The revision rhinoplasty can be performed in closed fashion without visible scars, and the alar base scars may be revised.
Kenneth Hughes, MD
Los Angeles, CA
Frequently revision surgery is done without an incision in the columella; ie it can be done using a closed technique. Having said that, I don't know what you need.
Without an exam it is difficult to say what can be done, but I will say that revising the tip can not be done from an alar base scar.
Without photographs, it's difficult to give an opinion on what may or may not need to be performed. Closed rhinoplasty techniques can be used to perform a revision rhinoplasty on your nose, even though it's been opened in the past. Look for a very experienced rhinoplasty surgeon for best results. For many examples, please see the link below to our closed rhinoplasty photo gallery
The only way to give you proper advice is for you to have a comprehensive examination by a surgeon experienced in revision rhinoplasty. As one who does many revisions, I can tell you that every situation is different. To be able to give you proper advice, I would need to see what had been done already. To give you some direction, I do think you need to have an open technique with a mid columellar scar (if done properly, this heals without people being able to see it) and reconstruction of your nasal tip with or without cartilage graft support. The idea of 'augmenting' may not be really at play here. It is to provide the proper structure and support the nasal tip requires to be in balance with the rest of your nose and face. It will be difficult for you to comprehend on your own. So seek good advice. Good luck!
Very often the tip of the nose can be brought down with revision rhinoplasty, it's not always about making the nose bigger, wider or stronger. As for the incision, the columellar incision is rarely visible to the untrained eye. Unfortunately, scars on the nostrils were used to reduce flared nostrils or ala. These are too far away from the tip structures to be used to revise the tip.