Hello and thank you for your question. Although an exam in person is ideal, from your photographs alone it appears that you can benefit from a subtle dorsal hump reduction, and de-rotation as your tip appears potentially over-rotated. Further tip refinement may also be performed where the nasal tip cartilage is modified. Due to your prior rhinoplasty, the cartilage in your septum was likely harvested and so you will likely require MTF (cadaver) cartilage. The modification of your nasal cartilage can be done with trimming, stitching or grafting. If your septum is deviated and you have breathing difficulty, a septoplasty may benefit you as well. The next step for you is to find the right aesthetic plastic surgeon. In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.
