What Exactly is Tip Refinement?

Some basics. The shape of the nose is the shape of the underlying architecture. In the nasal tip, the architecture is cartilage. If the cartilages are rounded and weakly supported, then the tip will have poor contour and definition. You need thinner width and strongly supported tip cartilages in order to have tip definition. If you cover this with a piece of silk or thin skin you will see great definition. If you cover the architecture with a thick mattress or thick skin, then you won't see much definition. Support is key in thick skin noses, not reducing architecture.

Tip refinement refers to reshaping and in most cases narrowing the dimensions of the nasal tip. Various techniques are used to achieve this depending on the patient, including dome division, cephalic margin trim and dome binding. Sometimes the cartilage is reshaped by removing small sections of it, but more commonly with modern rhinoplasty techniques, the cartilages are repositioned and reshaped rather than reduced. Tip refinement techniques are often used in conjunction with tip rotation (elevation).

In rhinoplasty jargon, the term "Tip Refinement" simply means reshaping the nasal tip to improve its appearance. This can involve making the tip narrower, smaller, less bulbous, less boxy, more/less upturned -- depending on the goals of the surgery.
The techniques used to achieve these goals depend on the type and shape of the patient's nose. Also, skin thikness can impact the result of "tip refinement". Changes to the tip may be less appearant in thick skin patients compared to thin skin patients.

Tip refinement is exactly as you have described. Depending on the patient it includes a combination of small amounts of cartilage removal and some sutures carefully paced to reshape the tip

Tip refinement is a myriad of techniques that are performed on the cartilages of the nasal tip to refine the nose, make it thinner, less bulbous and more pleasing. There are multiple different techniques that are used including cartilage grafts, tip grafts, and strut grafts, and sometimes removing cartilage. The tip refinement is usually performed at the same time as a rhinoplasty but can be performed independently if only the tip is out of balance with the remainder of the nose.

Another word for "refinement" is "definition". With the thick overlying skin the surgeon cannot demonstrate the clear, visible shape and contour of the underlying cartilage. This is the result, regardless of what maneuver or technique is used during the operation. Be grateful that your surgeon is honest with you and is trying to establish reasonable expectations.

The term tip refinement applies to al the situations that you mention in your question. Not everybody that undergoes a rhinoplasty needs to have all of this done (or any tip refinement for that matter), but these are all techniques that we use to reshape the tip.
We normally use a combination of some cartilage excision with suture techniques to reshape the tip. This allows us to narrow, rotate, enlarge and or modify it as needed. Cartilage grafts are often used to gain height and/or definition of the nasal tip. This is particularly helpful in people with thick skin.