Surgery on soft thick tissue?

I had a Rhinoplasty done about 10 years ago. The change was very minimal and I was not happy with the outcome. Now I feel my nose is not symmetrical,and there is a visible scar on the left hand side. I saw a plastic surgeon in Brisbane and he would not operate on my nose as it has lots of soft thick tissue and he said that it would be too difficult to operate. I really want my nose skinnier and with smaller nostrils. I do not like the roundness. I would like a normal nose that does not stand out.I would like to know if there is a surgeon who will operate on my nose at all?

Anne70 February 26th, 2016 QLD

  • Answer
     Sam Cunneen

    Sam Cunneen

    9 answers

    Plastic Surgeon
    Western Australia, Australia

    Dear Anne, thank you for your question. Revision rhinoplasty is a tough game. 
    I personally don't think that thick skin is a deterrent as long as you understand that with thicker skin the changes the surgeon makes are more difficult to see. This can be a good thing as it smooths over any little bumps left but it can blunt the results.
    It is a bit difficult to assess your nose from the photos but it appears that there is significant cartilage loss in the upper part of you nose which may need replacing.
    I don't know that you want to travel to Perth to see me, but I am sure there will be a good plastic surgeon in Brisbane willing to help you out on a difficult problem.
    Let me know if I can help you more,All the best Dr Sam CunneenPlastic and Reconstructive Surgeon
  • Answer
    Dr. Raymond Goh

    Raymond Goh

    123 answers

    Plastic Surgeon
    Queensland, Australia

    Hi Anne. 
    It would be interesting to know what was performed in your primary rhinoplasty, and what the before and after photos look like in regards to the primary procedure. Information regarding what's been taken out, added, or adjusted can help to explain the current appearance of the nose. Additional oblique and worms-eye (from below) photos would also be helpful. 
    I can understand your perspective. The tip of the nose is bulbous in nature, with a "parenthesis" - () - deformity. This can sometimes be due to upward mal-positioning of the lower cartilages of the nose. Your Alars (nostril wall) appear to be slightly retracted in the photos, together with some droopiness of the tip. Whether this is static (there all the time) or dynamic (only when smiling), is difficult to determine.
    Revision rhinoplasty in general is more difficult than a primary procedure. It carries more risks and potential for complications. The thickness of the skin does play a role in outcome. Swelling is usually more prolonged after surgery in thick skin noses and definition is harder to achieve. The important factor to any rhinoplasty, primary or secondary, however, remains the creation of a solid framework and long term support for the nose.  
    I hope this helps.
    Kind regards,
    Dr Ray Goh