Am I Pushing It With A Fifth Time Rhinoplasty?

As long as the skin envelope has not been damaged, revision rhinoplasty is often safe even with multiple previous surgeries.  Difficulty breathing with a drooping tip may be due to nasal valve collapse, and turbinate reduction surgery alone may not be adequate.  Revising a nose with multiple prior surgeries requires extensive grafting to ensure that the changes are permanent, and rib grafting is often necessary.

If you don't like how your nose looks one could consider another revision. Some surgeons are more adept and comfortable doing these cases than other, so you should chose your surgeon wisely. It's hard to be specific without seeing your nose, though.

As a separate issue, surgery on your turbinates won't affect your nasal appearance (and is no easier or more difficult having had prior rhinoplasty surgery) but can help with nasal breathing problems. With so many prior rhinoplasties your surgeon should make sure there haven't been structural changes to your nose that are leading to breathing problems.

Your next surgery is classified as a 'tertiary rhinoplasty'  that is a rhinoplasty after two or more unsuccessful surgeries.  Very different techniques are necessary for success and you should choose a surgeon well versed in these cases.  My bias is to select a plastic and reconstructive surgeon with extensive reconstructive experience as that is what has given me the skills to deliver excellent tertiary rhinoplasty results.  In general, harvest of a small portion of rib is necessary and replacing the basic structural integrity of the nose with some variation of an 'L-strut' followed by customized tip and alar grafting is necessary.  In this way a truly aesthetically and functionally sound new nose is produced.  I hope this helps!

All the best,

Rian A. Maercks M.D.