What Exactly Would my Revision Rhino Require? Is It Straightforward? What Are the Costs?

The changes to your columella and ala can be addressed with revision surgery. Also, your tip projection can be improved as well. This would likely help with some of the nostril enlargement you're noticing as well as creating a supratip break. It's not clear how long ago your initial surgery was, but you'd want to wait about a year before having a revision procedure.

Additional photographic views would help provide a fuller assessment. Revision tip work is relatively more complicated, but not impossible to do.

Surgery costs vary widely depending on the region of the country, surgeon experience and surgery length. About $7000 plus operating room and anesthesia fees would be an average cost.

Based on your photos it appears that you have slight hanging of the columella and alar retraction - both of which can be corrected with revision rhinoplasty

Your surgeon achieved what you wanted: Refinement of the tip and narrowing of the nose in a subtle way. But "subtle" tell-tale signs of a rhinoplasty are often :Loss of tip projection and slight retraction of the nostrils.

As Dr.Schwartz mentioned grafting can improve this. Predictable and subtle "refinement" in a secondary Rhinoplasty is best done by an experienced Surgeon devoting a majority of his practice in (secondary) Rhinoplasty. I am sure there are some very good surgeon in your area: Jack Sheen,MD used to be one.

Every time you have surgery on your nose the results are less predicatble, the resolution of swelling longer etc.

Do your homework, find a surgeon very experienced and think the revision to be the last procedure on your nose (in other words: Go for a home run!).

Good luck