Is it possible to have a minor revision to my nose? First rhinoplasty done 20+ years ago.

The small hump can be easily filed down. The tip can be modified to improve symmetry. It can be achieved without grafting as your needs are not drastic.
Regards
Dr. J

There are many issues going on in your nose which include residual dorsal hump, a droopy tip, hanging columella, left-sided alar notching and an inverted V deformity. A full revision rhinoplasty is going to be required to address all of these issues. It is very important to know how much cartilage left on the inside of the nose for grafting purposes since you will require spreader grafts placed in the midportion of the nose. Osteotomies will be required to narrow bridge after the dorsal hump has been shaved down. To reduce the alar notching will require a composite graft of cartilage and skin harvested from the ear. Reduction of the hanging columella and lifting nasal tip can be accomplished by removal of excess skin and cartilage in that area on the inside of the nose. A closed rhinoplasty approach can accomplish these all of your goals. All incisions are placed on the inside of the nose. No external incisions are required.