Best way to correct external nasal valve collapse and over done alar base? I'm going on surgery #3. (photos)

 Revision rhinoplasty for correction of nasal valve collapse and Overly narrowed alar base. The base car be enlarged by removal of the feet of the lower medial crura. The valve collapse is better treated with your own tissue  and not foreign substances. See you very experienced revision rhinoplasty surgeon who can show you many results of his work with noses like yours.

My perspective on your issue is unique because I perform both cosmetic rhinoplasty and complex nasal reconstruction after skin cancer removal. I usually use lateral crural strut grafts to address alar position issues. As noted you can use soft tissue techniques, such as V-Y to widen you alar base but you need support from cartilage to counteract the negative pressure that is causing collapse during inspiration. I would need to examine you to give a more detailed surgical plan, as there are a variety of techniques that could be utilized to achieve your goals. 
I do agree that I would stay away from Medpor in the nose. If it becomes infected you could have a major problem, and it could be difficult to remove. Hope this helps.

Hello,Thanks for your question. Looking at your nasal pictures, your alar rims seem supported enough. I would stay away from Medpor in the external nasal valve area. I would recommend medialization of your medial crural footplates at the base of your columella. Moving each one closer to the midline of the nose opens the base of the nose, allowing more airflow. Additionally, you can widen the alar base with V-Y advancement techniques or composite graft placement. I would recommend that you consult with a revision rhinoplasty specialist before you have any further surgery to make sure you are having an expert in nasal correction evaluate your case.Good luck,Dr. Shah