I had surgery for a deviated septum four years ago. Soon afterward my breathing problem returned. Surgery again? I was recently told by another doctor that I have a deviated septum and that I should have the surgery again. At the time of my first surgery

It. It is possible that something shifted inside your nose after your original septoplasty. This isn't very common in my experience, though. It is possible that there is additional improvement to the nasal airway that could be attained with revision surgery. Other areas to consider are whether you have enlargement of the inferior turbinates or other areas of airway blockage.
Having. Having had a septoplasty that worked well but now is worse makes me think that there may be a different cause. Perhaps there is a new allergy causing swelling. As we get older, the normal physiology of our nose also gradually changes--more congestion, more mucous, thicker mucous, softer cartilage that can collapse, etc. Surgery is not perfect and you may still have a crooked septum that was fine after surgery, but if there is more inflammation in the nose it can become symptomatic again. I would definitely want to try medical therapy and maybe allergy testing before trying redo surgery that is more difficult and has a higher complication rate (hole in the septum).