Should I have a fourth revision rhinoplasty? (Photos)

To narrow the dorsum, firstly... you have to narrow it! do suggest this to your surgon... infracturing a nose without previously narrowing the osseous dorsum is... just infracturing a nose. Sounds silly but is real and trustworthy strategy.To narrow a dorsum you have to do paramedial saw reduction of the synostosis betwen osseus septum (center) and nasal bones (sides).Advice: McCarthy's Plastic Surgery textbook, Head and Neck manuals, Dr. Sheen's rhinoplasty chapter.Additionally there are other issues in your nose: nasal pinching, not very good tip outcome, poor definition, and massive irregularities (suitable for temporal fascial hiding).Let me finish telling you I'd never perform a congenital craniofacial surgery in a newborn, toddler, child, teenager or adult... even though I am massively experienced in cosmetic and revision rhinoplasties, the former is not my expertise and the latter does not authomatically entitle my experience in it.

The risks following a rhinoplasty increase with each revision.  With that said, it does look like all you need would be to infracture the nasal bones, and by itself this should not increase the risk significantly.  Given that you have had 3 previous rhinoplasties it would not be a bad idea to consult with another experienced rhinoplasty surgeon in your area for a second opinion.  I'm not suggesting you go to another surgeon just that getting another in-person opinion might make you feel better about going ahead with your original surgeon.  Good luck.