Hello and thank you for your question. After rhinoplasty (nasal surgery), the nose can become REALLY swollen, and this swelling can take a LONG TIME to resolve (up to 2 years to fully resolve). I am not sure how long ago you had your most recent revision operation, but if it was less than 2 full years, I would recommend that you continue to observe things for now to allow all swelling to fully resolve. If there are still concerns after 2 years post-op, you can consider surgery. There is no guarantee that another operation will make things perfect, but surgery can definitely help make things better. Though some surgeons would say they can achieve your goal via a closed technique, I would argue that the open approach is much more effective in facilitating complex, precise maneuvers to refine the nasal shape and size to a particular aesthetic and look, particularly in a revision operation. To address the upper 1/3 and middle 1/3 of the dorsum, assuming they remain prominent after the swelling fully resolves, you are talking about taking down the bone (upper 1/3) and cartilage (middle 1/3), which cannot be done effectively with just rasping. To answer your other question, if done correctly, rasping should not affect the tip. However, with re-opening a previously operated nose, extra precautions have to be taken and structural reinforcements have to be made to ensure that the tip does not distort post-op as a result of the deforming forces involved in healing/scarring. Rhinoplasty is arguably the most difficult procedure to perform in all of plastic surgery, and revision/secondary/tertiary operations are much more difficult than primary operations. Consequently, I would recommend only going to see a surgeon who feels very comfortable with both primary and revision rhinoplasty procedures, and who has significant training and experience in these types of surgeries. This is a surgery of millimeters, so if the surgeon you're going to only does 1-2 per month, you are not going to get the best result possible. Of course it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from photos and descriptions provided. I recommend for you to come see me or another plastic surgeon comfortable with rhinoplasty procedures for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps! Best Wishes, Dr. Donald Groves Plastic Surgeon