Revision rhinoplasty requires exceptional skill on behalf of the surgeon and great communication with the patient about realistic goals and expectations. Common cosmetic concerns include a dorsal hump, wide nose, sunken nose, irregularities, and asymmetries. Functional concerns include difficulty breathing through the nose, which can and should be addressed at the same time as your rhinoplasty. In a revision rhinoplasty, cartilage from your septum may have been depleted and therefore often an alternative source of cartilage is needed, such as from the ear. This is just one of the important differences between primary and revision rhinoplasty that need to be discussed in detail before you decide to proceed with surgery. In your situation, there is some degree of midvault collapse. It can be improved with cartilage grafting and dorsal refinement. Make sure to seek out the care of a board certified surgeon with extensive experience in revision rhinoplasty. Find someone you connect with, who will listen to your concerns and provide you with a framework for what is possible. Gary Linkov, MD Rhinoplasty Specialist Manhattan