it is hard to answer your questions without getting a sense for the width and height of your nasal bridge. a soft tissue graft may be indicated if you have sensitivity of the bridge
Revision Rhinoplasty Options
Revision rhinoplasty is not one operation, but many potential operations. Every patient is unique. Revision is more commonly associated with the tip, but may also involve the bridge or upper nose. Each surgeon that you see will provide his/her recommendations, which will vary. If you think the bridge is too wide and you have an "open roof", then osteotomies and bone reshaping may be appropriate. Only after a comprehensive evaluation can a rhinoplasty surgeon help determine appropriate options for you. Best of luck.
What needs to be done during revision rhinoplasty
There is no one set of techniques that need to be done to correct prior rhinoplasty problems. A lot would depend on your specific exam findings. If you were left with an open roof you may need osteotomies to refracture the bones to bring them inward. Placing an onlay cartilage graft could be indicated, though this would also raise your bridge somewhat. This would be useful to correct an overly scooped out bridge.
Other concerns with this type of surgery is address any nasal valve collpase. The internal nasal valve will often narrow over time in patients with bridge hump removals that aren't adequately supported. Cartilage grafting may be used to improve this problem in addition to the issue you mentioned with your tip.
Your surgeon should be able to address your questions. If not, I would find someone who can.
An open roof deformity is usually addressed by osteotomies. It is possible to place a graft across the top of the nose but only if the bridge is narrow and looks scooped out. Adding a graft to the top of the bridge will only increase the height of the nose. Usually osteotomies are performed to close the open roof. Any tip surgery can be done at the same time.
Fixing an open roof deformity after rhinoplasty
An open roof deformity is where the bony component of the bridge of your nose has not been closed together after hump reduction. Typically, an open roof deformity is treated with osteotomy. If you desire to replace the hump that you had previously removed without necessarily having osteotomies, then placing a graft on the deformity will also close the deformity but will alter your profile.
Revision rhinoplasty approaches
Even more than with primary rhinoplasty, revision rhinoplasty is a highly customized procedure. It's normal that two surgeons would each propose slightly different solutions to your problem. Regardless of what the surgeons recommend, each should be able to show you a reasonable approximation of what the nose will look like afterward. This is one area where computer imaging can be super helpful. I use it extensively for rhinoplasty planning.
All the best,
Revision Rhinoplasty for Open Roof and Tip Deformity
Both recommendations are approriate depending on what was done during the original surgery and what you look like today. If you choose to send pictures to me, I'll be happy to give a more specific answer. I usually recommend an open rhinoplasty in revision surgery.
Closing open roof deformity with Revision Rhinoplasty
The open roof deformity needs to be closed. You can have osteotomies to close the open roof, or if you have a scoped out nasal bridge, an onlay nasal implant (I prefer silicone straight, no L- shaped ones) for this purpose) will cover the open roof deformity but you will need one of those to treat the open roof regardless of what else is done to your nose during the Revision Rhinoplasty.
Without seeing you or your pictures its impossible to determine what the best action for a revision rhinoplasty is. However, if you have a true open roof deformity then you need osteotomies to bring the bones together. You may or may not need an onlay graft as well but the osteotomies are usually a requirement. You may also require spreader grafts if you also have an inverted V deformity. But again without seeing you none of us can tell you what to do. Your surgery can be open or closed. That depends on the surgeon's comfort. You have already had one bad rhinoplasty so make sure you do lots of research and choose your next surgeon carefully. Good luck