Should I let my surgeon shave down my knuckled cartilage? (Photos)

To have *anything* done to the nose, it needs to be fully anesthetized, and *you* need to be fully anesthetized. No matter how tiny a feature seems, it can be quite complicated to correct, and the surgeon needs to be prepared to do a full revision rhinoplasty. The photos you posted crop your face out of the photos, and we don't see enough angles to tell what's really going on with the nose. If there are issues on the profile views, or other issues besides that tiny bump on the tip, *all* of the issues should be addressed if you are having another operation. And an "in-office" procedure is a real operation, a real revision rhinoplasty.

How *much* to make changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

In your case their may be problem but generally the healing and changes are not over until one year. I suggest you to be forthright about the appearance of your nose relative to the features you wanted. Tell the surgeon how you feel. Your surgeon has recorded your desired appearance in your chart and/or with photo morphing (changing your nose to on the computer). In my experience (over 3000 nose surgeries) about 1/3 of those revision rhinoplasties. When they come to me right after surgery, patients are frustrated if 1) the desired result was not achieved as recorded before the surgery, there is an undesirable result with bumps or asymmetries AND 3) the surgeon disagrees with the patient on the outcome. Have the surgeon show you before the before and after results or read the goals to you. If your surgeon agrees and asks you to wait and reassures you that they will do their best to achieve a result AND you trust the your surgeon, then you should listen and wait. If your surgeon is unable “to see” your concern or tells you it is what you wanted and it is clearly not a desirable result, you would be justified in seeking a second opinion. Remember, this will cost you more money, and only your surgeon has seen and understands your anatomy…still you have to trust your surgeon if a revision is being considered.