Depending what was done during your last two surgeries, and depending on what you prefer your nose to appear like this point going forward, you can certainly be a candidate for a third surgery. Your goals must be clearly communicatted and this is best done in an in-person consultation with a revision rhinoplasty specialist. I would be happy to provide you a comprehensive evaluation with a review of your history and goals along with a viewing of patients with your similar issues who successfully underwent revision rhinoplasty.
Is a Third Rhinoplasty Safe and Reasonable?
A third rhinoplasty is appropriate depending on what wasdone during the previous operations and what is necessary to achieve a reasonble result 18 months after your last surgery. Your bulbous tip can be refined. Have a consultation with a surgeon who specializes in revision rhinoplasty. Each procedure becomes more difficult - you want this to be your last.
There is no hard and fast limit to a number of surgeries. However, each time you operate on the nose there is additional scar tissue and the support framework for the nose can get compromised. This can be a concern. Additionally, if you have thin skin every irregularity can be noticeable. Good luck and be careful
Revision rhinoplasty to refine tip and augment nasal bridge
In general there is no limit to the number of rhinoplasty surgeries that one can have. With successive surgery there may be limitations with what can be achieved due to scar tissue, disruption of the existing anatomy, etc.
Judging by the one photo you submitted I could see that augmenting your bridge may help a bit with refining your tip. It may sound a bit counter-intuitive, but by improving the projection of the bridge and tip the nose will appear narrower and more refined. This effect is especially helpful in patients with thicker skin.
Every surgical procedure adds a level of difficulty due to additional scar tissue, compromise of blood supply, and possible loss of key structural elements. One photo view is not sufficient to make a complete recommendation. However, one piece of advice I will share is that tertiary Rhinoplasty requires a very defined and realistic view of what your goals are with further surgery, shared with a very experienced Rhinoplasty surgeon. Failure to do so will lead to a fourth Rhinoplasty and so on.
Multiple attempt at revision rhinoplasty can be treacherous. The quality of the tissues may make it more diffiuclt to mold and work with. Defining the tip more, say in a thick skinned nose, may not be attainable as say it would in a thin skinned nose. If you are considering addtional surgery, then I would recommend going with a very experienced revision rhinoplasty surgeon.
Bulbous tip after revision rhinoplasty
Reviewing your photo reveals a bulbous tip that is not in harmony with the rest of your nose. The third and final procedure, a tip rhinoplasty is a reasonable procedure, if it is performed by an expert revision rhinoplasty surgeon. The only limitation, if you have thick nasal skin. In this case reducing nasal tip to more defined form is challenging. Good luck. Dr. Kevin Sadati
Is rhinoplasty safe and indicated after 2 rhinoplasties.
It is as safe as the surgeon is good! If your goals can be achieved then you can proceed. Make sure you see an experienced revision rhinoplasty expert. Whether it is done open or closed depends on what needs to be done to the nose. In 35 years of rhinoplasty I have never had vascular compromise with open rhinoplasty revisions. Some I do closed and others open.
There is no number limit to rhinoplasties, but should be done closed for safety
You can almost always have another surgery--but what can be achieved and what has to be done depends on a number of issues.
The surgeon performing your next operation needs to be aware that the circulation is not what it was originally. This is one of the reasons that I believe and teach that that closed rhinoplasty, which allows the surgeon to limit dissection and never close a wound under tension, is much safer than open rhinoplasty for revisions. Data supports my beliefs. Soft tissue loss can occur when the circulation is not normal, but almost never happens after closed rhinoplasty. Even the best open rhinoplasty surgeons have healing problems on occasion.
It is also important that you and the surgeon have a well-defined and achievable goal, and that you have evidence (from photographs) that the surgeon has done your type of correction before, and that you like the results.
In your case, two reductions have not improved you because you need both dorsal and tip grafts to shape your skin--it cannot shrink to the shape that you want. Assuming that you want a straight profile and a smaller lower nose, that strategy will definitely work, but must be performed by a surgeon experienced in the techniques--that you trust. Good luck!
Rhinoplasty for the third time
A third rhinoplasty is not unreasonable if you had issues or regrets from the second one years after the first. Since you are 18 months out from the last procedure you current result is soft and stable and unlikely to change. The third procedure might work out best if you try computer simulation to try out the result and changes on paper beforehand. This may help ;you and your surgeon understand the goal in mind.
Best of luck,