Since you have had 4 rhinoplasties (Seattle), anyone considering your surgery will be very cautious. That many procedures leaves the nose with low blood supply and hence more at risk for additional procedures. Grafts in these noses have less blood supply and are more likely to have decreased volume and action that they were intended. That needs to be understood. Tip grafts can make your nose more defined but thick skin prevents the details from showing. You can always make the skin less thick by reducing the fat underneath the tip but this can be risky but possibly the only way to define the tip in this situation in addition to the tip grafts.
Thanks for reading, Dr Young
Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington