Advice on what went wrong with my first rhinoplasty (14 years ago)

It looks very much as though your nasal bones were not narrowed in the first operation. Those wide nasal bones are making the upper half of your nose look wide.
Then, if you're going to have a revision, I'd love for you to see some morphs of some changes to your profile. To my eye, the tip is strongly projecting compared to the rest of the bridge. The tip could be brought closer to your face. Moving the tip would also give more opportunity to put the tip closer to the middle of your nose, too.
However, this would not be a rhinoplasty that most surgeons could accomplish with any predictability or skill. You have to be very careful in researching your surgeon. And if you *do* decide to have changes made to the profile, morphs are mandatory, so you and the surgeon are on the same page, and he must convince you that he has the skill to make those changes.

Not trying to be over critical here, but your profile shows a clear and severe saddle-nose deformity for over scoop of the bridge. It is true your over projected and somehow upturned tip aggravates the scoop at the bridge, nevertheless beyond any shade of doubt you are a typical bad outcome after over aggressive dorsal resection.

Additionally, you have an evident open roof deformy plus its regular companion the inverted V deformity, this happened because you did not get ostetotomies (infractures) as mandatory per book.

Some damage to the tip support on one side and probably caudal septum deviation are creating that deviated tip, this is another major goal, the third, of your revision.

The lateral alar cartilages are practically missing, subtotally removed, with nasal pinching and impigement of the nasal valve that is collapsed; essential to repair this and rebuild your tip.

Probably rib grafting will be needed; difficulty 9/0 in revision cases, better find a good and experienced surgeon who focuses on these four therapeuitc / reconstructive goals.

Based on your photographs, your tip veers to the left, and this is associated with an indentation in your left hip, and an overall wide nasal appearance in the bridge. On profile, your nasal tip appears to be a bit over projected, which means it sticks out a bit too far. If you have severe dissatisfaction with your nasal appearance and breathing, please consider meeting with several reputable rhinoplasty specialists who are familiar with cartilage grafting techniques, for consideration of revision rhinoplasty, for a more symmetrical, better breathing, and less operated looking nasal appearance. Wishing you well moving forward. Sincerely, Dr Joseph

Hello and thank you for your question. Based on your photographs, you are a great candidate for revision rhinoplasty. Maneuvers for your surgery would include straightening of the tip, nasal tip deprojection, 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