You do not "need" to do anything with your nose. If you are bothered by something about it and can articulate precisely what that might be, then the chances are it can be addressed. Whether you will be happy with your "new" nose is another matter because there might be some trade offs. In your case raising the dorsum with a graft might lead to visible edges of that graft or having it be too high or askew. Perhaps the most conservative thing to do would be to have some filler injected into the bridge to simulate what a graft might do. Any of the hyaluronic acid based gels such as Restylane or Juvederm are very safe and can even be dissolved if you don't like the effect they have. If you like the effect then you could continue with the fillers or you could move forward with a cartilage graft when the timing is right.
Revision rhinoplasty is a complex procedure, and the risks must be weighed against the potential benefits and cost. Augmenting a bridge can be more difficult with certain skin types, as can de-projecting a tip. Consult with an experienced rhinoplasty specialist who can examine you in person and give a complete recommendation.
Only you can decide if you "need" a revision. However, slight augmentation of your bridge with cartilage would address your concerns and the results would be permanent.
Overall, your nose is very nice, and I am not sure I would operate. The tip can be deprojected, but just because this can be done does not mean that it should be done. It all depends upon your motivation and your goals.
Find a board certified plastic surgeon who performs hundreds
of rhinoplasties and rhinoplasty revisions each year. Then look at the
plastic surgeon's website before and after photo galleries to get a
sense of who can deliver the results.
Kenneth Hughes, MD
Los Angeles, CA