Uneven columella / tip after two surgeries - can this be improved? (Photos)

Let's start with your original nose, which I assume is the first one holding a mic.

You had a typical jewish or semitic type of nose (similar to a popular singer from the 80s), I concur with a mild "beak", not a bad one, there seems to protrude a little the caudal septum at the supratip, and this was the lesser of the techical challenges of your rhinoplasty.

However, your nose wast 9/10 in difficulty scale of high-end structure rhinoplasty cases; take with a pinch of salt these comments give you showed us only one lateral preoperative perspective; your preoperative issues:
-long nose syndrome, this is the lenght between radix and tip, in the US sphere aka as hooked or witch's nose, due to overly long triangular cartilages (nasal wall)
-long tip syndrome, this is the distance between the base of the columella and the tip, overly projected, in the US they call this pinoccio nose, however being both the nose and the tip both abnormally long for your facial proportions, they buffer and mask each other, leading to an apparently well balanced triangle
-a hump larger than meets the eye, with a little supratip protrusion ("beak" in the US), however this really huge hump is masked withing a huge triangle of nose (long tip, long nose); in "small triangles" you have to lengthen nose and tip, leading to nasal enlargement (asian and african noses), and this reduces the actual hump excess, and in the overly large noses with long tip and nose it is the opposite, the hump is larger than initially seems naked eye
-pay attention, in the preop but also in today's images, it is noticeable a congenital malformation of the alar cartilages at the infratip lobule, where the cartilage ends the domes and the middle cruras ("leg") start we have the infratip lobule making a curve for the transition between tip and columela; well in your case it is inverted or concave, sunken, making a contour depression; this is a must-treat feature for structural and aesthetic reasons, it makes a dissociation between tip and columella (a cut or indent) and creates an abnormally or overly sharp tip ("eats" the gentle transition curvature between tip and columella), like having a "peg" pinchin the tip however applied in a vertical direction
-you suffered from badly verticalized lateral cruras (parenthesis tip) and poor, if any, nostril rim support leading to alar retraction and overly large nostrils, septal show, etc, another must treat
-as a consecuence of the former plus the thin / weak features of the lateral cruras, besides their verticality, the nasal valve looks pinched, so you had both horizontal (due to poor valve support) and vertical (due to congenital abnormality) pinching of the nasal tip, making it look artificial

That nose needed a comprehensive, invasive, thorough and subtotal skeletal re-design and very careful rebalancing by means of almost a complete portfolio of structure rhinoplasty surgical gestures; insted it seems to be you have only received resections, reductions, removals, taking away and then taking away more elements, without the basic aforementioned aesthetic and technical judgements.

Not only, there are big errors in your current anatomy:
-open roof deformity, still surgeons don't know how to make osteotomies? Dr. Joseph in 1905 invented them and told us they were compulsory after removing a bridge, victim of post-truth? surgeon's fear?
-total and rare-to-see collapse of of the nasal valve, you hardly inhale air at strong inspiration, badly pinched look
-the infratip lobule congenital concavity persists unattended
-bad profile management, in a V shaped like with under-resection of the lower half, a lot of hump remains
-no tip deprojection
-no nasal shortening
-fake tip, overly sharp, "operated look"
-massive alar rim retraction and nostril augmentation
-etc

Now you are a candidate for a revision, a true one, the first one (I don't believe the other to "revisions" can be flagged as such) and the last one too, a resolutive procedure employing many different structure rhinoplasty graftings and maneuvers. Seek the advice of a good and reliable revision rhinoplasty surgone who does not try to sell you anything, offering a 5-6 hours lengthy procedure and who shares a technical focus similar to the one described above.

Based upon your photos, you appear to have relatively thin nasal skin, with a pointy tip, and a hanging columella. In many cases, we can add microdroplet Silikon-1000 to the nasal tip to achieve a more pleasing, and less operated nasal tip appearance. This may be a welcome alternative to further surgery. I hope this helps! Sincerely, Dr Joseph

Even after three attempts, your nose, at least from these photos, is still very strong in its forward projection away from your face. That, and the fact that the bridge seems prominent on the 3/4 view where you're not smiling, make the nose look long as well, with the tip sitting lower than it has to. I don't know why the other operations failed -- I usually think of decreasing the projection and elevating the tip as two of the more predictable changes to make in a rhinoplasty, even a revision.

It would be nice to see a full set of photos, posed like you did for this question post, but starting from one profile and going around a little at a time to the other profile. Morphs could be made from the photos to give you an idea of what's possible: you'd understand better what might be the main target of another rhinoplasty if you decided to have it.

In general, the more we want to change a nose -- changes measured in millimeters -- the more likely it is to succeed. Tiny tweaks are difficult to make with any predictability. If morphs of your nose that you like show a significant change, that would be optimistic for another try.

All due respect, I would not use the surgeon who did your second and third operations. There is some evidence there that he might lack whatever expertise or assessments or judgements that are required for your nose.

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. With good surgical technique, you could 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