Should I correct an inverted V deformity or just the tip, that really bothers me, in a revision rhinoplasty? (photo)

Click on the "Learn more" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_TinkerTinkerBell.html
I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.Mostly, I elevated the tip of the nose, and lowered the height of the bridge to match the new position of the tip.Your "inverted V" is very mild, and usually can be addressed by moving the nasal bones closer to each other. Working on the "V" with spreader grafts widens the middle part of the nose, and I don't think you'd like that. Then, the tip is so droopy. That's what I'd focus on.Also, elevating the tip is *not* accomplished with a strut from the ear. A strut doesn't elevate a tip. Rather, it's much more complicated work on the tip cartilages that allows the tip to elevate.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Learn more" link on how to stay out of trouble while searching for a rhinoplasty surgeon, and how to tell whether your previous surgeon should be performing your revision. You should only have surgery if you are able to make yourself very confident in your surgeon's skills. Read that page very carefully. Most plastic surgeons are quite poor at this operation, and I believe my advice will go a long way toward keeping you safe.
I'd love to hear what you think of the morph. Did it seem to address your main concerns?
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
In your case in particular, you need to find a surgeon who understands all of the issues I mentioned, and how they fit together, and who can actually accomplish them in surgery. 

Hello,
Thanks for your question. You could certainly leave the inverted V deformity alone. However, if you are having breathing issues, it should be repaired. Also, with time an inverted V deformity tends to look worse. You also have polly beak deformity of the supratip. That would need to be repaired as well to get a smooth appearing bridge on profile. The tip can be rotated up a bit and properly anchored with sutures, although you might need a columellar strut graft as well if your tip cartilages are weak. If you came to me. I would recommend a proper correction with septal spreader grafts, polly beak deformity repair, tip rotation, and tip support. Good luck,Dr. Shah

unless you have breathing problems I would not recommend spreader grafts. Besides, in revision rhinoplasty one needs to keep an open mind on what he might find inside as sometimes you might be surprised what surgeons might do. I would suggest correcting both deformities with minimal work and use spreader grafts only if you have breathing problems or what is known as internal valve collapse.
Best of luck, 
Shady Hayek

While it is always seductive to consider simpler methods for revision rhinoplasty when the primary operation has been unsatisfactory, revision rhinoplasty is usually done BEST when a complete operation is performed. Unless the issues are minor, you will likely be most pleased by a holistic approach.... I believe this to be true largely because all of the structures of the nose are interrelated. In my hands, revision rhinoplasty is most meticulously performed via an open approach.good luck...