The lids are very delicate, and once they become excessively scarred it can lead to very serious complications down the road. That combined with your history of ophthalmitis is very concerning. Without knowing your entire history, a fourth lid surgery sounds like a very high risk proposition. At a minimum you'd want your ophthalmitis completely resolved before considering any additional operations! If you don't already have a ophthalmologist, now is the time.
Can the cartilage regrow? Not significantly. In thinner people a visible defect is not uncommon. There are options to reconstruct the donor site if it is very bothersome, though that would entail additional surgery.Can the scar be revised to be invisible? No. All surgeries leave scars, even if it just a fine pale line. If it is less than a year old, it will likely continue to improve over time.
Sure, an alar base reduction is certainly possible under local.That said, there are two other issues that you have to consider. Number one, nostril asymmetry can have many causes and treatments, of which alar reduction is only one. You many need work on other parts of the nose or a graft.Two, it's always sensible to wait for a certain amount of time after surgery before doing any sort of major revision. As the nose heals, swelling decreases, and scar matures, the nose will often change, either for better or for worse. Trying to do fine modifications while still healing from a previous surgery can be very challenging. A year is a little conservative but many surgeons would want to wait several months after a revision before performing additional surgery.
Unfortunately, if the cartilage is infected it is unlikely to heal surgical intervention. Generally the graft needs to be removed and any infected or devitalized tissue debrided, in addition to antibiotic treatment. If this results in a residual deformity, this may require a delayed reconstruction once the infection clears.
