Your case is difficult to assess from an historical point of view, 2 different procedures spaced long time have taken place making thus very uncertain judgements about the quality of the work done before, mainly due to the very poor quality of the pics posted to depict the first rhinoplasty results.Also, a great care has to be taken considering the short period of only 3 months, when a revision rhinoplasty recovery period has barely began, since normally takes 10 to 18 or even 24 months to stabilitize.In spite of that I'll try to enlighten with some judicious comments:-the primary congenital nose was a not easy one, if any is; it was a very broad bridge case, with atypically high radix, this means a difficult dorsum management; also the tip was difficult, a bulbous, cleft, overpojected and poorly shaped one, with verticalization of the lateral cruras (aka "parenthesis tip deformity"); it was also pretty oversized needing an ambitous downsizing in a context of thick and sebaceous skin (which normally has difficulties to shrink after nasal reductions)-all the former aims to make understandable that such cases are firstly difficult technically and suitable for high end surgeons and not ones applying standard nasal reduction procedures, you were the perfect case for a lengthy, delicate, creative and enjoyable (for those with skills) so called "structure rhinoplasty", research about this; also aims to set clear that your skin might have behaved disfavorably and this is not attributable to the surgeons who did the work-considering it is difficult to judge the quality of the work, however it is possible to assess the situation in the images posted (better ones might help) and the eventual issues needing correction and how to fix them if you underwent another revision rhinoplasty; this comes next-your nose is not a crooked one, let's be careful and judicious using the terms; crookedness is used to define noses with a C shape after, normally, major nasal traumatism, some botched rhinoplasties and also congenital issues; yours is just slightly asymmetrical and currently the swelling is more predominant on one side, which leads to your subjetive belief of crookedness; I understand your frustration with my disagreement, however knowing it is, the most likely, just a virtual and temporary effect may ease this feeling; be patient and let's see the evolution, to be honest and with vast experience in my hands, I don't envision crookedness as a reason motivating a revision for your nose-your dorsum is indeed pinched, specially the supratip, very artiificial, due to reasons not within my current understanding but perfectly visible during open revision; this is a good reason for a revision, rebuild of the middle vault is required in your case, eventually using spreader grafts very carefully calibrated-there is a slight inverted V deformity, could worsen in a few months, if necessary can be treated-the tip is very poorly supported, prone to collapse and totally undefined, this is the most difficult and important part for your future revision, you need a surgeon who is very very good at this-the most tricky and uncertain part: poor contraction of the skin at tip and supratip; this is due to the thick features of your skin and, as I said, not due to technical deficiencies; if this persists after the stabilization period and is a confirmed issue there are 2 options to correct it; 1) theoretically only but never applicable: trimming away skin wedges leaving scars; obviously if the skin is in excess and does not shrink one solution might be cutting it away, however this is sheer theorization and not a real technical indication due to the scars involved, at least not in your case; 2) augmenting or raising the supratip dorsum and providing firm projection to the tip, and this IS indeed the solution when the skin fails to shrink at tip-supratip and appears a hollow polly beak deformity due to that cause-the animation of your tip when you smile is corrected by trimming the depressor of the columella, a tiny muscle-I notice, correct me if I am wrong, you never got alar flare reduction, IMHO you really need it to balance your noseNot much else can be said at this stage and with those images.Seek the advice and hands of a serious professional who offers to you a time-consuming and expensive procedure; stay far from minimally invassive snake-charming procedures, synthetic implants, fillers, wrapped diced cartilage, etc.
