Alarplasty/Tip Plasty v. Full Rhino -- more affordable?

It is interesting to learn that your nose was "excellent" following the rhinoplasty only to develop this marked asymmetry following FFS 4 years later! Besides what appears to be an upper liplift with a staghorn incision, I am wondering if you had any other FFS surgery. It is well known that advancing the white lip cephalad can cause nostril asymmetries, despite accomplishing a very acceptable liplift result. If one were to address the right alar retraction, an open approach would be best to determine if scar contraction was the cause. This could be easily corrected, but usually requires suturing of the LLC to something quite stable to avoid another scar contracture. Finally, the use of a composite graft from the ear may be ultimately necessary to bring the alar rim down.

Revision rhinoplasty for the unsatisfactory result. You will need a revision for your caudal septal deviation in your Left nostril , soft tissue grafts to your tip, etc as well as release of your lip. See a very experienced FFS surgeon for this who does natural noses.

The tricky thing with nostrils is that they actually don't have any cartilage support in them at the edge of the nostril rim. Above the nostril, up to about 5 mm or so, the same cartilages that run through the nasal tip push down on the nostril rim to keep it in the right place.
Sometimes in a rhinoplasty surgery the two cartilages of the nasal tip end up a bit asymmetric, with one higher than the other, which then brings one of the nostrils to this higher position as well. There is usually also some associated weakness of the sidewall of the nose in this situation, which can compromise nasal breathing on that side. This is what I see when I look at the photos you have provided. When rhinoplasty leads to one nostril margin going up, such as what is occurring on your right side (left side of the photo), it typically needs to be carefully repositioned back down by moving the cartilages themselves back down. In my opinion, by far the most effective way to do this is with open approach tip rhinoplasty. I personally feel that this is the best chance to restore a more symmetric appearance and improved breathing function.
Still, the most important thing for your situation is to have a good consultation with a board-certified plastic or facial plastic surgeon, where you feel comfortable with the approach the surgeon recommends and the plan makes sense to you.

To my eye your main problem is the hanging columella and I can under and why it bothers you. The columella is the part between the nostrils. It is easily corrected by trimming cartilage from that area at the lower edge of the septum. Very common from rhinoplasty because surgeons don’t know to trim at first time. Luckily a straightforward fix. You do not need cartilage grafting. That may have been what caused this to begin with.

Your nose looks great. The risks of having an alarplasty and tip plasty far outweigh any potential benefit. However, if you still want to do it, here is some info.
Tip-plasty and Alarplasty

You can have the lower half of the nose (tip and nostrils) addressed without breaking the nasal bones. Tip-plasty can address the bulbous tip either through closed or open approach to make it narrow and refined.
Alarplasty is a very fine and quick procedure that can narrow the nostrils and reduce the flare to soften the appearance. It has other names as well like ‘Weir Excisions’ or ‘Nostril Reduction’. However, it is important to note that asymmetry of nostrils is common and cannot be corrected with alarplasty.
Both of these can be done under local anethesia.
Watch the video link below.
Regards
Dr. J

Thank you for your question and sharing your photographs.

The front view appearance of the nasal bridge seems very good and there is no reason to change it with a full rhinoplasty. This is of course assuming that adjustment in the contour of the tip on its own would give you the profile that you like.

There is an asymmetry of the anterior nasal spine which needs to be worked on to help positioned and align the tip better, and it can be combined with surgery to lower the nostril rim on the right side and alar base reduction if you feel you need it.

The current shape of the tip suggests a torsion to the right, and it may be that restoring the alignment of the tip cartilages automatically improves the position and shape of the right nostril. This can only be determined during surgery.

Your nose lacks support especially at the tip... that is why you are under-projected and the tip cartilages are uneven.... nostril shape follows tip morphology... the addition of what looks like a nostril sill type of lip lift has added to the problems

Good luck....