You have reasonable concerns about the appearance of your nose and you have waited an adequate time for healing to stabilize. For patients with average to thick nose skin, better tip definition may be obtained with a tip graft that increases the projection of the nose. Increasing projection stretches (and thins) the skin on the tip, which improves definition. If your nasal tip is not already over-projected on profile, than this may be a good solution for you. The bridge may be narrowed and made to better resemble an hourglass shape. However, remember that any narrowing done on the outside is also narrowing on the inside, which may affect breathing. The goal is to achieve a balance between your aesthetic goals and adequate nasal function.
Revision rhinoplasty candidate
Revision rhinoplasty is going to be harder than a primary rhinoplasty with a less predictability of healing. Look for a very experienced rhinoplasty surgeon who has dedicated a significant component of their practice to the discipline a rhinoplasty and revision rhinoplasty. The tip of the nose can be made more narrow with suture techniques, cartilage grafting and a conservative cartilage removal. Osteotomies of the bridge line are required to narrow the nasal bones. An alar plasty can be performed to narrow wide nostrils.
Revising the tip will certainly define it better. To reduce the width you need Alarplasty.
Considering nasal revision due to rounded tip and wide bridge.
At three years post surgery you can safely undergo a revision. It appears that ample cartilage framework was left, and a conservative procedure was done. A revision rhinoplasty should be straightforward, and in an experienced surgeons hands, the bridge could be narrowed without changing the profile (unless that was desirable) and giving the tip more definition. Your question suggests that you recognize the importance of choosing your surgeon carefully.
Worried that revision rhinoplasty surgery could give worse results!
This is a realistic concern that needs to be carefully discussed in the context of a personal examination and review of your goals and present anatomy.
It should go without saying that his also requires the care of an experienced surgeon, as subtle improvements are more difficult to achieve than major changes. The more minimal the request for "improvement," the more unlikely actually achieving them there is. Or, conversely, the more likely that things could be worse.
After 3 years, re-operation is safely possible, but not if you choose someone who does not understand the subtlety needed in situations like yours. Obtain several consultations with experienced ABPS-certified plastic surgeons or board-certified ENT surgeons before you make a decision to proceed. That being said, your requests do not sound unreasonable and your single photo shows appropriate anatomy for the requested changes. Of course, personal examination and evaluation of more than just a frontal view will aid in this discussion. Best wishes! Dr. Tholen
I think that you need to post other photos and perhaps also show your preop photos if possible. Best to always see someone in person for an evaluation.