Refining the nose during Asian rhinoplasty
While your skin is thick, you could achieve dramatic refinement with a rib cartilage graft. Based on your pictures, a combination of radix augmentation (the bridge of your nose between your eyes), tip projection and refinement with a septal extension graft + shield graft, and alar base modification with Weir + sill incisions, you could achieve the refinement you are looking for. I would advise against synthetic implants as they have a higher rate of complications than tissue from your own body.
Yes you can have a significant improvement to your nose.
My approach would include the following and perhaps other techniques
1) open rhino
2) costal (rib) cartilage
3) dorsal onlay, alar rim, columellar grafts
4) thin skin carefully
I would recommend that you undergo a rhinoplasty using some of your own cartilage. This can be obtained from your nose, your ear or your rib depending on how much is needed. By adding some cartilage to different areas of your nose, we are able to refine the look of your nasal bridge and help modify your tip and achieve the definition you desire. I am not a fan of implants in the nose and have seen too many patients that need to have them removed even 40 years after they have been put in.
I would recommend using your own cartilage for grafting to augment and define your tip. Your own septal, ear or rib cartilage are better options that synthetic implants.
Rhinoplasty without implant!
Your rhinoplasty can do what u want without the need for an implant. The radix and tip can be brought forward with your own cartilage from septum or ear.
Asian Rhinoplasty and Bulbous tip
You have a typical ethnic nose, low bridge, bulbous tip and wide alae. This can be reduced by defatting the tip and putting cartilage grafts in the tip. The dorsum can be augmented using a custom carved silastic implant. It should not extend into the tip as it may extrude. See video link for more info.
Rhinoplasty for thick skin
Adding an implant to the bridge of the nose will only make the nose higher and wider. To narrow the bulbous tip, suture techniques to the lower lateral cartilages are required. An alar plasty is required to narrow wide nostrils and the nasal base.
Bulbous, thick skin, tip rhinoplasty
There are several ways to increase tip projection, height, support and definition. The first is by means of a cartilage graft called a columellar strut that is taken from the septum and placed under the tip. In addition, tip defining sutures and tip cartilage grafts can be used as well. A patient's own tissue is generally preferred to implants in the nose and face. Trimming of the cartilage in the nose (cephalic trim) is a quite successful technique as well. Finally, a limited, conservative excision of the fatty tissue under the nasal tip skin can also be performed. So in answer to your question, yes, a lot can be done "to refine a bulbous, thick-skinned nose."
Tip refinement and Asian rhinoplasty
refinement of your nose is possible but the goal that you have here in this photograph provided it is not likely obtainable. He can certainly better define the dome cartilage a few tip and perform an alar base reduction as well as some other maneuvers. I'm not 100% sure which ones would be helpful to you without an actual consultation but I will attach a brief video that outlines some important keys to success with Asian rhinoplasty
Chase Lay, MD
Asian facial plastic specialist
Double board-certified facial plastic surgeon