Revision tip plasty under local anesthesia?

In expert hands, narrowing a boxy tip and elevating the tip are two of the more predictable changes to make to a nose, even in a revision. If you have had two revisions, and the tip is still substantially not where you want it, I would take care to be extra judicious in selecting your next surgeon. Rhinoplasty is an exquisitely difficult operation to get right, and revision rhinoplasty more so, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that a nose like yours needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery.

Hello and thank you for your question. Based on your description, the best and safest result would likely be achieved using general anesthesia with a formal revision. With good surgical technique, you could likely have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon