Reduction Rhinoplasty - Why can't I have the little nose I want?

  I understand your frustration, but like anything else there are limits to what can be done. The limitations of how small you can make a nose include, the skin envelope, the cartilage and the function of your nose. If you take out too much cartilage your nose will collapse and you will look terrible as well as not breathe well. The good news is that your doctor is being honest with you and is giving you realistic expectations.  The problem I often see is that the surgeon promises results he or she cannot deliver.  At least your physician is honest.

Good Luck

A rhinoplasty is able to refine and enhance the appearance of the nose, but does have anatomical limitations. Skin thickness, bone structure, and cartilage all alter the maximum refinement options. Additionally, the ideal nose is one that harmonizes and balances your features, and an overly reduced nose may not be ideal for your facial structure. Going forward, I would recommend you to discuss your concerns with your surgeon, but also discuss your aesthetic goals with other board certified plastic surgeons. 

Reducing the nose too small can result in functional problems such as sinusitis or compromise of the nasal airway with obstruction

There are anatomic limits to rhinoplasty.  Primarily, as volume of cartilage and bone is reduced, the skin has to go somewhere.  A well shaped nose needs structural support and if this is removed for the purpose of making the nose smaller, the result will be bad.

It sounds like your skin thickness is limiting how dramatic of nasal reduction your surgeon can perform. Surgeons must balance the ideal down-sizing of a nose with the anticipated ability for the skin to take on this new volume.

When the nasal framework is made smaller you still have the same amount of skin that has to redrape over it (no skin is removed during the surgery). Luckily, thanks to scar contracture, the skin will "shrink wrap" to some extent around this new, smaller nose over time. The thicker your skin, however, the less this can occur. If your nose is over-reduced you can be left with an amorphous nasal tip from this excess skin.