What can be done to help me achieve a cleaner and more natural appearing nose? (photo)

I see what you're talking about concerning the upper part of the nose. Is there a big rib graft in there? That graft might be wide, making the upper bridge and radix appear wide between your eyes and making those shadows. You mention that the nose looks Romanesque. Well, one really needs to see the profile view to determine that. A wide graft that extends too high up to the top of the nose can make the nose look very long, too, as you mention. The nose can look shorter if the upper parts of the graft are removed, so the nose doesn't look like it "begins" between your eyebrows.

It's never easy, but it is generally possible to remove a graft and trim it to a better size and shape and then replace it. That's what we often try to do. But it would help greatly if I had some 3/4 and profile views and your understanding of what was done to make the nose look so prominent and long.

Hello and thank you for your question. Based on your photograph, you have alar retraction with notching of the soft triangles. This can be fixed in a revision surgery. Nasal tip deprojection can certainly be performed at the same. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Much more information is needed, such as a full set of facial and nasal photographs from all angles, since the nose is a three-dimensional structure. A copy of the operative report would also be required to determine what maneuvers were performed in your first procedure. Revision rhinoplasty is one of the most difficult procedures to perform correctly in the field of cosmetic surgery, so it's also important to have realistic expectations about what can and cannot be accomplished with the procedure.