grafting and nasal length/projection?

Thanks jerseyyam for your question! It seems that you're not quite happy with how your revision rhinoplasty turned out. You are particularly worried about the increased de-rotation and tip projection.
Without visiting you in person, I am unable to give precise medical advice, however I can provide some broad details on possible remedies for your issues:
Removing the crushed cartilage onlay might be a good choice if it is the main reason for the increased projection. But removing the graft can impair the tip structure or create a conspicuous depression. In order to decide whether further support is required, your surgeon may require thorough examination of the underlying tissues. It’s impossible to be accurate with regards of diagnosis and treatment without at least some pictures of your preoperative pictures.
A deprojection process might be taken into consideration if the enhanced projection is substantial. This entails surgically decreasing the nasal tip's protrusion. This process can be used to improve the tip shape in combination with graft removal or other methods.
Seeking advice from a board-certified plastic surgeon with expertise in revision rhinoplasty is crucial. To determine the precise problems with your nose, they can do a comprehensive examination. They discuss the possible advantages and disadvantages of various operations and are familiar with the specifics of your first and revision surgeries. Lastly, they develop a customized treatment plan to meet your unique requirements and objectives.
Keep in mind that it's essential to communicate honestly and openly with your surgeon. Be ready to articulate your expectations and concerns in a clear and concise manner.
As a triple Board-Certified Plastic Surgeon and experienced rhinoplasty surgeon, I specialize in revision rhinoplasty. This complex procedure requires meticulous attention to detail and a deep understanding of facial and nasal anatomy. I am committed to correcting imperfections and restoring both the form and function of the nose. My philosophy is to listen carefully to the goals and desirers of my patients with a focus on patient satisfaction, I utilize advanced techniques to achieve natural-looking and long-lasting results.
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian
TRIPLE Board Certified Plastic Surgeon

Hi, It is better for you to consult with your facial plastic surgeon who can examine you and give you opinion based on examination.

Your questions can be answered, but I'd need to see what your nose looks like first. How *much* the tip and nose need to be shortened, and how *much* the graft is controlling the appearance of the nose, and how *much* you need the nose to change in order for it to be ideal for you, would all determine whether more surgery is a good idea, and how much can be done.

You would have to see some good morphs so you can establish a goal for the operation, too.

If you like, feel free to re-ask your question with photographs. In general, revision rhinoplasty is exponentially more difficult than primary rhinoplasty. So the decision to undergo tertiary revision rhinoplasty is not an easy one. Consider meeting with several reputable rhinoplasty specialists who can review your previous operative reports, evaluate you comprehensively, and help you with a plan moving forward. I hope this is helpful and good luck! Sincerely, Dr Joseph

Hello and thank you for your question. Based on your description, you may benefit from a revision with nasal tip deprojection. 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