I have been refused a revision rhinoplasty. What are my options now? (photo)

Dear Kerry, The deviation of the middle and lower part of the septum seems to be a significant aspect of the problem. It can be addressed, and usually requires reinforcement either with septal cartilage or with rib cartilage. Once this is addressed, alignment of the tip cartilages becomes more manageable. I suspect the advice from the previous surgeons is because the profile looks good but both the front and profile views can be addressed. 

Hi Kerry, from the image you have posted:
Your nasal septum appears to be deviated and tilted. I suspect that this is why your nose has obvious asymmetry of the mid section and the tip area.
This should be amenable to revision rhinoplasty including septal work, but a full assessment would be needed and you will need to be aware of the limits.
All the best, Waseem 

I see what you point out, although one frontal view doesn't give the information that a complete set of photos from all angles could.Your tip cartilages seem very strong, and asymmetric. Probably it's the three-quarter views that would show the prominence of the tip best.I can't tell from the frontal view, but when the cartilages are this strong, they also usually hold the tip down, and hold it out forward away from the face. So elevating the tip and bringing the tip back closer to the face could be a good part of a revision on your nose. Those changes would just overall make the nose smaller, too, and that'd be good, because then whatever asymmetries or other bothersome features remain after surgery, they would exist on a smaller nose, and so they'd be smaller, too, and they'd bother you less.The bridge seems wide and asymmetric, too, prominent on your right more than your left.These are all changes that are possible. In fact, they are fairly routine in a revision, but it takes huge expertise, and it's good that a surgeon who doesn't feel comfortable with the task doesn't offer you the operation.The woman in the short video that I posted with this answer had the tip of her nose elevated and narrowed in her revision operation.
How *much* to elevate the tip, or deproject the nose, or narrow the tip and bridge? 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 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 always 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 only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
Remember also 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.
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?