Seeking 2nd Revision Rhinoplasty - Room for improvement or would the risks likely outweigh the benefits? (Photos)

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include release of scar tissue followed by placement of extended spreader grafts to help reduce nostril show, tip refinement, tip rotation, 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

To start with, you need to understand why your outcome is evidently poor and indeed there is a hugh margin to improve your nose; your surgeon failed to detect or lacked the expertise/talent to master one of the most difficult types of primary noses, the so called "tension nose", a term used in the US but rejected in the industry, in Europe we refer to this typology as a imbalanced nose with hypertrofic upper 2/3s and hypoplastic lower 1/3.

Tension noses have a large bump, large bones, large triangular cartilages and, paradoxically, the tip, alae and annexes are underdeveloped, between relatively small down to objectively tiny, showing a shortfall of skin at the lower end of the nose (didn't you ever wonder why your upper lip is always being pulled up and the philtrum tight? correct, because your nasal development tried to recruit skin from adjacent areas).

Tension nose rhinoplasties are of very high difficulty, the surgeon needs to have very good aesthetic judgement and a vast portfolio of technical resources, given he must reduce the upper 2/3s (but not as much as naked eye it might seem, otherwise that'd be a saddle) and augment, yes, augment projection and derortate the constricted tip and alae but... attention... this augmentation has to be carried out using a very very strong framework of graftings and neo-skeleton, so that it will be able to expand and beat the resistance of the constricting cutaenous hood happening to exist at the lower 1/3.

Additionaly, not that complexity wouldn't be enough, you suffered from verticalized lateral cruras and bozy tip, absurdly known in US as "parenthesis tip deformity", needing rim grafting, lataral crura relocation, tip grafting, tutoring, etc.

Your current result is quite poor, the tip is even more rotated and piggy (nostril show) than preop, the tip still is boxy, etc, yes I recommend a revision but you have to consult with dozens of surgeons, travelling or online, so that you can confirm the treatment proposal is close to the scenario I am depicting in my answer.

See the link attached to this answer to know more and view results of tension noses.