Is the level of re-projection I'm trying to achieve considered major (needing costal) or minor (only needed conchal)?

Revision rhinoplasty to increase projection after several rhinoplasties. Based on 44 years of rhinoplasty I usually only use conchal cartilage for noses similar to yours. 

Hello, thank you for question and photos, based on them firstly you need to complete your healing process which is at least one year long, then after detailed examination when required a Revision Rhinoplasty procedure can be performed and nose can be improved for better. However, there is always a finite limite about how much a nose can safely be altered. Closed and Atraumatic Technique provides maximal healing, minimal edema without a scar on columella.Regards,

You appear to have relatively adequate tip projection albeit with a slight caudal (downward) dip of your anterior-most portion.... a dorsal reduction and slight radix set back along with adding a bit of tip support would likely give you what you desire.... as always, an exam yields the most information

 Revision rhinoplasty is always more difficult than a primary rhinoplasty due to the fact that there is scar tissue present, thick skin, and previous alterations to the normal anatomy. It's also important to wait at least one year before embarking on another procedure. It's also important to look at the nose in all three dimensions, since the nose is a three-dimensional structure, and rhinoplasty is performed in all three dimensions. It's impossible to do that with a one-dimensional side  profile photograph. It's also  Important to have realistic expectations, since there is no perfect nose and there's a only a finite amount of stress that the skin will allow to get additional projection.  Skin necrosis can occur  when trying project the tip of the nose too much with rib cartilage. Consider Shaving down the dorsal hump that is present  which will give the visual illusion of tip has more projection. When going in for consultations, it's important to bring your previous  operative reports to understand what was accomplished in previous procedures, and know how much  cartilage is left over on the inside of the nose for potential grafting purposes.

I would consider slightly reducing the dorsal hump providing a supra tip break which would give the same appearance as having the tip slightly projected. Currently the dorsum is slightly higher then the tip. The other alternative is using a grafting material and that would be determined by how much cartilage you have left in the nose. I would suggest seeking consultations with experts in the field and bring your last operative report and your last preoperative photographs to better understand what techniques were used during your revision procedure. Furthermore you should wait an entire year since your last surgery to ensure all of the swelling has dissipated. See some examples in the link and video attached. Best regards, Michael V. Elam, M.D.