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Steven M. Denenberg, M.D.
Dr. Denenberg's articles on Medium.com.
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Questioner: Is There Really No Chance for Improvement with Revision Rhinoplasty, or This Surgeon is Just Not Capable to Fix my Nose?
I had closed rhino 4 y ago.looked for more feminine nose.The results were bad.For scar tissue on the supratip I had a series of kenalog shots,ultrasound therapy,tried with endermologie.Nose is still uneven and big.I decided to have a revision.I find a surgeon who changed his mind in the last minute, told me that my nose with next operation will be worst and bigger,because my organism is prone to make scar tissue and that every surgeon who say that will fix my nose,only wont to take my money!?
(Questioner submitted photos)

Dr. Denenberg's answer: More improvement might be possible in the profile than the width of the tip area

In general, the more we want to change a nose in a revision, the more likely we are to get a meaningful improvement. See my "Web reference" link for a morph I made of your nose, and I'll explain in more detail.

If we are only trying to subtly thin the scar tissue at the tip of your nose, that's not likely to work well enough to make a worthwhile difference. But if we wanted to make changes along the lines of my morph, we're much more likely to succeed: if we shorten your nose substantially, and bring it back closer to your face, then even if the amount of thinning of the tip is disappointing, there will be enough other big changes to make you happy with your revision. Your nose would look smaller, but perhaps in a different way than you tried with the Kenalog shots, etc.

In capable hands, elevating the tip of the nose is one of the most predictable changes to make, even in a revision. It requires advanced work on the tip of the nose, though, so you have to be sure, by looking at before and after photos, that your surgeon has proven his skill by accomplishing those changes for his other patients.

Link to this question on RealSelf.com