Cosmetic and functional issues 17 months post op - how much improvement can I realistically expect from a revision? (Photos)

You appear to have a relatively pleasing nasal profile appearance, however, you appear to have asymmetrical nostrils, and a deviated nasal septum, as seen on the base view of your nose. If your initial surgeon left an adequate amount of cartilage in your nasal septum, you would not need cartilage from elsewhere to reconstruct your Airway. When we meet patients that have nasal Airway obstruction, and a paucity of nasal septal cartilage, we prefer to use MTF profile sheets of cadaver rib cartilage for reconstruction. I hope this helps, and I wish you well moving forward. Sincerely, Dr Joseph

In cases like yours, where both breathing and appearance are affected, a detailed evaluation of the internal nasal structures is essential before planning revision surgery. The CT finding of septal deviation to the left explains part of your obstruction, and the improvement you feel with NoseVent suggests narrowing of the internal nasal valve as well.
A revision septorhinoplasty can improve both form and function, but the extent of correction depends on how much structural support remains from the first operation. When previous surgery has removed or weakened the septal cartilage, additional grafting material is often needed to rebuild the internal framework. In such cases, rib cartilage is a reliable and commonly used option, as it provides enough strength to restore both airway support and external shape.
From a cosmetic standpoint, the crooked appearance, nostril asymmetry, and the depression above the left nostril can typically be improved by straightening the septum, restoring tip support, and adding precise grafts for balance and symmetry.
Carefully planned reconstruction can lead to significant improvement in both breathing and appearance.
This approach focuses on restoring the natural architecture of your nose rather than simply changing its shape, which usually brings the most stable and satisfying result.Güray Yeşiladalı, MD

I have many technical comments abour your case; to start with there is no significant septal deviation in the CT scan you've posted, so don't get a septoplasty; the sources of difficult breathing are many, among them... a collapse or damage to the nasal valve, something that is evident in your photos. The fact nose vent, a treatment for nasal valve disfunction, is helpful... proves my thesis.

Secondly, you do not have a crooked nose, only the natural and non treatable nasal and facial asymmetry we all have, so don't you focus on that, your nose has enough problems, read on:
-over shortened nose, over rotated tip, upturned (piggy), shortened septum
-nasal valve collapse, pinched look
-over sharpened tip, aggressive transdomal plications
-over aggressive resection of alar support
-contour irregularities

This is a case for a difficult, comprehensive but in good hands very rewarding revision rhinoplasty, do research well the surgeon's experience, talent and passion for fine work on difficult cases; do perform dozens of in person and online consultations before moving forward.

In the link associated to this answer you can find further information and images related to your problems.

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 placement of extended alar contour grafts to help improve nostril symmetry, tensioning of the tip, among other maneuvers. Your breathing can also likely be improved. 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