Timing of 5th Rhinoplasty Procedure
The pictures you submit lead me to believe you just had the 4th surgery. Wait for resolution of current swelling, which will probably be several months to a year, before considering another revision. With the help of your expert revision surgeon, you will be able to evaluate your present result. If you're not patient, the outcome can be disastrous.
Although 4 rhinoplasties seem like a lot, it all depends on what was done in each of them. Many patients will have little done between the first, second or third. This should be taken into consideration by the surgeon. I also believe that some revisions can be done as soon as 3 months after the previous procedure. Typically, most surgeons would say to wait one year.
As far as lengthening your nose and tip refinement, that needs to be determined in a consultation. If you have an ethnic nose you may need to have your tip defatted. Lengthening the nose can also be performed from the top down as opposed to the lengthening it from the tip.
The enemy of good is better (surgeons understand this).
At this point in time you risk the problem of ending up having Michael Jackon's Nose (RIP). IF you put repeatedly operated and scarred skin on stretch or tension with a lengthening graft (not graph), it is likely that the skin will ulcerate. This will result in exposure and probable loss of the graft.
Currently you have a good result and despite your desire to seek a better outcome, my advice to you is to refrain from any additional surgery before you get in irreparable trouble: " The enemy of good is better".
The swelling has not resolved yet, and will take a long time for the swelling to go away because of the scarring. So, give it time to heal and the swelling to subside, DO NOT THINK OF ANOTHER RHINOPLASTY.
With every surgery you run the risk of destroying your nose permanently.
Multiple revision rhinoplasties
With each surgical revision of your nose, the results become increasingly unpredictable especially if you are trying to make additional refinements to the tip or lengthening the nose. My advice would be to wait for all swelling to resolve before you consider additional rhinoplasty surgery of at least one year. It may be possible to do additional surgery but that would depend on healing factors and the current status of your nose and skin. Besides if you wait you might be satisfied with the two year results from your current surgery.
3 rhinoplasties is enough!
You need to stop having rhinoplasties. At this point, after 3 surgeries by hopefully well-qualified surgeons, you are as good as it gets for you in most all cases. Give the swelling a year to go down and try to adapt to your nose. There are just times to stop and this is probably one of them!