Revision - are my expectations realistic? (Photo)

Question

Hi <3 I did a primary rhinoplasty in 2017. I'd like to refine my tip. I've been told I have thick skin (middle eastern). I'd like to shave down the side and bring down the root of the nose and also get more definition on tip. What's possible here? Also I feel some days my nose is more swollen. I have a large bump (I think scar tissue) inside nostril as well. Would love advice on what to do to achieve my desired result (defined tip and shave down bridge of nose for more curved side profile).

Ali Sajjadian, MD, FACS · Answer

Thanks TaianaDuncan for your question! Based on your description, you're aiming to refine the nasal tip, shave down the nasal bridge and address internal nasal issues to Resolve the bump and potential swelling.
To refine the nasal tip, a qualified surgeon can carefully sculpt the nasal tip's cartilage to give it the proper definition and shape. In some situations, particularly when structural integrity is lacking, cartilage grafts may be utilized to strengthen or enhance the nasal tip.
A section of the bone on the bridge of your nose can be carefully removed to create a smoother profile in order to shave down the nasal bridge via bone contouring.
To address Internal Nasal Issues your surgeon can do septoplasty to correct any underlying septal deviations that may be contributing to breathing difficulties or persistent swelling. Morever, The internal bump, likely scar tissue, can be surgically removed to improve airflow and reduce discomfort. Sometimes the lower turbinates need to be pushed out to improve airway. 
Although thicker skin might occasionally make surgical outcomes less predictable, a talented surgeon can take this into consideration and still provide outstanding results. Methods such as meticulous dissection and accurate suturing can maximize healing and reduce scarring. Occasionally cartilage need to be removed and internal splinting placed to help with proper healing.
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 philospphy 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

Eric M. Joseph, MD · Answer

Unfortunately, revision rhinoplasty surgery is exponentially more difficult than primary rhinoplasty surgery. And I agree with what you've been told: You appear to have thick nasal tip skin. When someone has thick skin in the nasal tip area, significant narrowing and refinements may not be feasible. Please consider meeting with several reputable rhinoplasty specialists who offer computer Imaging so you can see what to expect moving forward. I hope this helps. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you may benefit from a tip refining revision rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts may also be used to help improve tip refinement. 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

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Ruslan Zhuravsky, DO · Answer

Hello, While thick skin can limit the level of refinement and has to be taken into account, it seems the main issue is from the actual shape of the tip. From the these photos, it seems the shape of the cartilages under the skin is more rounded, which results in a fuller appearing tip. This is one of the most common issues that I see in revisions of all skin types. When it comes to the tip, the shape is the most important aspect, but it is also the hardest to address. Cartilage can be very stubborn and difficult to reshape ---To understand this, just try to fold your ear and see how it springs back to its original shape. --- So the techniques required to get the desired shape are usually the more meticulous and time consuming ones. The goal of these techniques is NOT to simply cut away cartilage and pinch it in with stitches, but to support the cartilages in a way that will allow the tip cartilages to have a soft curve at the tip and transition into a flatter segment on the sides. This may be hard to visualize but seeing a video on the anatomy of the nose might help. As for the bridge, yes it can be lowered but you must also consider deepening the radix and deprotecting the tip in order to maintain adequate proportions. Make sure to seek out a surgeon that truly specializes in rhinoplasty and performs frequent revisions.

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