Need a 4th Revision Rhinoplasty. Will It Help?

As long as the tissues are healthy, you are motivated, and your expectations are realistic there is room for improvement.  You may very well need a rib graft to correct the contour deformity of the bridge

If all you are looking to improve is the hanging columella, then, yes, I think a minor revision done with particular techniques would give you an improvement (see link).

I read your concerns and reviewed your photos. In my view, you should reserve any further revision rhinoplasty surgery as a last resort. You have some tip asymmetry, and nostril retraction on both sides. You may want to consider a non-surgical rhinoplasty procedure to add some volume to your nose, lower your nostril margins, and restore tip symmetry. I prefer to use Silikon-1000, an off-label filler, for permanent results.

I hope this is helpful for you.

Regards from NJ:

You never HAVE to have a revision rhinoplasty. The main issue is whether the problems that concern you can be improved with surgery and whether the risks, recovery time, and expense are worth it.

In experienced hands your nose can be improved. If you are seriously considering revision surgery I would be sure to consult with a few surgeons who have extensive experience with revision cases like yours.

A better sense of what could realistically be done would come from an examination of your nose.

One should be very careful when undergoing a fourth revision rhinoplasty.  An alar retraction is best treated with a combination of composite grafts from the ear along with any alar baton grafting.  Columellar hanging and show are best treated by resection of both membranous and cartilaginous caudal septum.  Look for a very experienced rhinoplasty surgeon who has lots of experience performing both primary and revision rhinoplasty before embarking on your next rhinoplasty endeavor.