Revision rhinoplasty for nostrils, notching & nose tip? (Photos)

The primary goal of your revision, as I see it, would be to shorten the nose, which means raising the tip. Whatever nostril work is possible would be done at the same time, but the majority of the work would be the shortening. The good news is that, even though it takes complex techniques, especially in a revision, it does tend to be one of the more predictable changes we can accomplish in a revision.
How *much* to elevate the tip, or deproject the nose, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

I'd love for you to see some excellent morphs of what could possibly be done with your nose. It might make you feel better about the possibilities. Morphs help you plan your ideal goal, and help the surgeon understand what you need in order to be happy, and correlate that with what he thinks is possible in his hands.
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.

Good Morning! Thanks for your questions and excellent photos. Those are very helpful. I can see what you're referring to. The asymmetry in the bridge and midvault can often be fixed with grafting - either cartilage or soft tissue. The tip may need to be refined and lifted. Repositioning the tip on a strong caudal septal extension graft can do wonders. Nostril width and flare can be adjusted via a base reduction being careful to not overdo-it as correction can be very difficult. As with any revision, there is a risk of creating new problems (although low). I would seek consultation with other surgeons if you're comfortable to gather more information. Best of luck!