Secondary Rhinoplasty After 20 Years, Are My Issues Fixable?

Yes, you can still consider a revision rhinoplasty after 20 years.  There are liimits based on your thick skin but you do have areas that can be addressed with surgery.

From looking at your photos I can see that your tip is under-projected which has led to a less defined tip. Reprojecting your tip into your relatively thick skin would help refine its appearance and actually make it appear smaller. Your bridge could also be augmented to strengthen your profile. Cartilage grafts would be needed for these manuevers. If you don't have adequate septal cartilage then ear or rib cartilage may be needed.

Visit with a few revision rhinoplasty specialists to get a complete assessment and to discuss your options further.

I read your question and reviewed your photos:

It's not clear from your concerns exactly what you would like to achieve with your nose. You don't have a "terrible" nose, and your thick skin makes it difficult to tell you've had previous rhinoplasty surgery.

You should consult several revision rhinoplasty experts to determine what you could achieve with further surgery.

Regards from NJ.

The best thing is to have a personalized consultation (would be better in person) so that the nose can be properly evaluated.  At this point, the most important issues are 1) getting a result that satisfied your aesthetic desires and 2) ensuring that you will still be able to breathe after your revision.  The skin is something we all take into consideration with any rhinoplasty patient.

You have an attractive natural appearing nose now.  Could you improve its looks with another revision? Yes, you could increase the height of the bridge and give the tip some more refinement with cartilage grafts.Getting good revision rhinoplasty results often requires the skill of a surgeon with many years experience with revisions. Be sure to see many before and after pictures of cases similar to yours.  

In the hands of an experienced rhinoplasty specialist, you should achieve a significant improvement. In my opinion, you need moderate dorsal augmentation to increase the height of your bridge, and smooth the irregularities. In addition to the thick skin, it appears that the skin envelope along the tip has contracted has a result of your previous surgeries, causing the round apperance. Restructuring the tip with cartilage grafts would improve on the shape of your tip. While every surgeon has different preferences, I would use rib cartilage to achieve the goals previously mentioned.